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Showing papers by "José Luis Zamorano published in 2019"


Journal ArticleDOI
TL;DR: New ESCardio Guidelines for the Diagnosis and Management of Acute PulmonaryEmbolism developed in collaboration with EuroRespSoc are available.
Abstract: New @ESCardio Guidelines for the Diagnosis and Management of Acute #PulmonaryEmbolism developed in collaboration with @EuroRespSoc now available: #cardiotwitter @erspublicationshttp://bit.ly/2HnrJaj

1,334 citations


Journal ArticleDOI
TL;DR: This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
Abstract: The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence

213 citations


Journal ArticleDOI
TL;DR: The NORRE study provides useful 2DE reference ranges for novel indices of non-invasively derived indices of myocardial work (MW) from a large group of healthy volunteers over a wide range of ages and gender.
Abstract: Aims - To obtain the normal ranges for 2D echocardiographic (2DE) indices of myocardial work (MW) from a large group of healthy volunteers over a wide range of ages and gender. Methods and results - A total of 226 (85 men, mean age: 45 ± 13 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. Global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE) were estimated from left ventricle (LV) pressure-strain loops. Peak LV systolic pressure was non-invasively derived from brachial artery cuff pressure. The lowest values of MW indices in men and women were 1270 mmHg% and 1310 mmHg% for GWI, 1650 mmHg% and 1544 mmHg% for GCW, and 90% and 91% for GWE, respectively. The highest value for GWW was 238 mmHg% in men and 239 mmHg% in women. Men had significant lower values of GWE and higher values of GWW. GWI and GCW significantly increased with age in women. Conclusion - The NORRE study provides useful 2DE reference ranges for novel indices of non-invasive MW.

178 citations


Journal ArticleDOI
TL;DR: This document from the ESC Cardio-Oncology council proposes the grounds for creating C-O Services in Europe based on expert opinion, and presents their rationale, organization, and implementation.
Abstract: Aims Anticancer therapies have extended the lives of millions of patients with malignancies, but for some this benefit is tempered by adverse cardiovascular (CV) effects. Cardiotoxicity may occur early or late after treatment initiation or termination. The extent of this cardiotoxicity is variable, depending on the type of drug used, combination with other drugs, mediastinal radiotherapy, the presence of CV risk factors, and comorbidities. A recent position paper from the European Society of Cardiology addressed the management of CV monitoring and management of patients treated for cancer. Methods and results The current document is focused on the basis of the Cardio-Oncology (C-O) Services, presenting their rationale, organization, and implementation. C-O Services address the spectrum of prevention, detection, monitoring, and treatment of cancer patients at risk of cardiotoxicity and/or with concomitant CV diseases. These services require a multidisciplinary approach, with the aims of promoting CV health and facilitating the most effective cancer therapy. Conclusion The expected growing volume of patients with cancer at risk of developing/worsening CV disease, the advent of new technological opportunities to refine diagnosis, and the necessity of early recognition of cancer therapy-related toxicity mandate an integrative multidisciplinary approach and care in a specialized environment. This document from the ESC Cardio-Oncology council proposes the grounds for creating C-O Services in Europe based on expert opinion.

175 citations


Journal ArticleDOI
Alfredo J. Lucendo, Stephan Miehlke1, Christoph Schlag2, Michael Vieth, Ulrike von Arnim3, Javier Molina-Infante, Dirk Hartmann, Albert J. Bredenoord, Constanza Ciriza de los Ríos, Stefan Schubert, Stefan Brückner4, Ahmed Madisch, J Hayat5, Jan Tack6, Stephen Attwood7, Ralph Mueller, Roland Greinwald, Alain M. Schoepfer8, Alex Straumann, Tim Vanuytsel, Hubert Louis, Carmen Musala, Dorothea Frederking, Monther Bajbouj, Simon Nennstiel, Renate Schmelz, Schmelz Heimerl, Anna Magdalena Stephan, Christiane Fibbe, Niels Liedtke, Jutta Keller, Ulrich Rosien, Sebastian Haag, Arne Schneider, Christoph Schmöcker, Hendrik Buchholz, Frank Lammert, Markus Casper, Matthias C. Reichert, Dirk Sommer, Hubert Mönnikes, Miriam Stengel, Marco Schmidtmann, Michaela Müller, Alexander J. Eckardt, Till Wehrmann, Peter Armerding, Wolf Peter Hofmann, Thomas Liceni, Arne Kandulski, Jochen Weigt, Norbert Börner, Anne Lutz-Vorderbrügge, Jörg Albert, Stefan Zeuzem, Irina Blumenstein, Kathrin Sprinzl, Johannes Hausmann, Arjan Bredenoord, Marijn J. Warners, Alfredo Lucendo Villarin, Ángel Arias, Maria Ángeles Tejero Bustos, María Jesús Carrillo Ramos, José María Olalla Gallardo, Rocío Juárez Tosina, José Luis Zamorano, Cecilio Santander Vaquero, Sergio Casabona Francés, Teresa Pérez, Teresa Rodriguez, Fernando Canga Rodríguez-Valcárcel, Isabel Castel de Lucas, Antonia Perelló Juan, Merce Barenys, Carlos Pons, Isabel Perez Martinez, M. Eugenia Lauret, Andrés Castaño García, Esmeralda Rubio, Petr Hruz, Simon Brunner, Andrew Poullis 
TL;DR: In a randomized trial of adults with active EoE, budesonide oral tablets were significantly more effective than placebo in inducing clinical and histologic remission.

147 citations


Journal ArticleDOI
TL;DR: This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users.
Abstract: Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.

81 citations


Journal ArticleDOI
TL;DR: LA-LS by CMR-FT provides accurate measurements of LA function in HCM patients and may become a novel potential predictor of poor cardiac outcomes, particularly cardiovascular mortality and HF.
Abstract: Left atrium (LA) size has an important role in determining prognosis and risk stratification in hypertrophic cardiomyopathy (HCM). Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a novel technique for the quantification of LA function. Our aim was first to evaluate LA function by CMR-FT and volumetric analysis in patients with HCM; and secondly we sought to determine the association of LA-longitudinal strain (LA-LS) with major cardiovascular outcomes, particularly all cause mortality and heart failure. 75 patients with HCM and 75 control subjects underwent a conventional CMR study including assessment of LA function by CMR-FT (LA-LS) and volumetric analysis. A primary endpoint of all-cause mortality and secondary combined endpoint of hospital admission related to heart failure, lethal ventricular arrhythmias or cardiovascular death were defined. Compared to controls, LA-LS and all volumetric indices of LA function were significantly impaired in HCM even in patients with normal LA volume and normal LV filling pressures. LA-LS showed moderate-high correlation with LA-emptying fraction (total, active and passive LA-EF, r = 0.68, r = 0.67, r = 0.31, p < 0.001 for all) and with parameters of diastolic function (E/e, r = 0.4, p < 0.001). The age, minimum LA volume and % of LGE were independent predictors of LA-LS (p < 0.01 for all). During a mean follow-up of 3.3 ± 1.2 years LA-LS was associated with the primary (HR: 0.85 (0.73–0.98), p = 0.02) and the secondary end-point (HR: 0.88 (0.82–0.96), p = 0.003). LA-LS by CMR-FT provides accurate measurements of LA function in HCM patients. LA-LS may become a novel potential predictor of poor cardiac outcomes, particularly cardiovascular mortality and HF.

42 citations


Journal ArticleDOI
TL;DR: The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer.
Abstract: Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology.

33 citations


Journal ArticleDOI
TL;DR: Proporcionar un enfoque multidisciplinario y practico para the prevencion y el tratamiento oficial de the fibrilacion auricular de pacientes con cancer activo y basado en the consenso of expertos.
Abstract: Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology.

26 citations


Journal ArticleDOI
TL;DR: A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies.
Abstract: Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower—although overall high—rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m2) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0.81–1.18), 1.31 (1.05–1.63), 1.77 (1.38–2.27), and 3.12 (2.25–4.33) for eGFR 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2, compared with eGFR ≥90 mL/min/1.73 m2. A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.

18 citations


Journal ArticleDOI
TL;DR: This first randomized, control-group, open-label blinded endpoint experimental trial assessing local ischemic preconditioning (IPC) in a pig model of acute myocardial infarction will be carried out in three separate sets of experiments performed in parallel by three laboratories.
Abstract: Despite many cardioprotective interventions have shown to protect the heart against ischemia/reperfusion injury in the experimental setting, only few of them have succeeded in translating their findings into positive proof-of-concept clinical trials. Controversial and inconsistent experimental and clinical evidence supports the urgency of a disruptive paradigm shift for testing cardioprotective therapies. There is a need to evaluate experimental reproducibility before stepping into the clinical arena. The CIBERCV (acronym for Spanish network-center for cardiovascular biomedical research) has set up the “Cardioprotection Large Animal Platform” (CIBER-CLAP) to perform experimental studies testing the efficacy and reproducibility of promising cardioprotective interventions based on a pre-specified design and protocols, randomization, blinding assessment and other robust methodological features. Our first randomized, control-group, open-label blinded endpoint experimental trial assessing local ischemic preconditioning (IPC) in a pig model of acute myocardial infarction (n = 87) will be carried out in three separate sets of experiments performed in parallel by three laboratories. Each set aims to assess: (A) CMR-based outcomes; (B) histopathological-based outcomes; and (C) protein-based outcomes. Three core labs will assess outcomes in a blinded fashion (CMR imaging, histopathology and proteomics) and 2 methodological core labs will conduct the randomization and statistical analysis.

Journal ArticleDOI
TL;DR: The safety and efficacy of combining oral anticoagulation (OAC) with percutaneous left atrial appendage closure (LAAC) in patients with well‐anticoagulated atrial fibrillation (AF) with recurrent strokes is evaluated.
Abstract: Background and purpose There are no recommendations regarding how to treat cardioembolic recurrent strokes when patients are well anticoagulated. We evaluated the safety and efficacy of combining oral anticoagulation (OAC) with percutaneous left atrial appendage closure (LAAC) in patients with well-anticoagulated atrial fibrillation (AF) with recurrent strokes. Methods In an explorative, prospective, observational study, LAAC was performed in patients with AF with at least two ischaemic strokes in the previous year, despite good anticoagulation using the Amplatzer Cardiac Plug (St Jude Medical, St Paul, MN, USA) or Amulet Abbot device (Abbot Vascular, Santa Clara, CA, USA). We recorded age, type of AF, CHA2 DS2 -VASC and HAS-BLED scores, types of OAC and risk factors. After closure, treatment with aspirin (100 mg/day) was continued for 3 months in combination with indefinite OAC. Clinical status, recurrent embolisms and bleeding complications were recorded during follow-up. Results A total of 19 patients were included (mean age, 72.1 ± 9.6 years; mean CHA2 DS2 -VASC score, 5.3 ± 1.48; mean number of previous strokes, 2.78 ± 1.15). Thirteen had spontaneous echocardiographic contrast and all had dilatation of the left atrium. Eighteen patients had a multilobulated left atrial appendage, 17 with 'chicken-wing' morphology and one patient had a left atrial appendage thrombus. There were no complications during the procedure. Only one patient had a transient ischaemic attack and no major bleeding occurred during a mean follow-up of 17.4 ± 11.5 months. Conclusion Combination therapy with indefinite OAC plus LAAC in patients with AF with recurrent strokes despite good anticoagulation should be considered in order to prevent a new stroke.

Journal ArticleDOI
TL;DR: MiRNAs were statistically correlated with critical parameters, including left ventricle ejection fraction (LVEF) and ventricular diameter, in women and young men, when stratified by gender and age, and co-expression of mir-154-5p and mir-182- 5p may potentially show diagnostic value.
Abstract: A new familial dilated cardiomyopathy (FDCM) was found related to mutations in BAG3 gene. MicroRNAs (miRNAs) represent new targets of FDCM, although no studies have assessed clinical association between Bcl2-associated athanogene 3 (BAG3)-related DCM and miRNAs. Here, we studied whether a clinical association between BAG3-related FDCM and circulating miRNAs may have diagnostic and prognostic value in a small cohort of familial related individuals carrying a BAG3 mutation (BAG3+) and/or diagnosed of dilated cardiomyopathy (DCM) (DCM+). The analysis of 1759 circulating miRNAs showed significant differences between BAG3+ and BAG3- individuals for miRNAs mir-3191-3p, 6769b-3p, 1249-ep, 154-5p, 6855-5p, and 182-5p, while comparisons between BAG3+/DCM+ versus BAG3+/DCM- were restricted to miRNAs mir-154-5p, 6885-5p, and 182-5p, showing significant correlation with systolic and diastolic blood pressure, A wave, left atrium length, and left atrium area. Additionally, when stratified by gender and age, miRNAs were statistically correlated with critical parameters, including left ventricle ejection fraction (LVEF) and ventricular diameter, in women and young men. Likewise, 56% of BAG3+/DCM+, significantly co-expressed mir-154-5p and mir-182-5p, and a slight 4% did not express such combination, suggesting that co-expression of mir-154-5p and mir-182-5p may potentially show diagnostic value. Further studies will require long-term follow-up, and validation in larger populations.

Journal ArticleDOI
TL;DR: El edoxaban es una alternativa coste-efectiva frente al acenocumarol en the prevencion del ictus y the embolia sistemica en pacientes con FANV en Espana.
Abstract: Resumen Introduccion y objetivos Analizar el coste-efectividad del edoxaban frente al acenocumarol en la prevencion del ictus y la embolia sistemica en pacientes con fibrilacion auricular no valvular (FANV) en Espana. Metodos Modelo de Markov, adaptado a Espana desde la perspectiva del Sistema Nacional de Salud, que simula la evolucion de una cohorte hipotetica de pacientes con FANV a lo largo de toda su vida a partir de diferentes estados de salud: ictus, hemorragias y otras complicaciones cardiovasculares. Los datos de eficacia y seguridad se obtuvieron a partir de la evidencia clinica disponible (principalmente del estudio en fase III ENGAGE AF-TIMI 48). Los costes del tratamiento de la FANV y sus complicaciones se obtuvieron de fuentes espanolas. Resultados El edoxaban resulto en 0,34 anos de vida ajustados por calidad (AVAC) adicionales en comparacion con el acenocumarol. El coste incremental con el edoxaban fue de 3.916 euros, derivado principalmente de un mayor coste farmacologico, que se compensa parcialmente por los menores costes de la monitorizacion del tratamiento y del tratamiento de eventos y complicaciones de la FANV. Se obtuvo un coste por AVAC de 11.518 euros, dentro de los umbrales comunmente considerados coste-efectivos en Espana (25.000-30.000 euros/AVAC). Los diferentes analisis de sensibilidad realizados confirmaron la robustez de los resultados. Conclusiones El edoxaban es una alternativa coste-efectiva frente al acenocumarol en la prevencion del ictus y la embolia sistemica en pacientes con FANV en Espana.

Journal ArticleDOI
TL;DR: Comparisons of intraventricular velocities and gradients obtained by vector flow mapping technology during early diastole in consecutive patients diagnosed with mild and advanced diastolic dysfunction at echocardiography and a control group validate the hypothesis of relationship between new parameters and severity of diastolics dysfunction and conventional markers of elevated LV filling pressure.
Abstract: Intraventricular velocity distribution reflects left ventricular (LV) diastolic function and can be measured non-invasively by flow mapping technologies. We designed our study to compare intraventricular velocities and gradients, obtained by vector flow mapping (VFM) technology during early diastole in consecutive patients diagnosed with mild and advanced diastolic dysfunction at echocardiography and a control group with a purpose to validate the hypothesis of relationship between new parameters and severity of diastolic dysfunction and conventional markers of elevated LV filling pressure. Two-dimensional streamline fields were obtained using VFM technology in 121 subjects (57 with normal diastolic function, 38 with mild diastolic dysfunction and 26 with advanced diastolic dysfunction). We measured several velocities and calculated a gradient along the selected streamline, which we compared between groups and correlated them with conventional echocardiographic parameters. Apical intraventricular velocity gradient (GrIV) was the lowest in control group, followed by mild and advanced diastolic dysfunction groups (5.3 ± 1.9 vs. 6.8 ± 2.5 vs. 13.6 ± 5.0/s, p < 0.001) and showed good correlation with E/e’ (r = 0.751, p < 000.1). GrIV/e’ ratio was the strongest single predictor of severity of diastolic dysfunction. Different degrees of diastolic dysfunction affect the Intraventricular velocity behavior during early diastole obtained by VFM. GrIV could discriminate between groups with different levels of diastolic dysfunction and was closely associated with classical echocardiographic indices of elevated LV filling pressure. GrIV/e’ ratio has a potential to become a single parameter needed to assess left ventricular diastolic function.

Journal ArticleDOI
TL;DR: Optimal AVD in resynchronization therapy favors physiological vortex flow patterns in the left ventricle during the end-diastolic and early systolic period, which are altered when nonoptimal values are programmed, increasing ED.
Abstract: Background Optimal atrioventricular delay (AVD) achieves maximum cardiac output in patients undergoing cardiac resynchronization therapy (CRT). Nonoptimal AVD decreases left ventricular (LV) end-diastolic volume and causes loss of flow momentum prior to LV ejection. Objective We investigated the potential role of energy dissipation (ED) in these changes in cardiac output through the study of intraventricular flow. We hypothesized that short and long AVD increases ED when compared with optimal AVD by altering the physiologic flow mechanics that preserve kinetic energy in the LV. Methods Forty-four patients under CRT underwent echocardiographic LV flow analysis under optimal, short, and long AVD. LV ED and vortical flow in the inflow-outflow tract were studied during the end-diastolic and early systolic period, and paired comparisons were obtained between optimal and nonoptimal values. Results ED in the left ventricle was minimal in optimal AVD and significantly increased with nonoptimal values (79.1 ± 27.5 J/m·sec in optimal AVD vs 96.5 ± 34.7 J/m·sec in short AVD; n = 18, P = .006; 123.3 ± 67.6 J/m·sec in optimal AVD vs 292.4 ± 202.5 J/m·sec in long AVD; P Conclusions Optimal AVD in resynchronization therapy favors physiological vortex flow patterns in the left ventricle during the end-diastolic and early systolic period. These patterns are altered when nonoptimal values are programmed, increasing ED.

Journal ArticleDOI
TL;DR: Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain.
Abstract: Introduction and objectives To assess the cost-effectiveness of edoxaban vs acenocoumarol in the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) in Spain. Methods Markov model, adapted to the Spanish setting from the perspective of the National Health System, stimulating the progression of a hypothetical cohort of patients with NVAF throughout their lifetime, with different health states: stroke, haemorrhage, and other cardiovascular complications. Efficacy and safety data were obtained from the available clinical evidence (mainly from the phase III ENGAGE AF-TIMI 48 study). The costs of managing NVAF and its complications were obtained from Spanish sources. Results Edoxaban use led to 0.34 additional quality-adjusted life years (QALY) compared with acenocoumarol. The incremental cost with edoxaban was 3916€, mainly because of higher pharmacological costs, which were partially offset by lower costs of treatment monitoring and managing NVAF events and complications. The cost per QALY was 11 518€, within the thresholds commonly considered cost-effective in Spain (25 000-30 000 €/QALY). The robustness of the results was confirmed by various sensitivity analyses. Conclusions Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain.

Journal ArticleDOI
TL;DR: Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure.
Abstract: The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR. Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112). LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR. Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.

Journal ArticleDOI
TL;DR: A nonsignificant effect of NCC on mortality compared with IDC in symptomatic adult patients being followed up at specialized heart failure units is shown.
Abstract: cardiac magnetic resonance imaging to complete the study, the use of this technique was uneven across the cohort. Of note, NCC was confirmed in all the patients who underwent magnetic resonance imaging. Importantly, only a minority of our patients underwent genetic testing. Finally, the presence of neuromuscular disorders was not evaluated and all patients came from and were followed up at heart failure units; this may have created a possible selection bias which could influence the observed outcomes. In conclusion, our study shows a nonsignificant effect of NCC on mortality compared with IDC in symptomatic adult patients being followed up at specialized heart failure units.

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TL;DR: A 49-year-old woman underwent Dacron patch aortoplasty for coarctation of the aorta (CoAo) at 5 years of age and was under antihypertensive treatment and had a 20-mm Hg right arm-leg gradient in the last clinical visit.
Abstract: A 49-year-old woman underwent Dacron patch aortoplasty for coarctation of the aorta (CoAo) at 5 years of age. She was under antihypertensive treatment and had a 20-mm Hg right arm-leg gradient in the last clinical visit. Electrocardiogram was normal and transthoracic echocardiography showed a


Journal ArticleDOI
TL;DR: In particular, en la actualidad, no conoce la estenosis aortica no como un problema valvular puro; en su evaluación se requiere integrar el denominado complejo ventriculo, valvulopatia, and arterial, to comprender los diferentes fenomenos fisiologicos que pueden generar diversos estados de flujo y gradientes, permitiendo aclarar su enfoque diagnostico, terapeutico,

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TL;DR: Two recent randomized trials have evaluated the safety and efficacy of MitraClip implantation in patients with symptomatic heart failure and moderate-severe secondary MR despite medical therapy.
Abstract: Secondary mitral regurgitation (MR) occurs in the absence of organic mitral valve disease. It is a result of left ventricular remodelling that impairs coaptation of the valve leaflets, and it is frequently seen in chronic heart failure with reduced left ventricular ejection fraction. It is a very frequent disease, with increasing prevalence.1 It is mainly a disease of the left ventricle (with ‘normal’ mitral valve), and so, its treatment is focused on left ventricular dysfunction. However, secondary MR can worsen the situation of heart failure (by increasing volume load), and mechanical correction has been proposed. The prognostic of surgical mitral valve repair is poor in patients with secondary MR.2–4 The surgical risk is often high, due to left ventricular failure and other co-morbidities. Interventional treatment for patients with secondary MR is also challenging. The 2017 European Society of Cardiology guidelines for the management of valvular heart disease5 provide a Class IIb Level C recommendation for the use of MitraClip in patients with secondary MR and impaired left ventricular function who remain symptomatic despite optimal medical therapy. Two recent randomized trials have evaluated the safety and efficacy of MitraClip implantation in patients with symptomatic heart failure and moderate-severe secondary MR despite medical therapy. The MITRA-FR trial6 is a randomized controlled trial. A total of 304 symptomatic heart failure patients with severe secondary MR [effective regurgitant orifice area (EROA) >20 mm2 or regurgitant volume >30 mL], and left ventricular ejection fraction between 15% and 40% were randomized to undergo percutaneous valve repair plus medical treatment (intervention group, n = 152) or medical treatment alone (control group, n = 152).The MITRA-FR