Showing papers by "José Luis Zamorano published in 2015"

2015 ESC Guidelines for the management of infective endocarditis

Abstract: 3D : three-dimensional AIDS : acquired immune deficiency syndrome b.i.d. : bis in die (twice daily) BCNIE : blood culture-negative infective endocarditis CDRIE : cardiac device-related infective endocarditis CHD : congenital heart disease CIED : cardiac implantable electronic device

Multimodality imaging of diseases of the thoracic aorta in adults: From the American society of echocardiography and the european association of cardiovascular imaging: Endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance

Abstract: Steven A. Goldstein, MD, Co-Chair, Arturo Evangelista, MD, FESC, Co-Chair, Suhny Abbara, MD, Andrew Arai, MD, Federico M. Asch, MD, FASE, Luigi P. Badano, MD, PhD, FESC, Michael A. Bolen, MD, Heidi M. Connolly, MD, Hug Cu ellar-Cal abria, MD, Martin Czerny, MD, Richard B. Devereux, MD, Raimund A. Erbel, MD, FASE, FESC, Rossella Fattori, MD, Eric M. Isselbacher, MD, Joseph M. Lindsay, MD, Marti McCulloch, MBA, RDCS, FASE, Hector I. Michelena, MD, FASE, Christoph A. Nienaber, MD, FESC, Jae K. Oh, MD, FASE, Mauro Pepi, MD, FESC, Allen J. Taylor, MD, Jonathan W. Weinsaft, MD, Jose Luis Zamorano, MD, FESC, FASE, Contributing Editors: Harry Dietz, MD, Kim Eagle, MD, John Elefteriades, MD, Guillaume Jondeau, MD, PhD, FESC, Herv e Rousseau, MD, PhD, and Marc Schepens, MD, Washington, District of Columbia; Barcelona and Madrid, Spain; Dallas and Houston, Texas; Bethesda and Baltimore, Maryland; Padua, Pesaro, and Milan, Italy; Cleveland, Ohio; Rochester, Minnesota; Zurich, Switzerland; New York, New York; Essen and Rostock, Germany; Boston, Massachusetts; Ann Arbor, Michigan; New Haven, Connecticut; Paris and Toulouse, France; and Brugge, Belgium

Detection of significant coronary artery disease by noninvasive anatomical and functional imaging.

Abstract: Background— The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. Methods and Results— A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88–0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69–0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65–0.75) but lower sensitivity (49%, P <0.001) and higher specificity (92%, P <0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography ( P <0.001). Conclusions— In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively. Clinical Trial Registration— URL: . Unique identifier: [NCT00979199][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00979199&atom=%2Fcirccvim%2F8%2F3%2Fe002179.atom

2015 ESC Guidelines for the management of infective endocarditis

Abstract: Authors/Task Force Members: Gilbert Habib* (Chairperson) (France), Patrizio Lancellotti* (co-Chairperson) (Belgium), Manuel J. Antunes (Portugal), Maria Grazia Bongiorni (Italy), Jean-Paul Casalta (France), Francesco Del Zotti (Italy), Raluca Dulgheru (Belgium), Gebrine El Khoury (Belgium), Paola Anna Erba (Italy), Bernard Iung (France), Jose M. Miro (Spain), Barbara J. Mulder (The Netherlands), Edyta Plonska-Gosciniak (Poland), Susanna Price (UK), Jolien Roos-Hesselink (The Netherlands), Ulrika Snygg-Martin (Sweden), Franck Thuny (France), Pilar Tornos Mas (Spain), Isidre Vilacosta (Spain), and Jose Luis Zamorano (Spain)

Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study

Abstract: Aims Reference values for Doppler parameters according to age and gender are recommended for the assessment of heart physiology, specifically for left ventricular (LV) diastolic function. In this study, we report normal reference ranges for Doppler parameters obtained in a large group of healthy volunteers. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following Doppler acquisition and measurement protocols approved by the European Association of Cardiovascular Imaging. Methods and results A total of 449 (mean age: 45.8 ± 13.7 years) healthy volunteers (198 men and 251 women) were enrolled at the collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was obtained from all subjects following predefined protocols. The majority of the Doppler diastolic parameters ( e ′, E / e ′) as well as right ventricle systolic s ′ wave velocity were similar in men and women. Left ventricle s ′ wave velocity was higher in men than in women. E wave and e ′ were higher in younger subjects and decreased progressively in the older ones. E / e ′ ratio increased with ageing. Septal e ′ <8 cm/s was present in 19.7% of the subjects in the 40–60 year group and in 55% of those in the ≥60 year group. However, the cut-off value of average E / e ′ or lateral E / e ′ remained <15 or 13, respectively, in the majority of patients. Conclusion The NORRE study provides the reference values for the most useful Doppler parameters in the evaluation of heart physiology. These data highlight the need of using age-specific reference values especially for the diagnosis of LV systolic and diastolic dysfunction and for the estimation of LV filling pressures.

The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association

Abstract: Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/ critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described.

The use of echocardiography in acute cardiovascular care : Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association

Abstract: Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described.

Normal reference values of left ventricular strain using three-dimensional speckle tracking echocardiography: results from a multicentre study

Abstract: Aims Three-dimensional (3D) speckle tracking echocardiography (3DSTE) has been shown to be an accurate and reliable clinical tool for the evaluation of global and regional left ventricular (LV) function through strain analysis, but the absence of normal values has precluded its widespread use in clinical practice. The aim of this prospective multicentre study was to establish normal reference values of LV strain parameters using 3DSTE in a large healthy population. Methods and results A total of 303 healthy subjects (156 males [51%], between 18 and 82 years of age, ejection fraction [EF] 61 ± 3%), stratified to provide approximately equal proportions of healthy subjects of 18–30, 31–40, 41–50, 51–60, and >60 years of age, underwent 3DSTE. Data were analysed for LV volumes, EF, mass, and global and regional circumferential, longitudinal, radial, and area strain. Significant but small differences between men and women were found for longitudinal and area strains, as well as between different age groups for all LV strain parameters. However, large differences in normal values were observed between different segments, walls, and levels of the LV for radial and longitudinal strains, whereas circumferential and area strains demonstrated generally consistent normal ranges across the LV. Conclusions Normal ranges of global and regional LV strain using 3DSTE have been established for clinical use. Differences in the magnitude of LV strain are present between men and women as well as different age groups. Moreover, there are differences between different segments, walls, and levels as part of the functional non-uniformity of the normal LV that necessitates the use of segment-specific normal ranges for radial and longitudinal strains. Circumferential and area strains demonstrate the most consistent normal ranges overall.

New oral anticoagulants: a practical guide for physicians

Abstract: New oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Unlike VKAs, these anticoagulants do not require routine INR monitoring and possess favorable pharmacological properties. The lack of an effective antidote, their cost, or reservations in patients with kidney disease may explain their slow rate of expansion. Safe and effective use of these new drugs will depend on clinical experience amongst the medical community. This review discusses the current NOACs, providing practical and easy-to-use algorithms for application in the clinical routine.

Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV ☆

Abstract: Resumen La practica clinica cardiologica requiere una organizacion compleja que influya en los resultados globales y puede diferir sustancialmente entre distintos hospitales y comunidades. El objetivo de este documento de consenso es definir indicadores de calidad en cardiologia, incluidos los indicadores para medir la calidad de los resultados (indicadores de resultados) y los parametros de calidad relacionados con mejores resultados en la practica clinica (indicadores de practica asistencial). El documento esta destinado principalmente al sistema de asistencia sanitaria de Espana y puede servir de base para documentos similares en otros paises.

Guía de práctica clínica de la ESC sobre revascularización miocárdica, 2014

Abstract: Autores/Miembros del Grupo de Trabajo: Stephan Windecker* (coordinador de la ESC) (Suiza), Philippe Kolh* (coordinador de la EACTS) (Bélgica), Fernando Alfonso (España), Jean-Philippe Collet (Francia), Jochen Cremer (Alemania), Volkmar Falk (Suiza), Gerasimos Filippatos (Grecia), Christian Hamm (Alemania), Stuart J. Head (Países Bajos), Peter Jüni (Suiza), A. Pieter Kappetein (Países Bajos), Adnan Kastrati (Alemania), Juhani Knuuti (Finlandia), Ulf Landmesser (Suiza), Günther Laufer (Austria), Franz-Josef Neumann (Alemania), Dimitrios J. Richter (Grecia), Patrick Schauerte (Alemania), Miguel Sousa Uva (Portugal), Giulio G. Stefanini (Suiza), David Paul Taggart (Reino Unido), Lucia Torracca (Italia), Marco Valgimigli (Italia), William Wijns (Bélgica) y Adam Witkowski (Polonia)

Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

Abstract: Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.

Analisis coste-efectividad de apixaban frente a acenocumarol en la prevencion del ictus en pacientes con fibrilacion auricular no valvular en Espana

Abstract: Resumen Introduccion y objetivos Analisis de coste-efectividad de apixaban (5 mg dos veces al dia) frente a acenocumarol (5 mg/dia) en la prevencion del ictus en pacientes con fibrilacion auricular no valvular en Espana. Metodos Modelo de Markov durante toda la vida del paciente con 10 estados de salud. Los datos de eficacia y seguridad de los farmacos proceden del ensayo clinico ARISTOTLE. Se asumio la equivalencia terapeutica de warfarina y acenocumarol. Perspectivas: Sistema Nacional de Salud y la sociedad. El coste de los medicamentos, las complicaciones y el manejo de la enfermedad se obtuvieron de fuentes espanolas. Resultados En una cohorte de 1.000 pacientes con fibrilacion auricular no valvular, con apixaban se evitarian frente a acenocumarol: 18 ictus, 71 hemorragias (28 intracraneales o mayores), 2 infartos de miocardio, 1 embolia sistemica y 23 muertes relacionadas. Con apixaban se obtendrian mas anos de vida (0,187) y mas anos de vida ajustados por calidad (0,194) por paciente. Los costes incrementales con apixaban para el Sistema Nacional de Salud y la sociedad serian de 2.488 y 1.826 euros por paciente. En consecuencia, se obtendria unos costes por ano de vida ganado de 13.305 y 9.765 euros, y unos costes por ano de vida ajustado por calidad ganado de 12.825 y 9.412 euros para el Sistema Nacional de Salud y la sociedad respectivamente. Los analisis de sensibilidad confirmaron la estabilidad del caso base. Conclusiones Segun este analisis, apixaban puede ser coste-efectivo en la prevencion del ictus en pacientes con fibrilacion auricular no valvular frente a acenocumarol.

Guía de práctica clínica de la ESC 2014 sobre el diagnóstico y el tratamiento de la embolia pulmonar aguda

Abstract: Comite de la ESC para la elaboracion de Guias de Practica Clinica (CPG): Jose Luis Zamorano (Presidente) (Espana), Stephan Achenbach (Alemania), Helmut Baumgartner (Alemania), Jeroen J. Bax (Paises Bajos), Hector Bueno (Espana), Veronica Dean (Francia), Christi Deaton (Reino Unido), Cetin Erol (Turquia), Robert Fagard (Belgica), Roberto Ferrari (Italia), David Hasdai (Israel), Arno Hoes (Paises Bajos), Paulus Kirchhof (Alemania/Reino Unido), Juhani Knuuti (Finlandia), Philippe Kolh (Belgica), Patrizio Lancellotti (Belgica), Ales Linhart (Republica Checa), Petros Nihoyannopoulos (Reino Unido), Massimo F. Piepoli (Italia), Piotr Ponikowski (Polonia), Per Anton Sirnes (Noruega), Juan Luis Tamargo (Espana), Michal Tendera (Polonia), Adam Torbicki (Polonia), William Wijns (Belgica), Stephan Windecker (Suiza) Revisores del documento: Cetin Erol (Coordinador de revision del CPG) (Turquia), David Jimenez (Coordinador de revision) (Espana), Walter Ageno (Italia), Stefan Agewall (Noruega), Riccardo Asteggiano (Italia), Rupert Bauersachs (Alemania), Cecilia Becattini (Italia), Henri Bounameaux (Suiza), Harry R. Buller (Paises Bajos), Constantinos H. Davos (Grecia), Christi Deaton (Reino Unido), Geert-Jan Geersing (Paises Bajos), Miguel Angel Gomez Sanchez (Espana), Jeroen Hendriks (Paises Bajos), Arno Hoes (Paises Bajos), Mustafa Kilickap (Turquia), Viacheslav Mareev (Rusia), Manuel Monreal (Espana), Joao Morais (Portugal), Petros Nihoyannopoulos (Reino Unido), Bogdan A. Popescu (Rumania), Olivier Sanchez** (Francia), Alex C . Spyropoulos (Estados Unidos) Otras entidades ESC que han participado en el desarrollo de este documento: Asociaciones: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention & Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), Heart Failure Association (HFA). Consejos: Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council for Cardiology Practice (CCP), Council on Cardiovascular Primary Care (CCPC). Grupos de Trabajo: Cardiovascular Pharmacology and Drug Therapy, Nuclear Cardiology and Cardiac Computed Tomography, Peripheral Circulation, Pulmonary Circulation and Right Ventricular Function, Thrombosis. Descargo de responsabilidad: La guia de practica clinica de la ESC representa la opinion de la ESC y se ha elaborado tras una cuidadosa consideracion del conocimiento cientifico y medico y de la evidencia disponible en el momento de su publicacion. La ESC no se hace responsable en caso de contradiccion, discrepancia o ambiguedad entre las guias de la ESC y cualesquiera otras recomendaciones o directrices oficiales publicadas por las autoridades de salud publica competentes, en particular en relacion con el buen uso de estrategias de salud o terapeuticas. Se anima a los profesionales de la salud a tomar en plena consideracion las guias de la ESC al ejercer su juicio clinico, asi como al determinar e implementar estrategias medicas preventivas, diagnosticas o terapeuticas; sin embargo, las guias de la ESC no invalidan en modo alguno la responsabilidad individual de los profesionales de la salud en la toma de decisiones apropiadas y precisas adecuadas al estado de salud de cada paciente y consultando con ese paciente y, cuando resulte apropiado o necesario, sus cuidadores. Las guias de la ESC tampoco eximen a los profesionales de la salud de tomar en consideracion plena y cuidadosa las recomendaciones o directrices oficiales actualizadas y relevantes publicadas por las autoridades competentes de salud publica, con objeto de tratar el caso de cada paciente a la luz de los datos cientificamente aceptados conforme a sus obligaciones eticas y profesionales respectivas. Es tambien responsabilidad del profesional de la salud verificar las normas y los reglamentos aplicables en relacion con farmacos y dispositivos medicos en el momento de la prescripcion. Revisores del documento de las Sociedades Cardiacas Nacionales: se listan en el anexo 1 al final del texto. Los documentos de declaracion de conflictos de intereses proporcionados por los expertos implicados en el desarrollo de esta guia estan disponibles en la pagina web de la ESC: www.escardio.org/guidelines

Reproducibility of a novel echocardiographic 3D automated software for the assessment of mitral valve anatomy

Abstract: 3D transesophageal echocardiography (TEE) is superior to 2D TEE in quantitative anatomic evaluation of the mitral valve (MV) but it shows limitations regarding automatic quantification. Here, we tested the inter-/intra-observer reproducibility of a novel full-automated software in the evaluation of MV anatomy compared to manual 3D assessment. Thirty-six out of 61 screened patients referred to our Cardiac Imaging Unit for TEE were retrospectively included. 3D TEE analysis was performed both manually and with the automated software by two independent operators. Mitral annular area, intercommissural distance, anterior leaflet length and posterior leaflet length were assessed. A significant correlation between both methods was found for all variables: intercommissural diameter (r = 0.84, p 0, 01), anterior leaflet length (r = 0.83, p < 0.01) and posterior leaflet length (r = 0.67, p < 0.01). Interobserver variability assessed by the intraclass correlation coefficient was superior for the automatic software: intercommisural distance 0.997 vs. 0.76; mitral annular area 0.957 vs. 0.858; anterior leaflet length 0.963 vs. 0.734 and posterior leaflet length 0.936 vs. 0.838. Intraobserver variability was good for both methods with a better level of agreement with the automatic software. The novel 3D automated software is reproducible in MV anatomy assessment. The incorporation of this new tool in clinical MV assessment may improve patient selection and outcomes for MV interventions as well as patient diagnosis and prognosis stratification. Yet, high-quality 3D images are indispensable.

Artículo especial Guía ESC 2015 sobre el diagnóstico y tratamiento de las enfermedades del pericardio: Grupo de Trabajo de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de las enfermedades del pericardio

Abstract: Otras entidades de la ESC que han participado en la elaboracion de este documento: Asociaciones: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA). Consejos: Council for Cardiology Practice (CCP), Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council on Cardiovascular Primary Care (CCPC). Grupos de Trabajo: Farmacoterapia Cardiovascular, Cirugia Cardiovascular, Cardiopatias Congenitas en el Adulto, Enfermedades del Miocardio y del Pericardio, Circulacion Pulmonar y Funcion Ventricular Derecha, Valvulopatias. El contenido de esta Guia de Practica Clinica de la Sociedad Europea de Cardiologia (ESC) se publica exclusivamente para uso personal y educativo. No se autoriza su uso comercial. No se autoriza la traduccion o reproduccion de ningun fragmento de esta guia sin la autorizacion escrita de la ESC. La autorizacion se solicitara por escrito a Oxford University Press, editorial de European Heart Journal y representante autorizado de la ESC para gestionar tales permisos. Descargo de responsabilidad. Esta guia recoge la opinion de la ESC y se ha elaborado tras el estudio minucioso de los datos y la evidencia disponibles hasta la fecha. La ESC no es responsable en caso de que haya alguna contradiccion, discrepancia o ambiguedad entre la guia de practica clinica (GPC) de la ESC y cualquier otra recomendacion oficial o GPC publicada por autoridades relevantes de la sanidad publica, particularmente en lo que se refiere al buen uso de la atencion sanitaria y las estrategias terapeuticas. Se espera que los profesionales de la salud tengan en consideracion esta GPC a la hora de tomar decisiones clinicas, asi como al implementar estrategias medicas preventivas, diagnosticas o terapeuticas. No obstante, esta guia no anula la responsabilidad individual de cada profesional al tomar las decisiones oportunas relativas a cada paciente, de acuerdo con dicho paciente y, cuando fuera necesario, con su tutor o representante legal. Ademas, las GPC de la ESC no eximen al profesional medico de su obligacion etica y profesional de consultar y considerar atentamente las recomendaciones y las GPC actualizadas emitidas por autoridades sanitarias competentes. Es tambien responsabilidad del profesional verificar la normativa y la legislacion sobre farmacos y dispositivos medicos a la hora de prescribirlos. Los formularios de autorizacion de todos los autores y revisores se encuentran en la pagina web de la ESC: www.escardio.org/guidelines

Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain

Abstract: Introduction and objectives Cost-effectiveness analysis of apixaban (5 mg twice daily) vs acenocoumarol (5 mg/day) in the prevention of stroke in patients with nonvalvular atrial fibrillation in Spain. Methods Markov model covering the patient's entire lifespan with 10 health states. Data on the efficacy and safety of the drugs were provided by the ARISTOTLE trial. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. Perspectives: The Spanish National Health System and society. Information on the cost of the drugs, complications, and the management of the disease was obtained from Spanish sources. Results In a cohort of 1000 patients with nonvalvular atrial fibrillation, administration of apixaban rather than acenocoumarol would avoid 18 strokes, 71 hemorrhages (28 intracranial or major), 2 myocardial infarctions, 1 systemic embolism, and 23 related deaths. Apixaban would prolong life (by 0.187 years) and result in more quality-adjusted life years (by 0.194 years) per patient. With apixaban, the incremental costs for the Spanish National Health System and for society would be € 2488 and € 1826 per patient, respectively. Consequently, the costs per life year gained would be € 13 305 and € 9765 and the costs per quality-adjusted life year gained would be € 12 825 and € 9412 for the Spanish National Health System and for society, respectively. The stability of the baseline case was confirmed by sensitivity analyses. Conclusions According to this analysis, apixaban may be cost-effective in the prevention of stroke in patients with nonvalvular atrial fibrillation compared with acenocoumarol.

Quantification of mitral regurgitation by echocardiography

Abstract: ### Learning objectives Mitral regurgitation (MR) is becoming increasingly prevalent, despite the reduced incidence of rheumatic disease, and is anticipated to increase in prevalence as the population ages. Approximately 10% of people ≥75 years of age have significant MR; these patients have decreased survival regardless of whether MR is a consequence of a primary mitral valve abnormality or secondary to left ventricular (LV) dysfunction.1 Surgery is only indicated in patients with severe MR, so an accurate quantification of MR severity is mandatory. Several methods may be used for quantification of MR severity. Cardiac magnetic resonance (CMR) can be used for MR evaluation and provides assessment of the effects of regurgitant lesions on cardiac chambers; however, it is not widely available, dedicated imaging phases are required that can be time consuming, significant experience is necessary, and accuracy and reproducibility data are limited. Using cardiac catheterisation, assessment of regurgitation may be limited when based on a single projection and requires assumptions regarding jet geometry. Cardiac CT (CCT) has the highest spatial resolution, but limitations arise from its poor temporal resolution, its inability to assess flow, and radiation exposure.2 Echocardiography remains the cornerstone for the evaluation of MR. It allows comprehensive evaluation of MR, from aetiology and mechanism to severity assessment and impact on cardiac morphology and function. Transthoracic echocardiography (TTE) is the first line imaging technique for the diagnosis and complete evaluation of MR. In most cases TTE is enough to derive a full characterisation of the pathology. However, in selected cases of poor acoustic …

Vector Flow Mapping in Mitral Valve Disease: a Novel Method for the Assessment of Flow Mechanics and Their Potential Implications for Mitral Valve Repair

Abstract: In the last few years, the development of new techniques enabling visualization and quantification of flow behavior inside cardiac chambers has increased the interest in flow mechanics, blood-tissue interaction, and the potential application of these new data to diagnosis and guidance of treatment. Several studies have focused on flow dynamics inside the left ventricle and a differential aspect in it: the vortex ring. In this article, we briefly describe the key role of the mitral valve on the generation of physiologic flow dynamics. We also review how mitral valve disease and its treatment can influence the distribution of flow inside the left ventricle and its potential clinical impact.

A rare cause of tough coronary occlusion

Abstract: A 50-year-old woman was admitted with chest discomfort, dyspnoea, and anterolateral ST-elevation ( Panel A ). Her medical history included a breast sarcoma with a lung metastasis treated 2 years before. Urgent coronary angiography identified an abrupt occlusion of the mid-LAD that was only partially crossed with a stiff wire. Several balloon inflations were unable to …

Fusión eco-escopia, una ayuda durante la punción transeptal

Abstract: In recent years, percutaneous procedures have been used increasingly to correct structural heart disease. Many of these procedures require transseptal puncture to access the left heart chambers, although complications such as cardiac tamponade and aortic perforation may occur. In certain situations, puncture of the atrial septum is required (for placement of a MitraClip device or closure of the left atrial appendage, for example). Fluoroscopy imaging cannot adequately display the position of anatomic landmarks, and often echocardiographic imaging is needed to guide puncture. An innovative system (EchoNavigator System, Philips) is now available. This system allows X-ray images and echocardiographic images to be combined in 2 or 3 dimensions in real time. The movement of the X-ray arc is synchronized with the transesophageal probe of the echocardiogram, and the different echocardiographic projections are sliced according to the position of the X-ray source. In the Figure, the transducer of the transesophageal echocardiography system, shown in green, indicates the appropriate synchronization of the echocardiogram and X-ray image. The echocardiographic image during transseptal puncture is shown on the left. On the right, we see how the echocardiographic image is combined on the X-ray image in real time using the EchoNavigator system, thereby helping to guide the puncture procedure. This tool allows different types of image to be superimposed to facilitate the intervention and improve the safety of the procedure. Figure.

Eco-X Ray Fusion for Transseptal Puncture.

Abstract: In recent years, percutaneous procedures have been used increasingly to correct structural heart disease. Many of these procedures require transseptal puncture to access the left heart chambers, although complications such as cardiac tamponade and aortic perforation may occur. In certain situations, puncture of the atrial septum is required (for placement of a MitraClip device or closure of the left atrial appendage, for example). Fluoroscopy imaging cannot adequately display the position of anatomic landmarks, and often echocardiographic imaging is needed to guide puncture. An innovative system (EchoNavigator System, Philips) is now available. This system allows X-ray images and echocardiographic images to be combined in 2 or 3 dimensions in real time. The movement of the X-ray arc is synchronized with the transesophageal probe of the echocardiogram, and the different echocardiographic projections are sliced according to the position of the X-ray source. In the Figure, the transducer of the transesophageal echocardiography system, shown in green, indicates the appropriate synchronization of the echocardiogram and X-ray image. The echocardiographic image during transseptal puncture is shown on the left. On the right, we see how the echocardiographic image is combined on the X-ray image in real time using the EchoNavigator system, thereby helping to guide the puncture procedure. This tool allows different types of image to be superimposed to facilitate the intervention and improve the safety of the procedure. Figure.

Mitral valve anatomy: pre-procedural screening and imaging techniques

Abstract: Mitral regurgitation is a source of significant morbidity and mortality with growing prevalence in an increasingly ageing population. The development of reparative percutaneous techniques allows offering treatment to patients ineligible for surgery. The mitral valve is a complex structure and these procedures are limited by anatomical variability and technical complexity. The most established mitral valve repair technique currently is the MitraClip, which requires a careful preoperative evaluation of the mitral valve apparatus to assess the patient's suitability for the intervention, where echocardiography plays an essential role.

Imaging in HF-PEF with Cardiovascular Magnetic Resonance

Abstract: Heart failure with preserved ejection fraction (HFPEF) represents up to 50 % of all patients with heart failure. Cardiac imaging modalities play a central role in the evaluation of this syndrome. Cardiovascular magnetic resonance (CMR) offers alternative and complementary applications to echocardiography for the evaluation of systolic and diastolic function. This report aims to highlight the potential role of CMR to identify specific aetiologies in HFPEF syndrome and to review the available CMR modalities for the evaluation of diastolic dysfunction.

Chronic giant hydatid cyst fistulized to the left ventricle: long-term survival without surgery

Abstract: A 71-year-old woman underwent emergency evaluation due to chest pain. She had undergone lung surgery at the age of 16, due to hydatid cysts. A cyst adjacent to the pericardium was not operated due to the high risk. Chest X-ray showed a cystic image (arrow) next to the heart ( Panel A ). Two-dimensional and 3 D echocardiograms ( Panel B …

3D-ECHO for TAVI: two arrows, just in case

Abstract: The legend tells that William Tell, an extremely accurate archer, lived in Burglen, Switzerland, around the 14th century. As a punishment for an act of rebellion, he was forced by the governor to shoot an arrow against an apple placed on his son's head. If he hit the target, he would be released. If he failed, he would be sentenced to death. William only needed an arrow to succeed, but had hidden a second one only visible to few witnesses. When inquired about that second arrow, he replied that, had the first one gone off target, he would have shot the second directly to the governor's heart. Ageing is a fact, and medicine must adapt itself to it to satisfy the requirements of an elderly population. Aortic stenosis is a frequent problem in this group of patients, appearing predominantly in individuals over 75 years of age. Transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with high surgical risk or considered inoperable. One of the key aspects before selecting a prosthetic aortic valve to be implanted percutaneously is accurate aortic annulus definition to decide the model and sizing. Historically, first approaches to this essential step were done through transthoracic echocardiography (TTE), parasternal long-axis plane. Shortly after, TEE soon showed to be superior, leading to better outcomes …