Showing papers by "José Luis Zamorano published in 2011"
TL;DR: This document is intended that this document will serve as a reference for echocardiographers participating in any or all stages of new transcatheter treatments for patients with valvular heart disease.
Abstract: The introduction of devices for transcatheter aortic valve implantation, mitral repair, and closure of prosthetic paravalvular leaks has led to a greatly expanded armamentarium of catheter-based approaches to patients with regurgitant as well as stenotic valvular disease. Echocardiography plays an essential role in identifying patients suitable for these interventions and in providing intra-procedural monitoring. Moreover, echocardiography is the primary modality for post-procedure follow-up. The echocardiographic assessment of patients undergoing transcatheter interventions places demands on echocardiographers that differ from those of the routine evaluation of patients with native or prosthetic valvular disease. Consequently, the European Association of Echocardiography in partnership with the American Society of Echocardiography has developed the recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. It is intended that this document will serve as a reference for echocardiographers participating in any or all stages of new transcatheter treatments for patients with valvular heart disease.
488 citations
TL;DR: The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo.
Abstract: Pocket-size imaging devices are a completely new type of echo machines which have recently reached the market. They are very cheap, smartphone-size hand-held echo machines with limited technical capabilities. The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo. EAE recommendations about pocket-size imaging devices can be summarized in: (1) pocket-size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited. (2) Imaging assessment with pocket-size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations. (3) With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket-size devices. (4) The patient has to be informed that an examination with the current generation of pocket-size imaging devices does not replace a complete echocardiogram.
213 citations
TL;DR: Clinical trials should be designed and conducted based on the knowledge of the pathophysiology of the clinical condition studied, the technical characteristics of the echo-Doppler modalities, and the variability of the tested parameters.
Abstract: The European Association of Echocardiography (EAE) has developed the present recommendations to assist clinical researchers in the design, implementation, and conduction of echocardiographic protocols for clinical trials and to guarantee their quality. Clinical trials should be designed and conducted based on the knowledge of the pathophysiology of the clinical condition studied, the technical characteristics of the echo-Doppler modalities, and the variability of the tested parameters. These procedures are important to choose the most reliable and reproducible techniques and parameters. Quality assurance must be guaranteed by adequate training of peripheral site operators to obtain optimal echo-Doppler data and by using a core laboratory for accurate and reproducible data analysis.
143 citations
TL;DR: The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI, suggesting both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary.
Abstract: Rationale: Home respiratory polygraphy (HRP) is an alternative to polysomnography (PSG) for sleep apnea–hypopnea syndrome (SAHS) diagnosis. However, therapeutic decision-making is a different process than diagnosis.Objectives: This study aimed to determine the agreement between HRP and in-hospital PSG for therapeutic decision-making in a large sample.Methods: Patients with an intermediate or high SAHS suspicion were included in a multicenter study (eight sleep centers) and assigned to home and hospital protocols in a random order. Therapeutic decisions (continuous positive airway pressure, no continuous positive airway pressure, or impossible decision) were made by an investigator in each center, based on using either HRP or PSG and a single set of auxiliary clinical variables. Patients and diagnostic methods (HRP and PSG) were assessed in random order using an electronic database. After a month the same therapeutic decision-making procedure was repeated with the same method.Measurements and Main Results:...
74 citations
TL;DR: The results show improvement in diastolic function parameters in patients with preserved LV systolic function, immediately after successful TAVI, and on multivariate analysis of covariance (ANCOVA) adjustments, the results remained significant.
Abstract: Aims Data regarding the effects of TAVI on LV after are scarce and conflicting results have been reported immediately after aortic valvuloplasty. This study aimed to determine the acute haemodynamic effects of transcatheter aortic valve implantation (TAVI) in left ventricle (LV) diastolic performance, immediately after aortic valvuloplasty and prosthesis deployment.
Methods and results Sixty-one patients with severe aortic valve stenosis, and preserved LV systolic function submitted to successful TAVI, were included. All procedures were guided through transoesophageal echocardiography, and parameters of diastolic function were evaluated before and minutes after TAVI. The mean age was 83.5 ± 6 years and mean log EuroSCORE was 18.2 ± 9.4. Before the procedure, all patients presented LV diastolic dysfunction. Immediately after TAVI, fewer patients presented a restrictive pattern [27 (44.3%), before the procedure, vs. 20 (34.4%), after TAVI ( P = 0.047)], and an increase in E wave deceleration time (211.2 ± 75.5 vs. 252.7 ± 102.3 cm/s, P = 0.001), in E wave velocity (109.5 ± 41.2 vs. 120.3 ± 43.6 cm/s, P = 0.025), and in isovolumetric relaxation time (83 ± 36.5 vs. 97.1 ± 36.0 ms, P = 0.013) was observed. On multivariate analysis of covariance (ANCOVA), adjusting to LV systolic function, heart rate, blood pressure, and haematocrit values, the results remained significant. Patients referred to percutaneous approach had invasive haemodynamic data collected, showing a decrease in LV end-diastolic pressure after valve implantation [18.8 ± 5.7 vs. 14.7 ± 4.7, mean difference −4.1 (95% CI: −5.9; −2.9)]. Patients with a restrictive pattern immediately after TAVI presented a smaller decrease in LV end diastolic pressure (−3.3 ± 4.7) than those with diastolic dysfunction grade I or II (−9.5 ± 4.7; P = 0.017).
Conclusion This is the first study describing LV diastolic performance during TAVI. Our results show improvement in diastolic function parameters in patients with preserved LV systolic function, immediately after successful TAVI.
56 citations
TL;DR: Obesity cardiomyopathy is associated not only with structural cardiac changes, but also with myocardial deformation changes, and this association occurs as early as in the childhood and it is independent from any other cardiovascular risk factor.
Abstract: Obesity is considered as a strong risk factor for cardiovascular morbidity and mortality. 3D-wall motion tracking echocardiography (3D-WMT) provides information regarding different parameters of left ventricular (LV) myocardial deformation. Our aim was to assess the presence of early myocardial deformation abnormalities in nonselected obese children free from other cardiovascular risk factors. Thirty consecutive nonselected obese children and 42 healthy volunteer children were enrolled. None of them had any cardiovascular risk factor. Every subject underwent a 2D-echo examination and a 3D-WMT study. Mean age was 13.9 ± 2.56 and 13.25 ± 2.68 years in the nonobese and obese groups, respectively (59.7% and 40.3% male). Statistically significant differences were found for: interventricular septum thickness, LV posterior wall thickness, LV end-diastolic volume, LV end-systolic volume, left atrium volume, LV mass, and lateral annulus peak velocity. Regarding the results obtained by 3D-WMT assessment, all the evaluated parameters were statistically significantly different between the two groups. When the influence of obesity on the different echocardiographic variables was evaluated by means of multivariate logistic regression analysis, the strongest relationship with obesity was found for LV average circumferential strain (β-coefficient: 0.74; r2: 0.55; P: 0.003). Thus, obesity cardiomyopathy is associated not only with structural cardiac changes, but also with myocardial deformation changes. Furthermore, this association occurs as early as in the childhood and it is independent from any other cardiovascular risk factor. The most related parameter to obesity is LV circumferential strain.
53 citations
TL;DR: In Fabry disease, reduced TDI velocity seems to be the initial sign of cardiac involvement that occurs before the development of cardiac hypertrophy, and ERT with agalsidase alfa should be considered at an earlier stage of the disease.
Abstract: Aims Cardiac involvement, including progressive cardiomyopathy, is common in Fabry disease and is a leading cause of premature mortality. We sought to determine if tissue Doppler imaging (TDI) could identify Fabry disease patients at risk for the development of cardiomyopathy and if enzyme replacement therapy (ERT) with agalsidase alfa might slow or prevent the progression of cardiac involvement.
Methods and results Fabry disease patients were enrolled in this prospective, observational study. Echocardiography was performed at baseline and periodically throughout the study. A single investigator, blinded to both the type of assessment (baseline or follow-up) and enzyme replacement status of the patient, evaluated all echocardiograms. Seventy-six patients (26 male, 50 females) were enrolled in the study. Twenty men and 13 women were treated with agalsidase alfa during the study. At baseline, increasing interventricular septum thickness was significantly associated with decreasing TDI velocities. Twenty-nine patients >18 years old (23 females) had no evidence of cardiac involvement at baseline (normal LVM and normal TDI velocities). In this cohort, 80% (16 of 20) of patients not on ERT progressed to demonstrating an abnormal TDI velocity during follow-up, whereas only 33% (3 of 9) of patients on ERT progressed to TDI abnormalities ( P = 0.031).
Conclusion In Fabry disease, reduced TDI velocity seems to be the initial sign of cardiac involvement that occurs before the development of cardiac hypertrophy. ERT with agalsidase alfa delays the onset of cardiac involvement and should be considered at an earlier stage of the disease, even in the absence of left ventricular hypertrophy.
52 citations
TL;DR: A proactive multifactorial risk factor intervention strategy that simultaneously treated both BP and cholesterol regardless of individual risk factors per se, is more effective in reducing calculated Framingham 10-year CHD risk than UC in patients with hypertension and additional risk factors.
Abstract: Objective:To investigate whether a proactive multifactorial risk factor intervention strategy using single-pill amlodipine/atorvastatin (5/10, 10/10 mg) in addition to other antihypertensive and lipid-lowering therapy, as required, resulted in greater reduction in calculated Framingham 10-year coronary heart disease (CHD) risk compared with usual care (UC) after 52-weeks treatment.Research design and methods:Prospective, multinational, open-label, cluster randomized trial, with the investigator as the unit of randomization. Eligible hypertensive patients were 35–79 years of age, with ≥3 additional cardiovascular risk factors, but no history of CHD and baseline total cholesterol (TC) ≤6.5 mmol/l.Clinical trial registration:www.ClinicalTrials.gov; trial identifier NCT00407537.Main outcome measure:The primary endpoint was calculated Framingham 10-year CHD risk at 52 weeks.Results:Of the 140 randomized sites, 136 sites contributed 1461 patients. Mean baseline age and low-density lipoprotein cholestero...
40 citations
TL;DR: Spirometry performed online from a hospital can be an adequate alternative to conventional spirometry for primary care centres, and very good agreement was found between intra- and interobserver reliability.
Abstract: Spirometry is essential for the diagnosis and management of common respiratory diseases. However, its use and quality are low in primary care. An important reason for this is the technical difficulty in performing conventional spirometry. If high-quality spirometry could be performed online, from the pulmonary function laboratory in hospitals, most of the technical problems could be solved. The aim of the present study was to compare spirometries performed online by remote technicians with conventional spirometry. This was a controlled, randomised crossover study of 261 patients referred from primary care centres for pulmonary consultation. They were randomised to undergo either conventional or online spirometry. The technician, located remotely, controlled the spirometer computer. Using a teleconference link, the technician guided the patient through the spirometry. The comparison between conventional and online spirometries was performed on intention to treat and per protocol bases for spirometric values and quality criteria. Agreement between the two spirometric methods was assessed with a Bland-Altman plot. A subpopulation of off-range patients was also characterised. Finally, intra- and interobserver agreement was evaluated using the intraclass correlation coefficient. No clinically significant differences were seen between the online and conventional spirometric values in both the intention to treat and per protocol analyses. The agreement in Bland-Altman analysis was poorer for intention to treat than for the per protocol analysis. The latter had a lower percentage of off-range patients and high agreement to determine abnormal spirometry in the off-range group. Conventional spirometry had a higher percentage of patients with spirometric quality criteria although the quality criteria difference was only 5.9%, when both procedures were the first to start. Very good agreement was found between intra- and interobserver reliability. Spirometry performed online from a hospital can be an adequate alternative to conventional spirometry for primary care centres.
33 citations
TL;DR: This is the first accurate description of the 3D TOE part, focusing on the surgeon requirements, of the mitral transcatheter valve-in-valve implantation for very high risk patients.
Abstract: Prosthesis deterioration rate, years after a previous surgical valve replacement, is rising. Usually, the standard management is reoperation, but for very high risk patients an alternative has arisen: the valve-in-valve approach. We present an 84-year-old Caucasian woman with a mitral bioprosthesis (Mosaic II, number 29) since 1994. Over the last few months the patient displayed worsening heart failure symptoms, until her current admission in NYHA III-IV functional class, because of a severely degenerated mitral prosthesis (severe regurgitation, severe pulmonary hypertension). The transapical access, conventionally used for transcatheter aortic valve implantation (Edwards SAPIEN THV 23) was chosen, guided by transoesophageal echocardiography (TOE) with a new three-dimensional (3D) probe. After the procedure, the mitral regurgitation completely disappeared, an appropriate valve opening was achieved (valve area >2 cm(2)) and the patient was discharged 6 days later, remaining well in the outpatient follow-up. Only a restricted number of patients have been submitted to mitral transcatheter valve-in-valve implantation and to the best of our knowledge this is the first accurate description of the 3D TOE part, focusing on the surgeon requirements.
31 citations
TL;DR: In patients with established arterial disease, concomitant use of PPIs and clopidogrel was associated with a nearly doubling of the incidence of subsequent myocardial infarction or ischemic stroke.
Abstract: Background:Among patients receiving clopidogrel for coronary artery disease, concomitant therapy with proton pump inhibitors (PPIs) has been associated with an increased risk for recurrent coronary events.Patients and Methods:Factores de Riesgo y ENfermedad Arterial (FRENA) is an ongoing, multicente
TL;DR: A feasibility study Leopoldo Perez de Isla, Vera Lennie, Maribel Quezada, Juan Guinea, Cristina Arce, Pilar Abad, Adriana Saltijeral, Nellys Carolina Campos, Jacobo Crespo, Borja Gonzalvez, Agustin Macia, Jose Zamorano and a Unidad de Imagen Cardiologica.
TL;DR: This study suggests that the automatic blood pressure equipment has greater diagnostic accuracy when the test is performed by physicians not specifically trained to use the Doppler probe.
Abstract: Relatively little is known on how the Doppler method compares with oscillometric measurement using a conventional automatic blood pressure device to determine the ankle-brachial index, when determinations are performed by physicians with little experience. To assess the diagnostic efficacy of both methods in this professional group, we calculated their sensitivity, specificity, and positive and negative predictive value in 158 legs of 85 patients with symptoms of intermittent claudication. Angiography was used as the gold standard. Of the legs examined, 131 showed significant arterial obstruction. The oscillometric method showed 97% sensitivity, 89% specificity, 98% positive predictive value, and 86% negative predictive value. The Doppler method showed 95% sensitivity, 56% specificity, 91% positive predictive value, and 68% negative predictive value. This study suggests that the automatic blood pressure equipment has greater diagnostic accuracy when the test is performed by physicians not specifically trained to use the Doppler probe.
TL;DR: Los resultados indican that el equipo automatico de presion arterial tiene mejor rentabilidad diagnostica cuando realizan la prueba medicos no especialmente entrenados en el manejo of the sonda Doppler.
Abstract: Resumen La seguridad para determinar el indice tobillo-brazo con metodo Doppler o con un aparato automatico convencional de medir la presion arterial no esta bien establecida cuando realizan la determinacion medicos con poca experiencia. Para evaluar la eficacia diagnostica de cada metodo en este grupo profesional, calculamos mediante angiografia la sensibilidad, la especificidad y los valores predictivos positivo y negativo en 158 piernas de 85 pacientes con sintomas de claudicacion intermitente. Del total de piernas analizadas, 131 (83%) presentaron obstruccion significativa. El metodo oscilometrico mostro sensibilidad del 97%, especificidad del 89%, valor predictivo positivo del 98% y valor predictivo negativo del 86%. El metodo Doppler mostro sensibilidad del 95%, especificidad del 56%, valor predictivo positivo del 91% y valor predictivo negativo del 68%. Los resultados indican que el equipo automatico de presion arterial tiene mejor rentabilidad diagnostica cuando realizan la prueba medicos no especialmente entrenados en el manejo de la sonda Doppler.
TL;DR: Nuestro objetivo es describir el valor sistolico maximo normal de referencia de AS in una muestra de sujetos sanos, y resultados muestran, por primera vez, los valores oficiales de AS en sujeto sanos.
Abstract: Resumen La tecnologia ecocardiografica denominada three-dimensional wall motion tracking es capaz de realizar un seguimiento tridimensional del miocardio y obtener multiples valores de su deformacion, entre los que se encuentra el area strain (AS), que combina el analisis de la deformacion longitudinal y circunferencial del ventriculo izquierdo. Nuestro objetivo es describir el valor sistolico maximo normal de referencia de AS en una muestra de sujetos sanos. Se recluto a 60 sujetos consecutivos, sin enfermedad ni factores de riesgo cardiovascular conocidos, y se les cuantifico el AS del ventriculo izquierdo. El valor promedio de AS fue –38,87 ± 5,89%. Los valores promedio a nivel de los segmentos basales, medio y apicales fueron –38,42 ± 7,58%, –38,74 ± 6,34% y –43,18 ± 12,81% respectivamente. Por lo tanto, nuestros resultados muestran, por primera vez, los valores de referencia de AS en sujetos sanos.
TL;DR: The normal maximum systolic reference AS value in a sample of healthy subjects is described, showing for the first time the reference values for AS in healthy subjects.
Abstract: The echocardiographic technology known as three-dimensional wall motion tracking offers three-dimensional images of the myocardium and provides multiple measures of deformation, one of which is known as “area strain” (AS), which combines left ventricular longitudinal and circumferential deformations. Our aim was to describe the normal maximum systolic reference AS value in a sample of healthy subjects. Sixty consecutive subjects without known cardiovascular risk factors or diseases were enrolled, and left ventricular AS was measured. Overall mean AS was –38.87 ± 5.89%. Mean values at the level of the basal, middle, and apical segments were –38.42% ± 7.58%, –38.74% ± 6.34%, and −43.18% ± 12.81%, respectively. Thus, our results show for the first time the reference values for AS in healthy subjects.
TL;DR: A high percentage of patients receiving this type of therapy at the end of the study probably contributed to obtaining a residual risk similar to that in the Heart Outcomes Prevention Evaluation (HOPE) study in the absence of treatment with RAAS blockers in approximately two-thirds of patients included in the ONTARGET trial.
Abstract: Some aspects of the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study are briefly commented on in this article. The three main topics of interest related to the study that require further analysis are the following: the influence of blood pressure control, and in particular, the target blood pressure for patients with established cardiovascular disease such as those admitted in the ONTARGET study, the renal aspects of the study, which are of great interest but do not adequately clarify, in particular, concerns over the dual blockade of the renin–angiotensin–aldosterone system (RAAS) with telmisartan and ramipril, and finally, and probably most importantly, the role of statins in the outcome of the study. A high percentage of patients receiving this type of therapy at the end of the study, which probably contributed to obtaining a residual risk similar to that in the Heart Outcomes Prevention Evaluation (HOPE) study in the absence of treatment with RAAS block...
TL;DR: Cardiac magnetic resonance (CMR) mitral valve parameters are associated with the presence of significant FMR and are different between ischemic and non isChemic patients.
Abstract: Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction bellow 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.
TL;DR: Thena descriptivo realizado sobre la poblacion general muestran valores similares del GIM y de presencia of placas ateroscleroticas entre los grupos de RCV medio y alto.
Abstract: Resumen Fundamento y objetivo La estimacion del grosor intimo-medial carotideo (GIM) es un metodo que se ha propuesto para la deteccion de la aterosclerosis subclinica dentro de la estrategia de prevencion cardiovascular. Los objetivos del estudio son describir la asociacion entre el GIM y la presencia de otros factores de riesgo cardiovascular (RCV), asi como describir la asociacion entre el GIM y el RCV segun SCORE. Sujetos y metodo Estudio descriptivo realizado sobre la poblacion general. Participaron 1.118 individuos a los que se les calculo el RCV segun la funcion SCORE. Se escogio a 467 participantes a quienes se les realizo un eco-doppler carotideo estimando el GIM y la presencia de placas ateroscleroticas. Resultados De los 467 individuos, el 24, 49 y 27% pertenecieron a los grupos de RCV bajo, medio y alto, respectivamente. El GIM promedio fue de 0,63745 mm. La media del GIM en los grupos de RCV bajo, medio y alto fue de 0,5629, 0,66269 y 0,66016 mm, respectivamente. El GIM aumenta con la edad y esta asociado a otros factores de RCV. En el 13% de las ecografias carotideas realizadas se encontraron placas de aterosclerosis. El mayor porcentaje de individuos con placas de aterosclerosis se encontro en los grupos de RCV medio y alto. Conclusiones Los resultados de este estudio muestran valores similares del GIM y de presencia de placas ateroscleroticas entre los grupos de RCV medio y alto. Existe una asociacion directa entre un GIM aumentado y la edad, el peso y la diabetes.
15 Nov 2011
TL;DR: The rationale for this combination therapy and the clinical trials that have demonstrated that these two agents can be combined without the loss of efficacy for either agent or an increase in the incidence of adverse events suggest that SPAA can play an important role in helping physicians improve the management of CV risk in their patients.
Abstract: Clinical guidelines now recognize the importance of a multifactorial approach to managing cardiovascular (CV) risk. This idea was taken a step further with the concept of the Polypill™. There are, however, considerable patent, pharmacokinetic, pharmacodynamic, registration, and cost implications that will need to be overcome before the Polypill™ or other single-pill combinations of CV medications become widely available. However, a medication targeting blood pressure (BP) and lipids provides much of the proposed benefits of the Polypill™. A single-pill combination of the antihypertensive amlodipine besylate and the lipid-lowering medication atorvastatin calcium (SPAA) is currently available in many parts of the world. This review describes the rationale for this combination therapy and the clinical trials that have demonstrated that these two agents can be combined without the loss of efficacy for either agent or an increase in the incidence of adverse events. The recently completed Cluster Randomized Usual Care vs Caduet Investigation Assessing Long-term-risk (CRUCIAL trial) is discussed in detail. CRUCIAL was a 12-month, international, multicenter, prospective, open-label, parallel design, cluster-randomized trial, which demonstrated that a proactive intervention strategy based on SPAA in addition to usual care (UC) had substantial benefits on estimated CV risk, BP, and lipids over continued UC alone. Adherence with antihypertensive and lipid-lowering therapies outside of the controlled environment of clinical trials is very low (~30%–40% at 12 months). Observational studies have demonstrated that improving adherence to lipid-lowering and antihypertensive medications may reduce CV events. One means of improving adherence is the use of single-pill combinations. Real-world observational studies have demonstrated that patients are more adherent to SPAA than co-administered antihypertensive and lipid-lowering therapy, and this improved adherence translated to reduced CV events. Taken together, these findings suggest that SPAA can play an important role in helping physicians improve the management of CV risk in their patients.
TL;DR: Evidence is provided of a more favorable effect of telmisartan on glucose homeostasis in patients with MS and low levels of serum cytokines, whereas systolic and diastolic blood pressure and the elevation of high-sensitivity C-reactive protein had a negative effect.
Abstract: Metabolic syndrome (MS) is a disease with an inflammatory component. Telmisartan improves insulin resistance in MS, but its relationship with the inflammatory state is unknown. We investigated the effect of 3-month telmisartan therapy on homeostatic model assessment-insulin resistance (HOMA-IR) in hypertensive subjects with MS with regard to the levels of circulating plasma cytokines. Methods A total of 42 patients were included in this study; 30 were men (71%), aged 50 ± 8.2 years (mean ± SD). Cytokines and metabolic parameters were analyzed before and after treatment with telmisartan. Results Twenty-eight patients showed low plasma levels of cytokines (group 1) similar to control subjects, and 14 showed high levels (group 2). Treatment with telmisartan diminished by 35% HOMA-IR in group 1 (4.5 ± 3.1 vs 2.9 ± 2.1), without improvement in group 2. In the multivariate analysis, the predictors of improvement of HOMA-IR in response to telmisartan treatment were low levels of cytokines, whereas systolic and diastolic blood pressure and the elevation of high-sensitivity C-reactive protein had a negative effect. Conclusions Our study provides evidence of a more favorable effect of telmisartan on glucose homeostasis in patients with MS and low levels of serum cytokines.
Journal Article•
TL;DR: After 12 months, the clinical outcome with the Soprano bioprosthesis, when used for AVR, was excellent, and showed good hemodynamic performance, with a significant reduction of left ventricular hypertrophy.
Abstract: BACKGROUND AND AIM OF THE STUDY During recent years, pericardial bioprostheses have gained widespread acceptance as cardiac valve substitutes. The study aim was to evaluate the early clinical and hemodynamic performance of the Sorin SopranoTM supra-annular aortic bioprosthesis, as used for aortic valve replacement (AVR). METHODS Between January 2004 and August 2006, a total of 501 patients (55% males; mean age 75 +/- 6.4 years) was prospectively enrolled into the study, which involved 10 European institutions. The indications for AVR were aortic stenosis in 91% of patients, aortic incompetence in 8%, and redo surgery in 1%. Preoperatively, 62% of the patients were in NYHA class III, and 12% in class IV. The mean prosthesis size was 21.4 +/- 1.8 mm. A non-everting technique was used in 88% of patients. Concomitant procedures were performed in 52% of cases (mainly coronary artery bypass grafts; 41%). The mean cross-clamp and cardiopulmonary bypass times were 70 +/- 27.2 min and 99 +/- 39.7 min, respectively. Doppler echocardiography performed at one and 12 months after surgery was evaluated by an independent core laboratory. RESULTS Postoperatively, there were 25 early deaths (5%) and 13 late deaths, with an overall survival at one year of 92.9% (95% CI: 90.2-94.8) and freedom from valve-related death of 98.6% (95% CI: 97.5-99.6). After 12 months, most patients (87%) were in NYHA classes I-II. Actuarial freedoms from thromboembolism, bleeding, endocarditis and paraprosthetic leak at one year were 97.1% (CI: 95.1-98.2), 98.9% (CI: 97.4-99.5), 99.1% (CI: 97.7-99.7), and 99.6% (CI: 98.3-99.9), respectively. No events of thrombosis and structural valve deterioration (SVD) were observed. Subsequent echocardiographic evaluation showed low mean (11.1 +/- 5.1 mmHg at one year) and peak (19.5 +/- 8.9 mmHg at one year) transvalvular gradients, and a significant reduction in left ventricular mass, from 211 +/- 78.5 g at one month to 185 +/- 64.7 g at 12 months (p <0.0001). CONCLUSION After 12 months, the clinical outcome with the Soprano bioprosthesis, when used for AVR, was excellent. The bioprosthesis also showed good hemodynamic performance, with a significant reduction of left ventricular hypertrophy.
TL;DR: Unas recomendaciones simples sobre DiMe a pacientes de alto riesgo vascular del ambiente hospitalario puede mejorar el perfil lipidico, and son tan eficaces como una presentacion mas extensa.
TL;DR: Histologic studies of human aortic valves support the theory that degenerative AS is the result of an active inflammatory disease process similar to atherosclerosis, and adiponectin is an endogenous anti-inflammatory hormone released by the adipose tissue that improves insulin sensitivity, suppresses gluconeogenesis and enhances fatty acid oxidation.
Abstract: was shown that treatment with atorvastatin inhibits cellular proliferation and bone matrix formation in the valve leaflets using a hypercholesterolemic rabbit model [7] . Histologic studies of human aortic valves support the theory that degenerative AS is the result of an active inflammatory disease process similar to atherosclerosis, by demonstrating the presence of low-density lipoprotein and other proteins implicated in atherogenesis such as lipoprotein (a), as well as apolipoprotein E in calcified valves [8] . Adiponectin is one of the few adipokines possessing multiple salutary effects on cardiovascular health. It is an endogenous anti-inflammatory hormone, released by the adipose tissue, that improves insulin sensitivity, suppresses gluconeogenesis and enhances fatty acid oxidation. Adiponectin was also found to be associated with increased apolipoprotein A1 and high-density lipoprotein cholesterol synthesis in a human hepatoma cell line, which may have beneficial effects on lipid metabolism [9] . Low serum levels of adiponectin have been recognized as a risk factor for atherosclerotic disease [10] and acute coronary syndromes [11] . Improved life expectancy has led to an increasing number of elderly patients with calcific aortic valve stenosis (AS) [1] , which has become the most common cardiovascular disease in developed countries, after coronary artery disease and hypertension [2] . Even if traditionally it was considered simply a degenerative phenomenon, in the last decades, several studies showed that AS pathogenesis shares many histological features with atherosclerosis, such as lipoprotein deposition, chronic inflammation and fibro-calcific tissue remodeling [3] . In addition, there is a well-known relation with cardiovascular risk factors including hypercholesterolemia, cigarette smoking, hypertension, diabetes and male gender [4] . The presence of metabolic syndrome is also associated with increased prevalence, faster disease progression and worse outcome in patients with AS [5, 6] . However, cause-effect relationships have not yet been established, mostly because the etiology of calcific aortic valve disease is likely multifactorial, requiring control of potential confounding variables in clinical studies. The association between hyperlipidemia and calcific aortic valve disease has been extensively studied, and it Received and accepted: May 27, 2011 Published online: July 12, 2011