17 results on '"Álvarez-Ortega C"'
Search Results
2. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: The CARDIOTOX registry
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López-Sendón, J. Álvarez-Ortega, C. Zamora Auñon, P. Buño Soto, A. Lyon, A.R. Farmakis, D. Cardinale, D. Canales Albendea, M. Feliu Batlle, J. Rodríguez Rodríguez, I. Rodríguez Fraga, O. Albaladejo, A. Mediavilla, G. González-Juanatey, J.R. Martínez Monzonis, A. Gómez Prieto, P. González-Costello, J. Serrano Antolín, J.M. Cadenas Chamorro, R. López Fernández, T.
- Abstract
Aim: Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results: We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-Terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001). Conclusions: The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices. © 2020 Published on behalf of the European Society of Cardiology. All rights reserved.
- Published
- 2020
3. Índice de calcificación coronaria en la tomografía computarizada para predecir la necesidad de aterectomía rotacional
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Galeote, Guillermo, Hernández, Harold, Caro Codón, Juan, Moreno Gómez, Raúl, Pardo, Antonio, Guzmán, Gabriela, Álvarez Ortega, C. A., Peinado, Rafael, López Soberón, Edurne, Jiménez Valero, Santiago, Sánchez Recalde, Angel, Valbuena López, Silvia, Moreno Yangüela, Mar, López Sendón, José Luis, Galeote, Guillermo, Hernández, Harold, Caro Codón, Juan, Moreno Gómez, Raúl, Pardo, Antonio, Guzmán, Gabriela, Álvarez Ortega, C. A., Peinado, Rafael, López Soberón, Edurne, Jiménez Valero, Santiago, Sánchez Recalde, Angel, Valbuena López, Silvia, Moreno Yangüela, Mar, and López Sendón, José Luis
- Abstract
Introduction and objectives: This study aims to investigate if the non-invasive assessment of coronary calcium score using multislice cardiac computerized tomography (MSCT) may anticipate the need for elective rotational atherectomy (RA) during percutaneous coronary intervention. Methods: Patients were considered eligible for the study after receiving a diagnosis of severe coronary stenosis with moderate or severely calcified plaques during index coronary angiography. Those patients underwent the Agatston coronary artery calcium (CAC) score quantification using the MSCT and then underwent percutaneous intervention. Only those lesions considered non-crossable or non-dilatable according to a pre-specified revascularization protocol were treated with RA. All operators were blinded to the MSCT results. According to the study protocol, clinical, angiographic and Agatston-related variables were included in the statistical analysis. Short and long-term outcomes were investigated in both treatment groups during follow-up. Results: A total of 40 patients were included in the analysis: 20 underwent RA and 20 conventional percutaneous coronary interventions. Most patients were included after suffering from an acute coronary syndrome and had complex coronary anatomy (mean Syntax score, 25 points). The logistic regression analysis showed that creatinine levels and the per-lesion Agatston score were the only predictors of RA. No significant differences were observed regarding in-hospital or long-term procedural outcomes. A novel parameter, the CAC-Cre index, was found to be useful to anticipate the need for RA. Conclusions: Coronary artery calcification analysis using the Agatston score is a simple technique that improves the non-invasive assessment of complex coronary plaques prior to percutaneous coronary intervention. The per-lesion Agatston score, serum creatinine levels, and the CAC-Cre index may become useful parameters to anticipate the need for elective RAs during percuta, Introducción y objetivos: El objetivo del estudio fue investigar si la evaluación no invasiva del índice de calcificación coronaria mediante tomografía computarizada cardiaca multidetector (TCMD) puede predecir la necesidad de una aterectomía rotacional (AR) electiva durante la intervención coronaria percutánea. Métodos: Se incluyeron pacientes diagnosticados de estenosis coronaria grave con placas moderadamente o gravemente calcificadas durante la angiografía coronaria. Esos pacientes se sometieron a la cuantificación del índice de calcificación coronaria con la escala de Agatston utilizando TCMD y posteriormente a intervención percutánea. Solo fueron tratadas con AR las lesiones que se consideraba que no era posible cruzar ni dilatar, según un protocolo de revascularización prediseñado. Ninguno de los operadores conocía de antemano los resultados de la TCMD. Según el protocolo del estudio, en el análisis estadístico se incluyeron variables clínicas, angiográficas y relacionadas con la puntuación Agatston. Durante el seguimiento se estudiaron los resultados a corto y largo plazo en ambos grupos. Resultados: Se analizaron 40 pacientes: 20 que recibieron AR y 20 con intervención coronaria percutánea convencional. La mayoría se incluyó después de un síndrome coronario agudo y tenían una anatomía coronaria compleja (puntuación media de la escala Syntax de 25 puntos). La creatinina y la puntuación de Agatston por lesión fueron los únicos factores predictivos de la AR. No se observaron diferencias significativas en el pronóstico dentro del hospital o a largo plazo. Un nuevo parámetro, el índice CAC-Cre, fue útil para predecir la necesidad de AR. Conclusiones: El análisis de la calcificación de las arterias coronarias mediante la puntuación de Agatston mejora la evaluación no invasiva de las placas coronarias complejas antes de la intervención coronaria percutánea. La puntuación de Agatston por lesión, la creatinina sérica y el índice CAC-Cre son parámetros útiles para pr
- Published
- 2019
4. Harmonic emission of wind power plants: Measurement and assessment
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Vazquez, R., Amaris, H., MONICA ALONSO, Zubiaur, R., and Álvarez-Ortega, C.
5. Optimal management of FACTS units for voltage stability enhancement in power networks with high wind energy penetration
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MONICA ALONSO, Amarís, H., Álvarez-Ortega, C., and Albarracín, R.
6. Incidence and clinical impact of inappropriate periprocedural and perioperative management of antiplatelet therapy.
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Anguita-Gámez M, Vivas D, Ferrandis R, González-Manzanares R, Anguita M, Esteve-Pastor MA, Echeverri M, Igualada J, Egocheaga I, Nozal-Mateo B, Abad-Motos A, Figuero E, Bouzó-Molina N, Lozano T, Álvarez-Ortega C, Torres J, Descalzo MJ, Catalá JC, Martín-Rioboo E, Molines A, Rodríguez-Contreras R, Carnero-Alcázar M, and Marín F
- Subjects
- Humans, Female, Male, Aged, Prospective Studies, Incidence, Middle Aged, Spain epidemiology, Aged, 80 and over, Inappropriate Prescribing statistics & numerical data, Aspirin therapeutic use, Aspirin adverse effects, Postoperative Complications epidemiology, Platelet Aggregation Inhibitors therapeutic use, Platelet Aggregation Inhibitors adverse effects, Perioperative Care, Thrombosis prevention & control, Thrombosis epidemiology, Thrombosis etiology, Hemorrhage chemically induced, Hemorrhage epidemiology
- Abstract
Background and Aims: There is little evidence on the impact of current recommendations on the use of antiplatelet therapy during the perioperative and periprocedural period in our setting. The aim of this study was to analyze the incidence and clinical impact of inappropriate use of antiplatelet therapy in a population of patients undergoing surgery or a diagnostic or therapeutic procedure in "real life" in Spain., Methods: A prospective multicenter observational study of patients treated with antiplatelet agents requiring intervention was conducted. The incidence of thrombotic and hemorrhagic events at 30 days was analyzed according to peri-intervention management of antiplatelet therapy., Results: We included 643 patients (31.9% women, 39.0% over 75 years of age), most of them (87.7%) receiving aspirin as antiplatelet therapy at a dose of 100mg/day. Indications for antiplatelet therapy were ischemic heart disease (44.9%), cerebrovascular disease (21.7%), and peripheral vascular disease (23.0%). Ischemic risk was low in 74.3%, while 51.6% had a low bleeding risk of the intervention. Periprocedural management was considered appropriate in 61.7% of cases. 30-day incidence of the combined primary endpoint of thrombotic events and major bleeding (12.1% versus 5.0%; p=0.002) and 30-day mortality (5.2% versus 1.5%; p=0.008) were significantly higher in patients with inappropriate periprocedural management of antiplatelet agents., Conclusions: Despite current recommendations for the use of antiplatelet drugs in the perioperative/periprocedural period, their implementation in the "real world" remains low. Inappropriate use is associated with an increased incidence of adverse events, both thrombotic and hemorrhagic., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)
- Published
- 2024
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7. Anthracycline-induced cardiovascular toxicity: validation of the Heart Failure Association and International Cardio-Oncology Society risk score.
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Rivero-Santana B, Saldaña-García J, Caro-Codón J, Zamora P, Moliner P, Martínez Monzonis A, Zatarain E, Álvarez-Ortega C, Gómez-Prieto P, Pernas S, Rodriguez I, Buño Soto A, Cadenas R, Palacios Ozores P, Pérez Ramírez S, Merino Salvador M, Valbuena S, Fernández Gasso L, Juárez V, Severo A, Terol B, de Soto Álvarez T, Rodríguez O, Brion M, González-Costello J, Canales Albendea M, González-Juanatey JR, Moreno R, López-Sendón J, and López-Fernández T
- Abstract
Background and Aims: Baseline cardiovascular toxicity risk stratification is critical in cardio-oncology. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) score aims to assess this risk but lacks real-life validation. This study validates the HFA-ICOS score for anthracycline-induced cardiovascular toxicity., Methods: Anthracycline-treated patients in the CARDIOTOX registry (NCT02039622) were stratified by the HFA-ICOS score. The primary endpoint was symptomatic or moderate to severe asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), with all-cause mortality and cardiovascular mortality as secondary endpoints., Results: The analysis included 1066 patients (mean age 54 ± 14 years; 81.9% women; 24.5% ≥65 years). According to the HFA-ICOS criteria, 571 patients (53.6%) were classified as low risk, 333 (31.2%) as moderate risk, 152 (14.3%) as high risk, and 10 (0.9%) as very high risk. Median follow-up was 54.8 months (interquartile range 24.6-81.8). A total of 197 patients (18.4%) died, and 718 (67.3%) developed CTRCD (symptomatic: n = 45; moderate to severe asymptomatic: n = 24; and mild asymptomatic: n = 649). Incidence rates of symptomatic or moderate to severe symptomatic CTRCD and all-cause mortality significantly increased with HFA-ICOS score [hazard ratio 28.74, 95% confidence interval (CI) 9.33-88.5; P < .001, and hazard ratio 7.43, 95% CI 3.21-17.2; P < .001) for very high-risk patients. The predictive model demonstrated good calibration (Brier score 0.04, 95% CI 0.03-0.05) and discrimination (area under the curve 0.78, 95% CI 0.70-0.82; Uno's C-statistic 0.78, 95% CI 0.71-0.84) for predicting symptomatic or severe/moderate asymptomatic CTRCD at 12 months., Conclusions: The HFA-ICOS score effectively categorizes patients by cardiovascular toxicity risk and demonstrates strong predictive ability for high-risk anthracycline-related cardiovascular toxicity and all-cause mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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8. Cardiac Sympathetic Denervation as a Treatment for Ventricular Arrhythmias Refractory to Conventional Treatment: A Case Series.
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Álvarez-Ortega C, Gómez-Martínez JD, Cardona-Gallardo MA, Torres-España NF, Pava-Molano LF, Sánchez-Ortiz ÁI, and Velásquez-Galvis M
- Abstract
Background: Ventricular arrhythmias are a leading cause of sudden death. The objective of this study was to characterise the results of patients with ventricular arrhythmias refractory to standard medical management, undergoing Video-assisted thoracoscopic cardiac sympathetic denervation (VAT-CSD) during 2012-2022 in Cali, Colombia., Methods: This was an observational retrospective study, using the Institutional General Thoracic Surgery Database for patient identification and retrospectively reviewing the clinical charts for data description and analysis., Results: Clinical records of 19 patients who underwent VAT-CSD for ventricular arrhythmia were analysed. The patients were predominantly male (73.7%) with an mean age of 62 years. Ischaemic heart disease was the main underlying condition (52.6%); all individuals had a diagnosis of heart failure, with comorbidities such as hypertension (63.1%), acute MI (57.8%) and diabetes (26.3%) also present. The procedure was performed bilaterally in 89.4% of cases and was successful with minimal perioperative complications. Postoperative follow-up showed improvement in symptoms, including a significant reduction in the number of ICD shocks and emergency department visits., Conclusion: VAT-CSD is a viable, safe and palliative therapeutic option for patients with ventricular arrhythmias who have not responded to conventional treatments, achieving a significant decrease in symptoms with low mortality and perioperative complications., Competing Interests: Disclosure: The authors have no conflicts of interest to declare. Funding: This study was funded by the Clinical Research Center at the Fundación Valle del Lili. Data availability: The de-identified data supporting the findings of this study are available upon request from the corresponding author. The data repository is Fundación Valle del Lili. Due to privacy or ethical restrictions, the data are not publicly available. We are dedicated to maintaining the confidentiality and safeguarding of participants' information. Authors' contributions: Conceptualisation: ÁISO, MVG; data curation: ÁISO; formal analysis: ÁISO, NFTE; funding acquisition: ÁISO, MVG; investigation: CÁO, JDGM, MACG, NFTE, LFPM, ÁISO, MVG; methodology: ÁISO; project administration: CÁO, JDGM; resources: CÁO, JDGM, MACG, NFTE, LFPM, ÁISO, MVG; software: ÁISO, NFTE; supervision: CÁO, JDGM; validation: ÁISO, MVG; visualisation: CÁO, JDGM, NFTE, ÁISO, MVG; writing – original draft preparation: CÁO, JDGM, MACG, NFTE, LFPM, ÁISO, MVG; writing – review & editing: CÁO, JDGM, NFTE, ÁISO, MVG. Ethics: This study was performed in line with the principles of the Declaration of Helsinki. Approved was granted by the Biomedical Research Ethics Committee of the Fundación Valle del Lili with protocol number 02003 on September 2022. Consent: This is an observational, anonymous and risk-free study. The Biomedical Research Ethics Committee of the Fundación Valle del Lili has confirmed that no informed written consent is required., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)
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- 2024
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9. Prospective observational registry of perioperative and periprocedural management of antithrombotic therapy in "real world": the REQXAA study.
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Vivas D, Anguita-Gámez M, Ferrandis R, Esteve-Pastor MA, Echeverri M, Igualada J, Anguita M, Egocheaga I, Nozal-Mateo B, Abad-Motos A, Figuero E, Bouzó-Molina N, Lozano T, Álvarez-Ortega C, Torres J, Descalzo MJ, Catalá JC, Martín-Rioboo E, Molines A, Rodríguez-Contreras R, Carnero-Alcázar M, and Marín F
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- Humans, Male, Aged, Fibrinolytic Agents therapeutic use, Fibrinolytic Agents adverse effects, Prospective Studies, Hemorrhage chemically induced, Hemorrhage epidemiology, Hemorrhage complications, Risk Factors, Registries, Platelet Aggregation Inhibitors adverse effects, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation drug therapy
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Introduction and Objectives: There is scarce real-world evidence on the management of perioperative antithrombotic treatment according to current recommendations. The aim of this study was to analyze the management of antithrombotic treatment in patients undergoing surgery or another invasive intervention and to assess the consequences of this management on the occurrence thrombotic or bleeding events., Methods: This prospective, observational, multicenter and multispecialty study analyzed patients receiving antithrombotic therapy who underwent surgery or another invasive intervention. The primary endpoint was defined as the incidence of adverse (thrombotic and/or hemorrhagic) events after 30 days of follow-up with respect to management of perioperative antithrombotic drugs., Results: We included 1266 patients (male: 63.5%; mean age 72.6 years). Nearly half of the patients (48.6%) were under chronic anticoagulation therapy (mainly for atrial fibrillation; CHA
2 DS2 -VASC : 3.7), while 53.3% of the patients were under chronic antiplatelet therapy (mainly for coronary artery disease). Low ischemic and hemorrhagic risk was found in 66.7% and 51.9%, respectively. Antithrombotic therapy management was in line with current recommendations in only 57.3% of the patients. Inappropriate management of antithrombotic therapy was an independent risk factor for both thrombotic and hemorrhagic events., Conclusions: The implementation of recommendations on the perioperative/periprocedural management of antithrombotic therapy in real-world patients is poor. Inappropriate management of antithrombotic treatment is associated with an increase in both thrombotic and hemorrhagic events., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2023
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10. Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study.
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Orozco-Beltrán D, Morales C, Artola-Menéndez S, Brotons C, Carrascosa S, González C, Baro Ó, Aliaga A, Ferreira de Campos K, Villarejo M, Hurtado C, Álvarez-Ortega C, Gómez-García A, Cedenilla M, and Fernández G
- Abstract
Background: Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A
1c (HbA1c ) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease., Objective: This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM., Methods: The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c ≤7.5% with a ≥0.5% reduction in HbA1c at week 24., Results: Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c ≤7.5% (64% vs 24%; P=.02) or HbA1c ≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed., Conclusions: The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario., (©Domingo Orozco-Beltrán, Cristóbal Morales, Sara Artola-Menéndez, Carlos Brotons, Sara Carrascosa, Cintia González, Óscar Baro, Alberto Aliaga, Karine Ferreira de Campos, María Villarejo, Carlos Hurtado, Carolina Álvarez-Ortega, Antón Gómez-García, Marta Cedenilla, Gonzalo Fernández. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 03.10.2022.)- Published
- 2022
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11. Cardiovascular risk factors during cancer treatment. Prevalence and prognostic relevance: insights from the CARDIOTOX registry.
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Caro-Codón J, López-Fernández T, Álvarez-Ortega C, Zamora Auñón P, Rodríguez IR, Gómez Prieto P, Buño Soto A, Canales Albendea M, Albaladejo A, Mediavilla G, Feliu Batlle J, Rodríguez Fraga O, Martínez Monzonis A, González-Costello J, Serrano Antolín JM, Cadenas Chamorro R, González-Juanatey JR, and López-Sendón J
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- Cardiotoxicity, Heart Disease Risk Factors, Humans, Prevalence, Prognosis, Prospective Studies, Registries, Risk Factors, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Neoplasms complications, Neoplasms drug therapy, Neoplasms epidemiology
- Abstract
Aims: The actual usefulness of cardiovascular (CV) risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Prospective multicentre study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk., Methods and Results: A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples, and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years, and 2 years after initiation of cancer therapy. At baseline, 893 patients (67.4%) presented at least one risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity (CTox) and all-cause mortality [hazard ratio (HR) 1.79 (95% confidence interval, CI 1.16-2.76) for SCORE 5-9 and HR 4.90 (95% CI 2.44-9.82) for SCORE ≥10 when compared with patients with lower SCORE (0-4)]., Conclusions: This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline CV risk assessment using SCORE predicted severe CTox and all-cause mortality. Therefore, its use should be considered in the evaluation of cancer patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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12. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry.
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López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, Buño Soto A, Lyon AR, Farmakis D, Cardinale D, Canales Albendea M, Feliu Batlle J, Rodríguez Rodríguez I, Rodríguez Fraga O, Albaladejo A, Mediavilla G, González-Juanatey JR, Martínez Monzonis A, Gómez Prieto P, González-Costello J, Serrano Antolín JM, Cadenas Chamorro R, and López Fernández T
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- Adult, Aged, Female, Humans, Male, Middle Aged, Prevalence, Registries, Stroke Volume, Ventricular Function, Left, Ventricular Dysfunction, Left chemically induced, Ventricular Dysfunction, Left epidemiology
- Abstract
Aim: Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking., Methods and Results: We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001)., Conclusions: The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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13. Clinical outcomes in myocardial infarction and multivessel disease after a cardiac rehabilitation programme: Partial versus complete revascularization.
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Mori Junco R, Dalmau Gonzalez-Gallarza R, Castro Conde A, González Fernandez O, Álvarez Ortega C, Blázquez Bermejo Z, Furuya-Kanamori L, Moreno Gomez R, and López de Sa Arreses E
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- Aged, Cardiac Rehabilitation adverse effects, Cardiac Rehabilitation mortality, Chi-Square Distribution, Coronary Artery Disease complications, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Stenosis complications, Coronary Stenosis diagnostic imaging, Coronary Stenosis mortality, Female, Hospitals, University, Humans, Kaplan-Meier Estimate, Linear Models, Male, Medical Records, Middle Aged, Patient Readmission, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Proportional Hazards Models, Retreatment, Retrospective Studies, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction etiology, ST Elevation Myocardial Infarction mortality, Severity of Illness Index, Spain, Time Factors, Treatment Outcome, Cardiac Rehabilitation methods, Coronary Artery Disease therapy, Coronary Stenosis therapy, Percutaneous Coronary Intervention methods, ST Elevation Myocardial Infarction therapy
- Abstract
Background: Current guideline recommendations encourage culprit vessel only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, recent studies have shown a better clinical outcome in patients who receive multivessel PCI., Aim: To measure and compare clinical outcomes between partial revascularization (PR) versus complete revascularization (CR) in patients with STEMI and multivessel disease who underwent a cardiac rehabilitation programme., Methods: We retrospectively reviewed the medical records of 282 patients with STEMI and multivessel disease who received PR or CR and were subsequently enrolled in a cardiac rehabilitation programme between July 2006 and November 2013 at La Paz University Hospital. The incidences of cardiovascular events, new PCI, hospital admissions for cardiovascular reasons and mortality were compared between the PR and CR groups., Results: Overall, 143 patients received PR and 139 received CR. Baseline characteristics were similar in both groups, except for mean age (59.3 vs. 56.7 years; P=0.02), diabetes mellitus prevalence (34.3% vs. 20.1%; P=0.01) and number of arteries with stenosis (2.6 vs. 2.3; P=0.001). During the mean follow-up of 48.0±25.9 months, a cardiovascular event occurred in 23 (16.1%) PR patients and 20 (14.4%) CR patients, with no statistically significant differences in the early (hazard ratio: 0.61, 95% confidence interval: 0.19-1.89) or late (hazard ratio: 1.40, 95% confidence interval: 0.62-3.14) follow-up periods. Cox regression, adjusted for age, sex, presence of diabetes mellitus and number of affected coronary vessels, showed no difference in new cardiovascular event risk., Conclusions: There were no statistical differences in clinical outcomes between PR and CR among patients who received cardiac rehabilitation., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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14. A Marble in the Heart.
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Caro-Codón J, Galeote G, Álvarez-Ortega C, Moreno R, and López-Sendón JL
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- Aged, 80 and over, Atrial Appendage pathology, Echocardiography, Transesophageal, Female, Humans, Treatment Outcome, Atrial Fibrillation therapy, Thrombosis diagnosis
- Published
- 2016
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15. Rapid Pacing-Induced Massive Mitral Regurgitation During Transcatheter Aortic Valve Implantation.
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Caro-Codón J, Valbuena-López S, Álvarez-Ortega C, Moreno-Yangüela M, and Moreno R
- Subjects
- Aged, 80 and over, Female, Humans, Cardiac Pacing, Artificial adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency etiology, Transcatheter Aortic Valve Replacement adverse effects
- Published
- 2016
- Full Text
- View/download PDF
16. Metabolic compensation of fitness costs associated with overexpression of the multidrug efflux pump MexEF-OprN in Pseudomonas aeruginosa.
- Author
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Olivares J, Álvarez-Ortega C, and Martinez JL
- Subjects
- Anaerobiosis, Electron Transport genetics, Genetic Fitness physiology, Hydrogen-Ion Concentration, Mutation, Nitrates metabolism, Nitric Oxide metabolism, Oxygen Consumption genetics, Pseudomonas aeruginosa growth & development, Real-Time Polymerase Chain Reaction, Bacterial Outer Membrane Proteins genetics, Drug Resistance, Multiple, Bacterial genetics, Genetic Fitness genetics, Pseudomonas aeruginosa genetics, Pseudomonas aeruginosa metabolism
- Abstract
The acquisition of antibiotic resistance has been associated with a possible nonspecific, metabolic burden that is reflected in decreased fitness among resistant bacteria. We have recently demonstrated that overexpression of the MexEF-OprN multidrug efflux pump does not produce a metabolic burden when measured by classical competitions tests but rather leads to a number of changes in the organism's physiology. One of these changes is the untimely activation of the nitrate respiratory chain under aerobic conditions. MexEF-OprN is a proton/substrate antiporter. Overexpression of this element should result in a constant influx of protons, which may lead to cytoplasmic acidification. Acidification was not observed in aerobiosis, a situation in which the MexEF-overproducing mutant increases oxygen consumption. This enhanced oxygen uptake serves to eliminate intracellular proton accumulation, preventing the cytoplasmic acidification that was observed exclusively under anaerobic conditions, a situation in which the fitness of the MexEF-OprN-overproducing mutant decreases. Finally, we determined that the early activation of the nitrate respiratory chain under aerobic conditions plays a role in preventing a deleterious effect associated with the overexpression of MexEF-OprN. Our results show that metabolic rewiring may assist in overcoming the potential fitness cost associated with the acquisition of antibiotic resistance. Furthermore, the capability to metabolically compensate for this effect is habitat dependent, as demonstrated by our results under anaerobic conditions. The development of drugs that prevent metabolic compensation of fitness costs may help to reduce the persistence and dissemination of antibiotic resistance., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)
- Published
- 2014
- Full Text
- View/download PDF
17. [Early surgery versus conventional treatment for infective endocarditis].
- Author
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Álvarez-Ortega CA
- Published
- 2012
- Full Text
- View/download PDF
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