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Barrionuevo-Sánchez MI, Ariza-Solé A, Viana-Tejedor A, Del Prado N, Rosillo N, Jorge-Pérez P, Sánchez-Salado JC, Lorente V, Alegre O, Llaó I, Martín-Asenjo R, Bernal JL, Fernández-Pérez C, Corbí-Pascual M, Pascual J, Marcos M, de la Cuerda F, Carmona J, Comin-Colet J, Elola FJ. Clinical profile, management and outcomes of patients with cardiogenic shock undergoing transfer between centers in Spain. Rev Esp Cardiol (Engl Ed) 2024; 77:226-233. [PMID: 37925017 DOI: 10.1016/j.rec.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyze the clinical profile, management, and prognosis of ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) requiring interhospital transfer, as well as the prognostic impact of structural variables of the treating centers in this setting. METHODS This study included patients with STEMI-CS treated at revascularization-capable centers from 2016 to 2020. The patients were divided into the following groups: group A: patients attended throughout their admission at hospitals with interventional cardiology without cardiac surgery; group B: patients treated at hospitals with interventional cardiology and cardiac surgery; and group C: patients transferred to centers with interventional cardiology and cardiac surgery. We analyzed the association between the volume of STEMI-CS cases treated, the availability of cardiac intensive care units (CICU), and heart transplant with hospital mortality. RESULTS A total of 4189 episodes were included: 1389 (33.2%) from group A, 2627 from group B (62.7%), and 173 from group C (4.1%). Transferred patients were younger, had a higher cardiovascular risk, and more commonly underwent revascularization, mechanical circulatory support, and heart transplant during hospitalization (P<.001). The crude mortality rate was lower in transferred patients (46.2% vs 60.3% in group A and 54.4% in group B, (P<.001)). Lower mortality was associated with a higher volume of care and CICU availability (OR, 0.75, P=.009; and 0.80, P=.047). CONCLUSIONS The proportion of transfers in patients with STEMI-CS in our setting is low. Transferred patients were younger and underwent more invasive procedures. Mortality was lower among patients transferred to centers with a higher volume of STEMI-CS cases and CICU.
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Affiliation(s)
- M Isabel Barrionuevo-Sánchez
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Jorge-Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - José Carlos Sánchez-Salado
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, 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
| | | | - Júlia Pascual
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, Spain
| | - Marta Marcos
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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
- Servicio de Cardiología, Hospital Universitario de Bellvitge, 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
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Huang F, Ammirati E, Ponnaiah M, Montero S, Raimbault V, Abrams D, Lebreton G, Pellegrino V, Ihle J, Bottiroli M, Persichini R, Barrionuevo-Sánchez MI, Ariza-Solé A, Ng PY, Sin SWC, Ayer R, Buscher H, Belaid S, Delmas C, Ferreira R, Roncon-Albuquerque R, Lόpez-Sobrino T, Bunge JJH, Fisser C, Franchineau G, McCanny J, Ohshimo S, Sionis A, Hernández-Pérez FJ, Barge-Caballero E, Balik M, Muglia H, Park S, Donker DW, Porral B, Aïssaoui N, Mekontso Dessap A, Burgos V, Lesouhaitier M, Fried J, Jung JS, Rosillo S, Scherrer V, Nseir S, Winszewski H, Jorge-Pérez P, Kimmoun A, Diaz R, Combes A, Schmidt M. Fulminant myocarditis proven by early biopsy and outcomes. Eur Heart J 2023; 44:5110-5124. [PMID: 37941449 DOI: 10.1093/eurheartj/ehad707] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.
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Affiliation(s)
- Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Maharajah Ponnaiah
- ICAN Intelligence and Omics, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Departament de Medicina, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Victor Raimbault
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital and Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris Cedex 13, France
| | | | - Joshua Ihle
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Maurizio Bottiroli
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, France
| | - Marisa Isabel Barrionuevo-Sánchez
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pauline Yeung Ng
- Adult Intensive Care Unit, Queen Mary Hospital, Hong-Kong, China
| | - Simon Wai Ching Sin
- Department of Anaesthesiology, The University of Hong Kong, Hong-Kong, China
| | - Raj Ayer
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Hergen Buscher
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Slimane Belaid
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Rita Ferreira
- Intensive Care Unit, Saint João Hospital, Porto, Portugal
| | | | | | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christoph Fisser
- Intensive Care Unit, University Medical Centre Regensburg, Regensburg, Germany
| | - Guillaume Franchineau
- Department of Intensive Care Medicine and Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Sorbonne Université, Paris Cedex 18, France
| | - Jamie McCanny
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust Hospital, London, UK
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco José Hernández-Pérez
- Advanced Heart Failure and Transplant Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Eduardo Barge-Caballero
- Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, A Coruña, Spain
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, General University Hospital, Prague, Czech Republic
| | | | - Sunghoon Park
- Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Beatriz Porral
- Intensive Care Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Nadia Aïssaoui
- Intensive Care Unit, Cochin Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris Cedex 5, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Mondor Hospital, Créteil, France
| | - Virginia Burgos
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Mathieu Lesouhaitier
- Departement of Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, Rennes 35200, France
| | - Justin Fried
- Department of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Sandra Rosillo
- Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Vincent Scherrer
- Department of Anesthesiology and Critical Care, CHU Rouen, Rouen F-76000, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, CHU de Lille, University Lille, Lille, France
| | | | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias Nuestra Señora de Candelaria, Canary Islands, Tenerife, Spain
| | - Antoine Kimmoun
- CHRU de NANCY, Service de Médecine Intensive et Réanimation, Inserm U1116, Université de Lorraine, Nancy, France
| | - Rodrigo Diaz
- Department of Cardiology, Clínica Las Condes, Las Condes, Chile
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
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Ibrahim-Achi Z, Jorge-Pérez P, Abreu-González P, López-Mejías R, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Malondialdehyde Serum Levels in Patients with Systemic Sclerosis Relate to Dyslipidemia and Low Ventricular Ejection Fraction. Antioxidants (Basel) 2023; 12:1668. [PMID: 37759971 PMCID: PMC10525833 DOI: 10.3390/antiox12091668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Systemic sclerosis (SSc) is a chronic disease characterized by vasculopathy with the involvement of dysfunctional microcirculatory vessels. Features of the disease include progressive fibrosis of the skin and internal organs and systemic inflammation characterized by the presence of circulating autoantibodies and proinflammatory cytokines. Furthermore, macrovascular disease and atherosclerosis are more common in patients with SSc than in the general population. Oxidative stress plays a crucial role in the development of several processes, including endothelial dysfunction, cancer, inflammation, and atherogenesis. Malondialdehyde (MDA) is a well-established marker of oxidative stress. In this work, we have analyzed the relationship between serum MDA levels and clinical, laboratory, and vascular characteristics in a well-characterized cohort of 53 patients with SSc. A multivariable analysis was performed to study the relationship between circulating MDA and disease characteristics in patients with SSc. Cardiovascular assessment was also performed, including ultrasonography of the carotid and aorta, and echocardiography. MDA showed a significant and positive relationship with the serum levels of lipid profile molecules such as total cholesterol (β coefficient = 0.006 (95% CI: 0.0004 to 0.01), nmol/mL, p = 0.037) and LDL cholesterol (β coefficient = 0.008 (95% CI: 0.001 to 0.01) nmol/mL, p = 0.017). On the contrary, most manifestations of the disease, including skin, lung, and joint involvement, as well as the presence of digital ulcers, were not related to MDA. However, high MDA levels were significantly and independently associated with lower ventricular ejection fraction after adjustment for covariates (β coefficient = -0.04 (95% CI: -0.06 to -0.02), nmol/mL, p = 0.001). In conclusion, serum MDA levels were related to higher levels of total and LDL cholesterol and a lower left ventricular ejection fraction in patients with SSc. MDA could serve as a potential biomarker of dyslipidemia and heart failure in SSc.
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Affiliation(s)
- Zeina Ibrahim-Achi
- Division of Angiology and Vascular Surgery, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Pablo Jorge-Pérez
- Division of Cardiology, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Pedro Abreu-González
- Unit of Physiology, Department of Basic Medical Sciences, University of La Laguna, 38200 Tenerife, Spain;
| | - Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Instituto de Investigación Marqués de Valdecilla, 39011 Santander, Spain;
| | | | | | - Iván Ferraz-Amaro
- Department of Internal Medicine, University of La Laguna, 38200 Tenerife, Spain;
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
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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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Bañeras J, Jorge-Pérez P, Bonanad C, López Lluva MT, Moll I, Fidel Kinori SG. Second victims and quality of support resources among cardiology professionals. Rev Esp Cardiol (Engl Ed) 2022; 75:686-688. [PMID: 35337779 DOI: 10.1016/j.rec.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Jordi Bañeras
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Pablo Jorge-Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Isaac Moll
- Servicio de Cardiología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sara Guila Fidel Kinori
- Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Psiquiatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Bañeras J, Martín-Cabeza MM, Barrionuevo-Sánchez MI, Lukic Otanovic A, Ródenas-Alesina E, Jorge-Pérez P. Cardiopulmonary resuscitation training in schools: it's time to react. Rev Esp Cardiol (Engl Ed) 2022; 75:347-348. [PMID: 34930695 DOI: 10.1016/j.rec.2021.10.016] [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: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Jordi Bañeras
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | | | | | | | - Eduard Ródenas-Alesina
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pablo Jorge-Pérez
- Departamento de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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7
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Bañeras J, Martín-Cabeza MM, Barrionuevo-Sánchez MI, Lukic Otanovic A, Ródenas-Alesina E, Jorge-Pérez P. La formación en reanimación cardiopulmonar en las escuelas: es hora de reaccionar. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Araiza-Garaygordobil D, Montalto C, Martinez-Amezcua P, Cabello-Lopez A, Gopar-Nieto R, Alabrese R, Almaghraby A, Catoya-Villa S, Chacon-Diaz M, Kaufmann CC, Corbi-Pascual M, Deharo P, El-Tahlawi M, Elgohari-Abdelwahab A, Guerra F, Jarakovic M, Martinez-Gomez E, Moderato L, Montero S, Morejon-Barragan P, Omar AM, Jorge-Pérez P, Przybyło P, Selim E, Sinan UY, Stratinaki M, Tica O, Trêpa M, Uribarri A, Uzokov J, Wilk K, Czerwińska-Jelonkiewicz K, Sionis A, Gierlotka M, Leonardi S, Krychtiuk KA, Tavazzi G. Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study. QJM 2021; 114:642-647. [PMID: 33486512 PMCID: PMC7928691 DOI: 10.1093/qjmed/hcab013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). AIM To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. DESIGN Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. RESULTS A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. CONCLUSIONS Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.
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Affiliation(s)
- D Araiza-Garaygordobil
- From the Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, México
| | - C Montalto
- Department of Cardiology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - A Cabello-Lopez
- Occupational Health Research Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México
| | - R Gopar-Nieto
- From the Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, México
| | - R Alabrese
- Department of Cardiology, Parma University Hospital, Italy
| | - A Almaghraby
- Department of Cardiology and Angiology, University of Alexandria, Egypt
| | - S Catoya-Villa
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Chacon-Diaz
- Cardiology Clinic and Intensive Cardiac Care, Instituto Nacional Cardiovascular INCOR-Essalud, Lima, Perú
| | - C C Kaufmann
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - M Corbi-Pascual
- Coronary Care Unit, Cardiology Service, Albacete General Hospital, Albacete
| | - P Deharo
- Aix Marseille University, Inserm, Inra, C2VN, Marseille, France
| | - M El-Tahlawi
- Department of Cardiology, Zagazig University Hospital, Zagazig, Egypt
| | | | - F Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ospedali Riuniti “Umberto I—Lancisi—Salesi”, Ancona, Italy
| | - M Jarakovic
- Cardiology Intensive Care Unit, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - E Martinez-Gomez
- Acute Cardiovascular Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - L Moderato
- Cardiology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - S Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - P Morejon-Barragan
- Coronary Care Unit, Cardiology Service, UAI University Hospital, Buenos Aires, Argentina
| | - A M Omar
- Tripoli University Hospital, Tripoli, Libya
| | - P Jorge-Pérez
- Acute Cardiovascular Care Unit, Cardiology Department, Canary Islands University Hospital, Tenerife, Spain
| | - P Przybyło
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - E Selim
- Coronary Care Unit, Emergency Department and Cardiology Clinic, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - U Y Sinan
- Department of Cardiology, PH and ACHD, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Turkey
| | - M Stratinaki
- Cardiology Department, General Hospital Venizeleio, Heraklion, Crete, Greece
| | - O Tica
- Faculty of Medicine and Pharmacy, University of Oradea; Emergency County Clinical Hospital of Oradea, Romania
| | - M Trêpa
- Cardiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Uribarri
- Cardiovascular Care Unit, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - J Uzokov
- Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - K Wilk
- Department of Cardiology, Medical University of Białystok, Bialystok, Poland
| | - K Czerwińska-Jelonkiewicz
- Intensive Therapy Unit, Harefield Hospital, Royal Brompton & Harefield NHS Fundation Trust, London, UK
| | - A Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - S Leonardi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology-Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - K A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - G Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
- Address correspondence to Dr Guido Tavazzi, MD, PhD, University of Pavia, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences; Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Anestesia e Rianimazione I, DEA Piano-1, Viale Golgi 19, 27100 Pavia, Italy.
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9
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Romaguera R, Cruz-González I, Jurado-Román A, Ojeda S, Fernández-Cisnal A, Jorge-Pérez P, Burgos-Palacios V, Ariza-Solé A, López-de-Sa E, Moreno R. Consideraciones sobre el abordaje invasivo de la cardiopat�a isqu�mica y estructural durante el brote de coronavirus COVID-19. RECIC 2021. [DOI: 10.24875/recic.m20000119] [Citation(s) in RCA: 6] [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: 11/17/2022] Open
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10
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Jorge-Pérez P, Durán-Cambra A. Cardiac involvement in COVID-19: does echocardiography matter? Rev Esp Cardiol (Engl Ed) 2021; 74:280-281. [PMID: 33272879 PMCID: PMC7674006 DOI: 10.1016/j.rec.2020.10.010] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Pablo Jorge-Pérez
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
| | - Albert Durán-Cambra
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Affiliation(s)
- Pablo Jorge-Pérez
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - Albert Durán-Cambra
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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12
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Jiménez-Rivera JJ, Álvarez-Castillo A, Ferrer-Rodríguez J, Iribarren-Sarrías JL, García-González MJ, Jorge-Pérez P, Lacalzada-Almeida J, Pérez-Hernández R, Montoto-López J, Martínez-Sanz R. Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy. J Cardiothorac Surg 2020; 15:108. [PMID: 32448319 PMCID: PMC7245898 DOI: 10.1186/s13019-020-01140-z] [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: 01/20/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Preconditioning with levosimendan may be a useful strategy to prevent this complication. In this context, design cost-effective strategies like preconditioning with levosimendan may become necessary. Methods In a sequential assignment of patients with Left Ventricle Ejection Fraction less than 40%, two strategies were compared in terms of cost-effectiveness: standard care (n = 41) versus preconditioning with Levosimendan (n = 13). The adverse effects studied included: postoperative new-onset atrial fibrillation, low cardiac output, renal failure and prolonged mechanical ventilation. The costs were evaluated using deterministic and probabilistic sensitivity analysis, and Monte Carlo simulations were performed. Results Preconditioning with levosimendan in moderate to severe systolic dysfunction (Left Ventricle Ejection Fraction < 40%), was associated with a lower incidence of postoperative low cardiac output in elective coronary artery bypass graft surgery 2(15.4%) vs 25(61%) (P < 0.01) and lesser intensive care unit length of stay 2(1–4) vs 4(3–6) days (P = 0.03). Average cost on levosimendan group was 14,792€ while the average cost per patient without levosimendan was 17,007€. Patients with no complications represented 53.8% of the total in the levosimendan arm, as compared to 31.7% in the non-levosimendan arm. In all Montecarlo simulations for sensitivity analysis, use of levosimendan was less expensive and more effective. Conclusions Preconditioning with levosimendan, is a cost-effective strategy preventing postoperative low cardiac output in patients with moderate-severe left ventricular systolic dysfunction undergoing elective coronary artery bypass graft surgery.
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Affiliation(s)
- Juan José Jiménez-Rivera
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain.
| | - Andrea Álvarez-Castillo
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Jorge Ferrer-Rodríguez
- Health Economist, University of La Laguna, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - José Luis Iribarren-Sarrías
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Martín Jesús García-González
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Juan Lacalzada-Almeida
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Rosalía Pérez-Hernández
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Javier Montoto-López
- Department of Cardiovascular Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Rafael Martínez-Sanz
- Department of Cardiovascular Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
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13
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Luis-Lima S, Escamilla-Cabrera B, Negrín-Mena N, Estupiñán S, Delgado-Mallén P, Marrero-Miranda D, González-Rinne A, Miquel-Rodríguez R, Cobo-Caso MÁ, Hernández-Guerra M, Oramas J, Batista N, Aldea-Perona A, Jorge-Pérez P, González-Alayón C, Moreno-Sanfiel M, González-Rodríguez JA, Henríquez L, Alonso-Pescoso R, Díaz-Martín L, González-Rinne F, Lavín-Gómez BA, Galindo-Hernández J, Sánchez-Gallego M, González-Delgado A, Jiménez-Sosa A, Torres A, Porrini E. Chronic kidney disease staging with cystatin C or creatinine-based formulas: flipping the coin. Nephrol Dial Transplant 2020; 34:287-294. [PMID: 29762739 DOI: 10.1093/ndt/gfy086] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/09/2018] [Indexed: 11/12/2022] Open
Abstract
Background Chronic kidney disease (CKD) affects 10-13% of the population worldwide. CKD classification stratifies patients in five stages of risk for progressive renal disease based on estimated glomerular filtration rate (eGFR) by formulas and albuminuria. However, the reliability of formulas to reflect real renal function is a matter of debate. The effect of the error of formulas in the CKD classification is unclear, particularly for cystatin C-based equations. Methods We evaluated the reliability of a large number of cystatin C and/or creatinine-based formulas in the definition of the stages of CKD in 882 subjects with different clinical situations over a wide range of glomerular filtration rates (GFRs) (4.2-173.7 mL/min). Results Misclassification was a constant for all 61 formulas evaluated and averaged 50% for creatinine-based and 35% for cystatin C-based equations. Most of the cases were misclassified as one stage higher or lower. However, in 10% of the subjects, one stage was skipped and patients were classified two stages above or below their real stage. No clinically relevant improvement was observed with cystatin C-based formulas compared with those based on creatinine. Conclusions The error in the classification of CKD stages by formulas was extremely common. Our study questions the reliability of both cystatin C and creatinine-based formulas to correctly classify CKD stages. Thus the correct classification of CKD stages based on estimated GFR is a matter of chance. This is a strong limitation in evaluating the severity of renal disease, the risk for progression and the evolution of renal dysfunction over time.
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Affiliation(s)
- Sergio Luis-Lima
- Research Unit Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Natalia Negrín-Mena
- Research Unit Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Sara Estupiñán
- Nephrology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | - Ana González-Rinne
- Nephrology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | - Juana Oramas
- Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Norberto Batista
- Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Ana Aldea-Perona
- Research Unit Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo Jorge-Pérez
- Cardiology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | - Laura Henríquez
- Endocrinology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Laura Díaz-Martín
- Research Unit Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | | | | | | | - Armando Torres
- Nephrology Department, Hospital Universitario de Canarias, Tenerife, Spain.,Internal Medicine Department, Universidad de La Laguna, Tenerife, Spain
| | - Esteban Porrini
- Internal Medicine Department, Universidad de La Laguna, Tenerife, Spain
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Báez-Ferrer N, Izquierdo-Gómez MM, Beyello-Belkasem C, Jorge-Pérez P, García-González MJ, Ferrer-Hita JJ, De la Rosa-Hernández A, García-Niebla J, Lacalzada-Almeida J. Long-Term Radiotherapy-Induced Cardiac Complications: A Case Report. Am J Case Rep 2019; 20:1182-1188. [PMID: 31401643 PMCID: PMC6753667 DOI: 10.12659/ajcr.917224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 48 Final Diagnosis: Late cardiac complications postradiotherapy Symptoms: Chest pain • dyspnea • syncope Medication: — Clinical Procedure: Diagnostic and therapeutic techniques in cardiology Specialty: Cardiology
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Affiliation(s)
- Néstor Báez-Ferrer
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | | | - Pablo Jorge-Pérez
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Julio J Ferrer-Hita
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Javier García-Niebla
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
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Lacalzada J, Jiménez JJ, Iribarren JL, de la Rosa A, Martín-Cabeza M, Izquierdo MM, Marí-López B, García-González MJ, Jorge-Pérez P, Barragán A, Laynez I. Early Transthoracic Echocardiography after Cardiac Surgery Predicts Postoperative Atrial Fibrillation. Echocardiography 2016; 33:1300-8. [PMID: 27144943 DOI: 10.1111/echo.13254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Postoperative atrial fibrillation (POAF) is frequent after cardiac surgery. We aimed to establish a predictive model of POAF based on postoperative transthoracic echocardiography (TTE) findings. METHODS This study included 147 patients (aged 67 ± 11 years; 109 men) undergoing coronary artery bypass grafting and/or aortic valve replacement. TTE and Doppler tissue imaging were performed on intensive care unit arrival after surgery. All patients were continuously monitored during hospitalization. The end point was the appearance of POAF. RESULTS POAF appeared in 37 patients (25.2%). These patients were older (69 ± 16 vs. 65 ± 12 years; P < 0.001) and had increased long axis of the left atrium (LA) dimension (5.4 ± 1 vs. 4.8 ± 0.9 cm, P = 0.02), lower early diastolic velocity of the mitral annulus (e') (6.9 ± 2.1 vs. 8 ± 1.8 cm/sec; P < 0.01), and higher early diastolic pulsed Doppler mitral ratio (E)/e' (E/e') (17.4 ± 6.8 vs. 13.8 ± 6; P = 0.01). Left ventricle diastolic dysfunction grade (DFG) of 2 or 3 relative to grade 0 was significant: odds ratio (OR) 22.5, 95% confidence interval (CI) 4.52-57.2; P < 0.001, and OR: 23.6, 95% CI: 3.57-60.1; P = 0.001), respectively. On multivariate analysis, the independent predictors of POAF were age (OR: 1.10, 95% CI: 1.01-1.18; P < 0.05), long-axis LA dimension (OR: 6.24, 95% CI: 1.97-8.23; P = 0.0017), DFG-2 (OR: 4.1, 95% CI: 1.57-15.81; P < 0.001), and DFG-3 (OR: 8.3, 95% CI: 4.11-25.37; P < 0.001). CONCLUSIONS Apart from age, the simple determination by postoperative TTE of long-axis LA dimension and DFG after cardiac surgery proved to be powerful independent predictors of POAF and may be useful for risk stratification of these patients.
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Affiliation(s)
- Juan Lacalzada
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
| | - Juan José Jiménez
- Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - José Luis Iribarren
- Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - Alejandro de la Rosa
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - Marta Martín-Cabeza
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - María Manuela Izquierdo
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - Belén Marí-López
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | | | - Pablo Jorge-Pérez
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - Antonio Barragán
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
| | - Ignacio Laynez
- Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain
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García-González MJ, Jorge-Pérez P, Jiménez-Sosa A, Acea AB, Lacalzada Almeida JB, Ferrer Hita JJ. Levosimendan improves hemodynamic status in critically ill patients with severe aortic stenosis and left ventricular dysfunction: an interventional study. Cardiovasc Ther 2016; 33:193-9. [PMID: 25959786 DOI: 10.1111/1755-5922.12132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To study the hemodynamic effect of levosimendan administration in acute heart failure patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF). METHODS Hemodynamic response to 24 h intravenous levosimendan infusion (0.1 μg/kg/min without a loading dose) in patients with severe AS (aortic valve area ≤1 cm(2) , time-velocity integral between left ventricular out-flow tract and aortic valve <0.25), reduced LVEF (≤40%), and a depressed cardiac index (CI) <2.2 L/min/m(2) was determined in a sequential group of nine patients aged 76 ± 10 years (5 men). RESULTS Baseline mean ejection fraction was 33 ± 0.7%; mean aortic valve area was 0.37 ±0.11 cm(2) /m(2) ; peak and mean gradients of 63.6 ± 20.53 and 36.7 ± 12.62 mmHg, respectively; and mean CI was 1.65 ± 0.20 L/min/m(2) . At 6 and 12 h of levosimendan therapy, mean CI had increased to 2.00 ± 0.41 L/min/m(2) (P = 0.02) and 2.17 ± 0.40 L/min/m(2) (P = 0.01), respectively. At 24 h, mean CI had increased further to 2.37 ± 0.49 L/min/m(2) (P = 0.01). A significant beneficial effect was also observed in pulmonary capillary wedge pressure, pulmonary artery mean pressure, central venous pressure, systemic vascular resistances, pulmonary vascular resistances, stroke volume index, left ventricular stroke work index. NTproBNP levels decreased at 24 h of levosimendan treatment. Levosimendan infusion was also well tolerated. Five patients subsequently underwent aortic valve surgery replacement. One died (of postoperative multiorgan failure). At 30 days, overall survival was 75%. CONCLUSIONS Levosimendan administration improves hemodynamic parameters in critically ill patients with severe AS and reduced LVEF. In our study, it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in surgical contraindicated patients. A controlled study is needed to confirm these preliminary findings.
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Affiliation(s)
- Martín J García-González
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain
| | - Pablo Jorge-Pérez
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain
| | - Alejandro Jiménez-Sosa
- Research Unit, Hospital Universitario de Canarias, Ctra. La Cuesta - Taco, San Cristobal de La Laguna, Sta. Cruz de Tenerife, Spain
| | - Antonio Barragán Acea
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain
| | - Juan B Lacalzada Almeida
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain
| | - Julio J Ferrer Hita
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain
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Jorge-Pérez P, Ferrer-Hita JJ, García-González MJ. Síncopes en un paciente con antecedente de radioterapia: la importancia de una valoración global de la afección cardiaca. Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2015.11.010] [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: 10/22/2022]
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Jorge-Pérez P, Ferrer-Hita JJ, García-González MJ. Syncopes in a Patient With a History of Radiotherapy: The Importance of a Comprehensive Assessment of Cardiac Involvement. Response. Rev Esp Cardiol (Engl Ed) 2016; 69:352-353. [PMID: 26778591 DOI: 10.1016/j.rec.2015.11.009] [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: 11/06/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Pablo Jorge-Pérez
- Unidad de Cuidados Intensivos Cardiológicos, Complejo Hospitalario Universitario de Canarias, Sta, Cruz de Tenerife, Spain.
| | - Julio J Ferrer-Hita
- Unidad de Arritmias, Complejo Hospitalario Universitario de Canarias, Sta, Cruz de Tenerife, Spain
| | - Martín J García-González
- Unidad de Cuidados Intensivos Cardiológicos, Complejo Hospitalario Universitario de Canarias, Sta, Cruz de Tenerife, Spain
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Jorge-Pérez P, García-González MJ, Beyello-Belkasem C, Ferrer-Hita JJ, Lacalzada-Almeida JB, de la Rosa-Hernández A. Síncope de repetición inducido por radioterapia. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.07.023] [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: 10/22/2022]
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Jorge-Pérez P, García-González MJ, Beyello-Belkasem C, Ferrer-Hita JJ, Lacalzada-Almeida JB, de la Rosa-Hernández A. Radiotherapy-induced Recurrent Syncope. ACTA ACUST UNITED AC 2015; 68:1033-4. [PMID: 26452476 DOI: 10.1016/j.rec.2015.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Pablo Jorge-Pérez
- Unidad de Cuidados Intensivos Cardiológicos, Complejo Hospitalario Universitario de Canarias, Sta. Cruz de Tenerife, Spain.
| | - Martín J García-González
- Unidad de Cuidados Intensivos Cardiológicos, Complejo Hospitalario Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Carima Beyello-Belkasem
- Unidad de Cuidados Intensivos Cardiológicos, Complejo Hospitalario Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Julio J Ferrer-Hita
- Unidad de Arritmias, Complejo Hospitalario Universitario de Canarias, Sta. Cruz de Tenerife, Spain
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