José Luis Zamorano

Bio: José Luis Zamorano is an academic researcher from Carlos III Health Institute. The author has contributed to research in topics: Heart failure & Myocardial infarction. The author has an hindex of 105, co-authored 695 publications receiving 133396 citations. Previous affiliations of José Luis Zamorano include Hospital Clínico San Carlos & Universidad Francisco de Vitoria.

Usefulness of Parametric Imaging-Based Quantitative Myocardial Contrast Echocardiography in Predicting the Functional Recovery of Akinetic Segments Following Primary Angioplasty in Acute Myocardial Infarction Patients

Abstract: Introduction and objectives Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a ) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE, and b ) to assess the usefulness of these measurements in predicting functional recovery of these segments. Patients and Method The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. Results The patients' mean age was 62.3±14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (?): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. Conclusions Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

Perforated Aortic Valve Aneurysm Due to Infective Endocarditis

Abstract: A 28-year-old man with no relevant medical history was admitted to our hospital for fever occurring early in the evening, weakness, dyspnea, and headache of 2 months’ duration. Blood culture was persistently positive for Streptococcus sanguinis (5/5). Upon admission, a diastolic murmur that had not been detected previously was found. Transthoracic echocardiography was performed and showed a large aneurysm in the noncoronary leaflet of a bicuspid aortic valve, severe aortic insufficiency, and left ventricular dilation (Figures A and B). Transesophageal echocardiography identified perforation of the aneurysm as the cause of aortic insufficiency (Figures C-H). After the patient had completed antibiotic treatment and blood cultures tested negative, a decision was made to operate due to persistent dyspnea in the presence of severe aortic insufficiency. The same findings were observed (Figure I) as described above. Aortic valve aneurysms are rare, with fewer than 15 cases reported in the literature. Although the most probable cause is infectious endocarditis, this disease has been demonstrated in only a few cases. Our case met 2 of the major Duke criteria and 2 minor criteria for the diagnosis of definite infectious endocarditis: positive blood culture, new valvular insufficiency, fever, and predisposing heart disease. Ultimately, the valve culture was sterile, but surgery was done after completing antibiotic treatment and achieving negative blood cultures. As in other published cases, there was an absence of characteristic images of endocarditis accompanying the aneurysm. Therefore, an isolated finding of aortic aneurysm advises assessing for infectious endocarditis to rule out the presence of this condition. Rev Esp Cardiol. 2014;67(3):222

Echocardiography and cardiac resynchronization therapy. Room for hope

Abstract: The characterization of heart failure as one of the major problems of society today is now a classical maxim. In fact, the prevalence of symptomatic heart failure in Europe is between 0.4% and 2%. 1 Despite the fact that our understanding of the disease and its pathophysiological mechanisms has improved, and the continuous advances in its treatment, the rate of mortality due to this cause continues to be high. 1 Approximately 30% to 50% of the patients with heart failure also have some type of electrical changes on surface electrocardiogram, most of which result from left bundle branch block. 2 This change in conduction, which involves a change in ventricular mechanics, ultimately leads to the development of both ventricular and interventricular dyssynchronous contraction and, finally, remodeling and deterioration of the contractionrelaxation dynamics. 2 Reduced cardiac output and ventricular filling time and an increase in wall stress and ventricular end-systolic volume have been reported in patients of this type. 2 The original idea that biventricular stimulation could synchronize the contraction between the 2 ventricles and between the different ventricular segments has undoubtedly generated great expectations in the treatment of these patients. 3-5 Different randomized clinical trials have demonstrated that not all the patients benefited from resynchronization therapy. In fact, there are patients that not only do not improve following resynchronization, but can even become worse. 3-5 The MUSTIC study 5 and the MIRACLE study included patients with severe heart failure, in sinus rhythm and with a QRS longer than 150 milliseconds in the first and of over 130 milliseconds in the second. In most of the patients in the 2 studies,

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

Harmonizing the Metabolic Syndrome A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity

Abstract: A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Abstract: The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.