Showing papers by "José Luis Zamorano published in 2006"

Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology

Abstract: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure. Numerous studies have demonstrated that patient outcomes improve when guideline recommendations, based on the rigorous assessment of evidence-based research, are applied in clinical practice. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and also by other organizations or related societies. The profusion of documents can put at stake the authority and credibility of guidelines, particularly if discrepancies appear between different documents on the same issue, as this can lead to confusion in the minds of physicians. In order to avoid these pitfalls, the ESC and other organizations have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents. The ESC recommendations for guidelines production can be found on the ESC website.1 It is beyond the scope of this preamble to recall all but the basic rules. In brief, the ESC appoints experts in the field to carry out a comprehensive review of the literature, with a view to making a critical evaluation of the use of diagnostic and therapeutic procedures and assessing the risk–benefit ratio of the therapies recommended for management and/or prevention of a given condition. Estimates of expected health outcomes are included, where data exist. The strength of evidence for or against particular procedures or treatments is weighed according to predefined scales for grading recommendations and levels of evidence, as outlined in what follows. The Task Force members of the writing panels, …

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society

Abstract: Sidney C. Smith, Jr, MD, FACC, FAHA, FESC, Chair; Alice K. Jacobs, MD, FACC, FAHA, Vice-Chair; Cynthia D. Adams, MSN, APRN-BC, FAHA; Jeffery L. Anderson, MD, FACC, FAHA; Elliott M. Antman, MD, FACC, FAHA[‡][1]; Jonathan L. Halperin, MD, FACC, FAHA; Sharon Ann Hunt, MD, FACC, FAHA; Rick Nishimura,

ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Abstract: It is important that the medical profession plays a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states. Rigorous and expert analysis of the available data documenting absolute and relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have jointly engaged in the production of such guidelines in the area of cardiovascular disease since 1980. The ACC/AHA Task Force on Practice Guidelines, whose charge is to develop, update, or revise practice guidelines for important cardiovascular diseases and procedures, directs this effort. The Task Force is pleased to have this guideline developed in conjunction with the European Society of Cardiology (ESC). Writing committees are charged with the task of performing an assessment of the evidence and acting as an independent group of authors to develop or update written recommendations for clinical practice. Experts in the subject under consideration have been selected from all 3 organizations to examine subject-specific data and write guidelines. The process includes additional representatives from other medical practitioner and specialty groups when appropriate. Writing committees are specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered as well as frequency of follow-up and cost effectiveness. When available, information from studies on cost will be considered; however, review …

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD).

Abstract: Guidelines and Expert Consensus documents aim to present management and recommendations based on all of the relevant evidence on a particular subject in order to help physicians to select the best possible management strategies for the individual patient, suffering from a specific condition, taking into account not only the impact on outcome, but also the risk benefit ratio of a particular diagnostic or therapeutic procedure. The ESC recommendations for guidelines production can be found on the ESC website†. In brief, the ESC appoints experts in the field to carry out a comprehensive and critical evaluation of the use of diagnostic and therapeutic procedures and to assess the risk–benefit ratio of the therapies recommended for management and/or prevention of a given condition. The strength of evidence for or against particular procedures or treatments is weighed according to predefined scales for grading recommendations and levels of evidence, as outlined below. Once the document has been finalized and approved by all the experts involved in the Task Force, it is submitted to outside specialists for review. If necessary, the document is revised once more to be finally approved by the Committee for Practice Guidelines and selected members of the Board of the ESC. The ESC Committee for Practice Guidelines ( CPG ) supervises and coordinates the preparation of new Guidelines and Expert Consensus Documents produced by Task Forces, expert groups, or consensus panels. The chosen experts in these writing panels are asked to provide disclosure statements of all relationships they may have, which might be perceived as real or potential conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. The Committee is also responsible for the endorsement of these Guidelines and Expert Consensus Documents or statements. | Classes of recommendations | |:-------------------------- | ------------------------------------------------------------------------------------------------------------------------ | | Class I | Evidence and/or general agreement that a given diagnostic procedure/treatment is beneficial, useful, and effective | | Class II | Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the treatment or procedure | | Class IIa | Weight of evidence/opinion is in favour of usefulness/efficacy | | Class IIb | Usefulness/efficacy is less well established by evidence/opinion | | Class III | Evidence or general agreement that the treatment or procedure is not useful/effective and, in some cases, may be harmful | Diabetes and cardiovascular diseases (CVD) often appear …

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines.

Abstract: CC/AHA/ESC 2006 Guidelines for Management f Patients With Ventricular Arrhythmias and the revention of Sudden Cardiac Death—Executive Summary Report of the American College of Cardiology/American Heart Association Task orce and the European Society of Cardiology Committee for Practice Guidelines Writing Committee to Develop Guidelines for Management of Patients With entricular Arrhythmias and the Prevention of Sudden Cardiac Death) eveloped in Collaboration With the European Heart Rhythm Association and the ublished by Elsevier Inc. doi:10.1016/j.jacc.2006.07.008

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

Abstract: WRITING COMMITTEE MEMBERS Valentin Fuster, MD, PhD, FACC, FAHA, FESC, Co-Chair; Lars E. Rydén, MD, PhD, FACC, FESC, FAHA, Co-Chair; David S. Cannom, MD, FACC; Harry J. Crijns, MD, FACC, FESC*; Anne B. Curtis, MD, FACC, FAHA; Kenneth A. Ellenbogen, MD, FACC†; Jonathan L. Halperin, MD, FACC, FAHA; Jean-Yves Le Heuzey, MD, FESC; G. Neal Kay, MD, FACC; James E. Lowe, MD, FACC; S. Bertil Olsson, MD, PhD, FESC; Eric N. Prystowsky, MD, FACC; Juan Luis Tamargo, MD, FESC; Samuel Wann, MD, FACC, FESC

Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome.

Abstract: Aims The development of mitral regurgitation (MR) after an acute myocardial infarction (AMI) is a recognized and frequent complication and its negative impact on survival has been observed. However, few data exist regarding MR after non-ST-segment elevation acute coronary syndrome (NSTSEACS). Our aim was to investigate the incidence, clinical predictors, and prognostic implications of MR in the setting of NSTSEACS. Methods and results We studied 300 consecutive patients (71.7% men, mean age 66.9±13 years) admitted to our coronary care unit for an NSTSEACS. Every patient underwent an echocardiographic study during the first week after the index NSTSEACS and was clinically followed up. MR was detected in 42% (126 patients; 88 men, mean age 71.3±11 years). Mean follow-up was 425.6±194.8 days. Only age and left ventricular (LV) ejection fraction (EF) were found as independent markers of the development of MR; no variable was found as an independent predictor of in-hospital mortality and only MR was found as an independent predictor of long-term outcome. Conclusion MR is frequent after an NSTSEACS. Age and a low LV EF are factors associated to its development. The presence and degree of MR confer a worse long-term prognosis to patients after a first NSTSEACS. Thus, the presence of MR should be specifically assessed in every patient after an NSTSEACS.

Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index

Abstract: Aim: Myocardial performance index (MPI) is usually measured with pulsed wave Doppler (PWD). Our aim was to assess the degree of agreement be- tween PWD and a method based on tissue Doppler imaging (TDI). Methods and results: Seventy-five patients with prior myocardial infarction and 20 healthy subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI at septal and lateral sides of mitral annulus. MPI and TDI-MPI at septal side showed the best intraclass correlation coefficient (ICC Z 0.54; p ! 0.0005). Ninety-five percent interval of agreement ranged from 0.27 to 0.22. These differ- ences were attributed to discrepancies in isovolumic contraction and relaxation times. In the healthy group the results were similar (ICC Z 0.44), although the 95% interval of agreement was lower (from 0.13 to 0.12). Conclusions: The agreement between PWD and TDI in the measurement of MPI is only moderate. This should be taken into account in the interpretation of studies

Trends and contexts in European cardiology practice for the next 15 years: the Madrid Declaration: a report from the European Conference on the Future of Cardiology, Madrid, 2-3 June 2006.

Abstract: In the near future, the practice of cardiology in Europe will be strongly influenced by a complex interplay of epidemiological, social, economical, professional, and technological evolving factors. The present report summarizes the conclusions of an expert conference organized by the European Society of Cardiology to discuss the interactions between these phenomena, in an attempt to foresee the potential scenario in which cardiovascular healthcare and research will develop in the near future, and to anticipate solutions to the identified problems.

[Guidelines on the management of stable angina pectoris: executive summary].

Abstract: Authors/Task Force Members, Kim Fox, Chairperson*, Maria Angeles Alonso Garcia, Madrid (Spain), Diego Ardissino, Parma (Italy), Pawel Buszman, Katowice (Poland), Paolo G. Camici, London (UK), Filippo Crea, Roma (Italy), Caroline Daly, London (UK), Guy De Backer, Ghent (Belgium), Paul Hjemdahl, Stockholm (Sweden), José Lopez-Sendon, Madrid (Spain), Jean Marco, Toulouse (France), João Morais, Leiria (Portugal), John Pepper, London (UK), Udo Sechtem, Stuttgart (Germany), Maarten Simoons, Rotterdam (The Netherlands), and Kristian Thygesen, Aarhus (Denmark)

Usefulness of clinical, electrocardiographic, and echocardiographic parameters to detect cardiac asynchrony in patients with left ventricular dysfunction secondary to ischemic or nonischemic heart disease.

Abstract: Objectives Specific evaluation using echocardiographic Doppler is superior to the measurement of the QRS complex to detect cardiac asynchrony Nevertheless, no clinical, electrocardiographic, or echocardiographic parameters have been evaluated to obtain an accurate and easy-to-use marker of cardiac asynchrony in patients with depressed left ventricular (LV) ejection fraction Our aim was to determine whether there is any marker of cardiac asynchrony in patients with LV systolic dysfunction that allows us to obviate the performance of a specific echocardiographic study before cardiac resynchronization therapy Methods In all, 316 consecutive patients with LV ejection fraction less than 40% were enrolled Interventricular asynchrony was defined as an interventricular mechanical delay longer than 40 milliseconds Intraventricular asynchrony was defined as the difference between time from Q wave to LV ejection end and the time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging greater than 50 milliseconds Results In all, 177 (56%) had ischemic and 139 (44%) had nonischemic heart disease The logistic regression analysis showed that only the presence of left bundle branch block was an independent predictor of interventricular asynchrony despite the cause of the underlying disease (odds ratio and 95% confidence interval 72 [39-134], P P P Conclusions The presence of left bundle branch block is a marker of interventricular asynchrony in patients with ventricular dysfunction despite the cause of the underlying cardiac disease Nevertheless, intraventricular cardiac asynchrony cannot be detected using conventional parameters A specific echocardiographic evaluation before cardiac resynchronization therapy must be performed in all these patients Our aim was to determine whether there is any marker of cardiac asynchrony in patients with left ventricular systolic dysfunction that allows us to obviate the performance of a specific echocardiographic study before cardiac resynchronization therapy Our results showed that only the presence of left bundle branch block was an independent predictor of interventricular asynchrony despite the cause of the underlying disease but none of the studied parameters was found as a predictor of intraventricular asynchrony

[Albuminuria and cardiovascular risk: basal results of the KORAL-CARDIO study].

Abstract: Introduccion y objetivos: La presencia de albuminuria identifica a un grupo de hipertensos con mayor riesgo cardiovascular y renal y obliga a controlar mejor la presion arterial con farmacos que bloqueen el sistema renina-angiotensina. El objetivo del estudio KORAL-CARDIO fue determinar las caracteristicas clinicas y de manejo de pacientes con hipertension, albuminuria y cardiopatia no tratados previamente con inhibidores angiotensinicos. Pacientes y metodos: Se incluyen prospectivamente 2.711 pacientes (44% mujeres) de 64 anos de media con hipertension arterial, cardiopatia isquemica o hipertensiva o fibrilacion auricular con positividad en la deteccion cualitativa de albuminuria. El 42% tenian ademas diabetes mellitus de tipo 2. Resultados: El 7,2% de los no diabeticos y el 12,7% de los diabeticos tenian macroalbuminuria; el 25% y el 35% respectivamente tenian indice de masa corporal de mas de 30 kg/m2. Las complicaciones asociadas fueron: cardiopatia isquemica (22 y 39%), ictus (4 y 8%), fibrilacion auricular (19 y 22%), hipercolesterolemia (42 y 53%), hipertension de grado 3 (8% en ambos casos). Recibian tratamiento antihipertensivo monofarmaco el 66% de los no diabeticos y el 63% de los diabeticos, y solo el 7% triple terapia; otros tratamientos fueron: hipolipemiantes (41 y 57%) y antiagregantes (37 y 58% respectivamente). Conclusiones: Las complicaciones asociadas a la albuminuria en hipertensos con cardiopatias, diabeticos y no diabeticos, no tratados con inhibidores angiotensinicos son muy frecuentes. El grado de control tensional fue escaso en este grupo.

Clinical and hemodynamic implications of supra-annular implant of biological aortic valves.

Abstract: The use of stented bioprostheses in elderly patients with degenerative aortic stenosis, despite being desirable, raises concerns about the harmful effects of residual obstruction to left ventricular outflow. To overcome this limitation new stented and stentless bioprostheses have been designed for supra-annular implant. However, the actual hemodynamic advantage of supra-annular implant over the intra-annular one remains incompletely understood. This review focuses on the geometry of biological valve prostheses designed for supra-annular implant and its implications for the echocardiographic assessment of valve hemodynamics. Available data about the hemodynamic performance of these valves implanted in the supra-annular position in comparison with the usual intra-annular implant are also reviewed. Other issues related to biological heart valve performance, such as biomaterials, tissue mechanics, durability, and clinical outcome are not addressed in this review.

Prognosis of coronary flow reserve: a new therapeutic target?

Abstract: Coronary circulation, as in other vascular territories, is able to maintain its constant flow even with changes in the myocardial perfusion pressure. This physiological adaptation mechanism is defined as autoregulation. The concept of coronary flow reserve (CFR) is related to the ratio between the coronary blood flow after maximum vasodilatation, and the coronary blood flow at rest.1 The highest CFR is in the subepicardial layer of the myocardium. The CFR is lower in the subendocardial layer, so in relation to a decrease in myocardial flow, the subendocardial CFR is exhausted first. It is well known that in the absence of macroscopic coronary artery disease, the decrease of the CFR can be attributed to alterations in the microvascular circulation.2 CFR can be measured by magnetic resonance imaging, positron emission tomography, coronariography, and transthoracic echocadiography. The last technique is especially useful because of its disposability, low costs, and the absence of radiation exposure. The lower limit of CFR proposed by Dimitrow et al .3 using different methods in control groups is 3.0. A reduction in CFR can be found in some diseases associated with coronary microvascular dysfunction such as hypertrophic cardiomyopathy (CFR 2.21±0.2), dilated cardiomyopathy (DCM) (CFR 1.9±0.2), and Syndrome X (CFR 2.27±0.3).4 The assessment of CFR … *Corresponding author. Tel: +34 91 3303290; Fax: +34 91 3303292. E-mail address : jlzamorano{at}vodafone.es