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1. Performance of Prognostic Risk Scores in Chronic Heart Failure Patients Enrolled in the European Society of Cardiology Heart Failure Long-Term Registry

Author

Crespo-Leiro, M., Anker, S., Mebazaa, A., Coats, A., Filippatos, G., Ferrari, R., Maggioni, A.P., Piepoli, M.F., Amir, O., Chioncel, O., Dahlström, U., Delgado Jimenez, J.F., Drozdz, J., Erglis, A., Fazlibegovic, E., Fonseca, C., Fruhwald, F., Gatzov, P., Goncalvesova, E., Hassanein, M., Hradec, J., Kavoliuniene, A., Lainscak, M., Logeart, D., Merkely, B., Metra, M., Otljanska, M., Seferovic, P.M., Srbinovska Kostovska, E., Temizhan, A., Tousoulis, D., Ferreira, T., Andarala, M., Fiorucci, E., Folkesson Lefrancq, E., Glémot, M., Gracia, G., Konte, M., Laroche, C., McNeill, P.A., Missiamenou, V., Taylor, C., Auer, J., Ablasser, K., Dolze, T., Brandner, K., Gstrein, S., Poelzl, G., Moertl, D., Reiter, S., Podczeck-Schweighofer, A., Muslibegovic, A., Vasilj, M., Cesko, M., Zelenika, D., Palic, B., Pravdic, D., Cuk, D., Vitlianova, K., Katova, T., Velikov, T., Kurteva, T., Kamenova, D., Antova, M., Sirakova, V., Krejci, J., Mikolaskova, M., Spinar, J., Krupicka, J., Malek, F., Hegarova, M., Lazarova, M., Monhart, Z., Sobhy, M., El Messiry, F., El Shazly, A.H., Elrakshy, Y., Youssef, A., Moneim, A.A., Noamany, M., Reda, A., Abdel Dayem, T.K., Farag, N., Ibrahim Halawa, S., Abdel Hamid, M., Said, K., Saleh, A., Ebeid, H., Hanna, R., Aziz, R., Louis, O., Enen, M.A., Ibrahim, B.S., Nasr, G., Elbahry, A., Sobhy, H., Ashmawy, M., Gouda, M., Aboleineen, W., Bernard, Y., Luporsi, P., Meneveau, N., Pillot, M., Morel, M., Seronde, M.-F., Schiele, F., Briand, F., Delahaye, F., Damy, T., Eicher, J.-C., de Groote, P., Fertin, M., Lamblin, N., Isnard, R., Lefol, C., Thevenin, S., Hagege, A., Jondeau, G., Le Marcis, V., Ly, J.-F., Coisne, D., Lequeux, B., Le Moal, V., Mascle, S., Lotton, P., Behar, N., Donal, E., Thebault, C., Ridard, C., Reynaud, A., Basquin, A., Bauer, F., Codjia, R., Galinier, M., Tourikis, P., Stavroula, M., Stefanadis, C., Chrysohoou, C., Kotrogiannis, I., Matzaraki, V., Dimitroula, T., Karavidas, A., Tsitsinakis, G., Kapelios, C., Nanas, J., Kampouri, H., Nana, E., Kaldara, E., Eugenidou, A., Vardas, P., Saloustros, I., Patrianakos, A., Tsaknakis, T., Evangelou, S., Nikoloulis, N., Tziourganou, H., Tsaroucha, A., Papadopoulou, A., Douras, A., Polgar, L., Kosztin, A., Nyolczas, N., Csaba Nagy, A., Halmosi, R., Elber, J., Alony, I., Shotan, A., Vazan Fuhrmann, A., Romano, S., Marcon, S., Penco, M., Di Mauro, M., Lemme, E., Carubelli, V., Rovetta, R., Bulgari, M., Quinzani, F., Lombardi, C., Bosi, S., Schiavina, G., Squeri, A., Barbieri, A., Di Tano, G., Pirelli, S., Fucili, A., Passero, T., Musio, S., Di Biase, M., Correale, M., Salvemini, G., Brognoli, S., Zanelli, E., Giordano, A., Agostoni, P., Italiano, G., Salvioni, E., Copelli, S., Modena, M.G., Reggianini, L., Valenti, C., Olaru, A., Bandino, S., Deidda, M., Mercuro, G., Cadeddu Dessalvi, C., Marino, P.N., Di Ruocco, M.V., Sartori, C., Piccinino, C., Parrinello, G., Licata, G., Torres, D., Giambanco, S., Busalacchi, S., Arrotti, S., Novo, S., Inciardi, R.M., Pieri, P., Chirco, P.R., Ausilia Galifi, M., Teresi, G., Buccheri, D., Minacapelli, A., Veniani, M., Frisinghelli, A., Priori, S.G., Cattaneo, S., Opasich, C., Gualco, A., Pagliaro, M., Mancone, M., Fedele, F., Cinque, A., Vellini, M., Scarfo, I., Romeo, F., Ferraiuolo, F., Sergi, D., Anselmi, M., Melandri, F., Leci, E., Iori, E., Bovolo, V., Pidello, S., Frea, S., Bergerone, S., Botta, M., Canavosio, F.G., Gaita, F., Merlo, M., Cinquetti, M., Sinagra, G., Ramani, F., Fabris, E., Stolfo, D., Artico, J., Miani, D., Fresco, C., Daneluzzi, C., Proclemer, A., Cicoira, M., Zanolla, L., Marchese, G., Torelli, F., Vassanelli, C., Voronina, N., Tamakauskas, V., Smalinskas, V., Karaliute, R., Petraskiene, I., Kazakauskaite, E., Rumbinaite, E., Vysniauskas, V., Brazyte-Ramanauskiene, R., Petraskiene, D., Stankala, S., Switala, P., Juszczyk, Z., Sinkiewicz, W., Gilewski, W., Pietrzak, J., Orzel, T., Kasztelowicz, P., Kardaszewicz, P., Lazorko-Piega, M., Gabryel, J., Mosakowska, K., Bellwon, J., Rynkiewicz, A., Raczak, G., Lewicka, E., Dabrowska-Kugacka, A., Bartkowiak, R., Sosnowska-Pasiarska, B., Wozakowska-Kaplon, B., Krzeminski, A., Zabojszcz, M., Mirek-Bryniarska, E., Grzegorzko, A., Bury, K., Nessler, J., Zalewski, J., Furman, A., Broncel, M., Poliwczak, A., Bala, A., Zycinski, P., Rudzinska, M., Jankowski, L., Kasprzak, J.D., Michalak, L., Wojtczak Soska, K., Huziuk, I., Retwinski, A., Flis, P., Weglarz, J., Bodys, A., Grajek, S., Kaluzna-Oleksy, M., Straburzynska-Migaj, E., Dankowski, R., Szymanowska, K., Grabia, J., Szyszka, A., Nowicka, A., Samcik, M., Wolniewicz, L., Baczynska, K., Komorowska, K., Poprawa, I., Komorowska, E., Sajnaga, D., Zolbach, A., Dudzik-Plocica, A., Abdulkarim, A.-F., Lauko-Rachocka, A., Kaminski, L., Kostka, A., Cichy, A., Ruszkowski, P., Splawski, M., Fitas, G., Szymczyk, A., Serwicka, A., Fiega, A., Zysko, D., Krysiak, W., Szabowski, S., Skorek, E., Pruszczyk, P., Bienias, P., Ciurzynski, M., Welnicki, M., Mamcarz, A., Folga, A., Zielinski, T., Rywik, T., Leszek, P., Sobieszczanska-Malek, M., Piotrowska, M., Kozar-Kaminska, K., Komuda, K., Wisniewska, J., Tarnowska, A., Balsam, P., Marchel, M., Opolski, G., Kaplon-Cieslicka, A., Gil, R.J., Mozenska, O., Byczkowska, K., Gil, K., Pawlak, A., Michalek, A., Krzesinski, P., Piotrowicz, K., Uzieblo-Zyczkowska, B., Stanczyk, A., Skrobowski, A., Ponikowski, P., Jankowska, E., Rozentryt, P., Polonski, L., Gadula-Gacek, E., Nowalany-Kozielska, E., Kuczaj, A., Kalarus, Z., Szulik, M., Przybylska, K., Klys, J., Prokop-Lewicka, G., Kleinrok, A., Tavares Aguiar, C., Ventosa, A., Pereira, S., Faria, R., Chin, J., De Jesus, I., Santos, R., Silva, P., Moreno, N., Queirós, C., Lourenço, C., Pereira, A., Castro, A., Andrade, A., Oliveira Guimaraes, T., Martins, S., Placido, R., Lima, G., Brito, D., Francisco, A.R., Cardiga, R., Proenca, M., Araujo, I., Marques, F., Moura, B., Leite, S., Campelo, M., Silva-Cardoso, J., Rodrigues, J., Rangel, I., Martins, E., Sofia Correia, A., Peres, M., Marta, L., Ferreira da Silva, G., Severino, D., Durao, D., Leao, S., Magalhaes, P., Moreira, I., Filipa Cordeiro, A., Ferreira, C., Araujo, C., Ferreira, A., Baptista, A., Radoi, M., Bicescu, G., Vinereanu, D., Sinescu, C.-J., Macarie, C., Popescu, R., Daha, I., Dan, G.-A., Stanescu, C., Dan, A., Craiu, E., Nechita, E., Aursulesei, V., Christodorescu, R., Otasevic, P., Simeunovic, D., Ristic, A.D., Celic, V., Pavlovic-Kleut, M., Suzic Lazic, J., Stojcevski, B., Pencic, B., Stevanovic, A., Andric, A., Iric-Cupic, V., Jovic, M., Davidovic, G., Milanov, S., Mitic, V., Atanaskovic, V., Antic, S., Pavlovic, M., Stanojevic, D., Stoickov, V., Ilic, S., Deljanin Ilic, M., Petrovic, D., Stojsic, S., Kecojevic, S., Dodic, S., Cemerlic Adic, N., Cankovic, M., Stojiljkovic, J., Mihajlovic, B., Radin, A., Radovanovic, S., Krotin, M., Klabnik, A., Pernicky, M., Murin, J., Kovar, F., Kmec, J., Semjanova, H., Strasek, M., Savnik Iskra, M., Ravnikar, T., Cernic Suligoj, N., Komel, J., Fras, Z., Jug, B., Glavic, T., Losic, R., Bombek, M., Krajnc, I., Krunic, B., Horvat, S., Kovac, D., Rajtman, D., Cencic, V., Letonja, M., Winkler, R., Valentincic, M., Melihen-Bartolic, C., Bartolic, A., Pusnik Vrckovnik, M., Kladnik, M., Slemenik Pusnik, C., Marolt, A., Klen, J., Drnovsek, B., Leskovar, B., Fernandez Anguita, M.J., Gallego Page, J.C., Salmeron Martinez, F.M., Andres, J., Genis, A.B., Mirabet, S., Mendez, A., Garcia-Cosio, L., Roig, E., Leon, V., Gonzalez-Costello, J., Muntane, G., Garay, A., Alcade-Martinez, V., Lopez Fernandez, S., Rivera-Lopez, R., Puga-Martinez, M., Fernandez-Alvarez, M., Serrano-Martinez, J.L., Grille-Cancela, Z., Marzoa-Rivas, R., Blanco-Canosa, P., Paniagua-Martin, M.J., Barge-Caballero, E., Laynez Cerdena, I., Famara Hernandez Baldomero, I., Lara Padron, A., Ofelia Rosillo, S., Dalmau Gonzalez-Gallarza, R., Salvador Montanes, O., Iniesta Manjavacas, A.M., Castro Conde, A., Araujo, A., Soria, T., Garcia-Pavia, P., Gomez-Bueno, M., Cobo-Marcos, M., Alonso-Pulpon, L., Segovia Cubero, J., Sayago, I., Gonzalez-Segovia, A., Briceno, A., Escribano Subias, P., Vicente Hernandez, M., Ruiz Cano, M.J., Gomez Sanchez, M.A., Barrios Garrido-Lestache, E., Garcia Pinilla, J.M., Garcia de la Villa, B., Sahuquillo, A., Bravo Marques, R., Torres Calvo, F., Perez-Martinez, M.T., Gracia-Rodenas, M.R., Garrido-Bravo, I.P., Pastor-Perez, F., Pascual-Figal, D.A., Diaz Molina, B., Orus, J., Epelde Gonzalo, F., Bertomeu, V., Valero, R., Martinez-Abellan, R., Quiles, J., Rodrigez-Ortega, J.A., Mateo, I., ElAmrani, A., Fernandez-Vivancos, C., Bierge Valero, D., Almenar-Bonet, L., Sanchez-Lazaro, I.J., Marques-Sule, E., Facila-Rubio, L., Perez-Silvestre, J., Garcia-Gonzalez, P., Ridocci-Soriano, F., Garcia-Escriva, D., Pellicer-Cabo, A., de la Fuente Galan, L., Lopez Diaz, J., Recio Platero, A., Arias, J.C., Blasco-Peiro, T., Sanz Julve, M., Sanchez-Insa, E., Aured-Guallar, C., Portoles-Ocampo, A., Melin, M., Hägglund, E., Stenberg, A., Lindahl, I.-M., Asserlund, B., Olsson, L., Afzelius, M., Karlström, P., Tengvall, L., Wiklund, P.-A., Olsson, B., Kalayci, S., Cavusoglu, Y., Gencer, E., Yilmaz, M.B., Gunes, H., Canepa, Marco, Fonseca, Candida, Chioncel, Ovidiu, Laroche, Cécile, Crespo-Leiro, Maria G., Coats, Andrew J.S., Mebazaa, Alexandre, Piepoli, Massimo F., Tavazzi, Luigi, and Maggioni, Aldo P.

Published
2018
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3. Use of mTOR inhibitors in chronic heart transplant recipients with renal failure: Calcineurin-inhibitors conversion or minimization?

Author

Gonzalez-Vilchez, F., Vazquez de Prada, J.A., Paniagua, M.J., Gomez-Bueno, M., Arizon, J.M., Almenar, L., Roig, E., Delgado, J., Lambert, J.L., Perez-Villa, F., Sanz-Julve, M.L., Crespo-Leiro, M., Segovia, J., Lopez-Granados, A., Martinez-Dolz, L., Mirabet, S., Escribano, P., Diaz-Molina, B., Farrero, M., and Blasco, T.

Published
2014
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5. Remote heart failure management using the HeartLogic algorithm. RE-HEART Registry

Author

de Juan Bagudá J, Gavira Gómez JJ, Pachón Iglesias M, Cózar León R, Escolar Pérez V, González Fernández Ó, Rivas Gándara N, Goirigolzarri Artaza J, Díaz Molina B, Macías Gallego A, Martínez Mateo V, Martínez Martínez JG, Marrero Negrín N, Alonso Salinas GL, González Torres L, Delgado Jiménez JF, Sánchez-Aguilera P, Díaz Infante E, Arcocha Torres MF, Peña Conde L, Méndez Fernández AB, Pérez Castellano N, Rubín López JM, Madrazo Delgado I, Fernández-Anguita MJ, Ramos Ruiz P, Medina Moreno O, Cordero Pereda D, de Diego Rus C, Arribas Ynsaurriaga F, García Bolao I, Salguero Bodes R, and RE-HEART Registry group

Subjects
Cardiac resynchronization therapy, Remote monitoring, Terapia de resincronización cardiaca, ICD, Monitorización a distancia, DAI, Heart failure, Estratificación de riesgo, Risk stratification, Insuficiencia cardiaca
Abstract

INTRODUCTION AND OBJECTIVES: HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. METHODS: We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). RESULTS: We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P

Published
2022

7. The Prognosis of Noncutaneous, Nonlymphomatous Malignancy After Heart Transplantation: Data From the Spanish Post-Heart Transplant Tumour Registry

Author

Crespo-Leiro, M.G., Alonso-Pulpón, L.A., Villa-Arranz, A., Brossa-Loidi, V., Almenar-Bonet, L., González-Vilchez, F., Delgado-Jiménez, J.F., Manito-Lorite, N., Díaz-Molina, B., Rábago, G., Arizón-del Prado, J.M., Romero-Rodríguez, N., Brossa, V., Blasco-Peiró, T., Pascual-Figal, D., de la Fuente-Galán, L., and Muñiz-García, J.

Published
2010
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8. Impact of intrapatient blood level variability of calcineurin inhibitors on heart transplant outcomes

Author

González-Vílchez F., Crespo-Leiro M.G., Delgado-Jiménez J., Pérez-Villa F., Segovia-Cubero J., Díaz-Molina B., Mirabet-Pérez S., Arizón del Prado J.M., Blasco-Peiró T., Martínez-Sellés M., Almenar-Bonet L., Garrido-Bravo I., Rábago G., and Vázquez de Prada J.A.

Subjects
Adult, Graft Rejection, all cause mortality, Adolescent, retrospective study, Calcineurin Inhibitors, education, mortality rate, treatment free survival, heart transplantation, blood level, behavioral disciplines and activities, Article, Tacrolimus, male, genetic variability, middle aged, mental disorders, calcineurin inhibitor, Humans, controlled study, cyclosporine, human, Retrospective Studies, Blood levels, Calcineurin inhibitors, Coefficient of variation, Coeficiente de variación, Concentración sanguínea, Heart transplant, Inhibidores de la calcineurina, Trasplante cardiaco, Variabilidad, Variability, cardiac graft rejection, disease association, immunosuppressive treatment, social sciences, immunosuppressive agent, major clinical study, human tissue, drug formulation, female, surgical procedures, operative, treatment outcome, heart graft, Immunosuppressive Agents
Abstract

Introduction and objectives: Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. Methods: We retrospectively studied patients aged = 18 years, with a first heart transplant performed between 2000 and 2014 and surviving = 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. Results: The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation > 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P =.056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P =.065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P =.011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. Conclusions: IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients. Full English text available from:www.revespcardiol.org/en © 2021 Sociedad Española de Cardiología

Published
2021

9. Malignancy following Heart Transplantation: Differences in Incidence and Prognosis between Sexes

Author

Minguito-Carazo C, Gómez-Bueno M, Almenar-Bonet L, Barge-Caballero E, González-Vílchez F, Delgado-Jiménez JF, Arizón-Del Prado JM, Sousa-Casasnovas I, Mirabet-Pérez S, González-Costello J, Sobrino-Márquez JM, Pérez-Villa F, Díaz-Molina B, Juan-Aracil GR, Blasco-Peiró T, De la Fuente-Galán L, Garrido-Bravo I, García-Guereta L, Camino M, Albert-Brotons DC, Muñiz J, and Crespo-Leiro MG

Subjects
heart transplantation, malignancy, sexes
Abstract

Male patients are at increased risk for developing malignancy post-heart transplantation (HT); however, real incidence and prognosis in both genders remains unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma and non-skin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs and NSSCs were lower in females (all tumors: 25.7 vs. 44.8 per 1000 person-years; Rate Ratio (RR) 0.68, (0.60-0.78), p

Published
2021

11. The falling incidence of hematologic cancer after heart transplantation

Author

Crespo-Leiro, M. G., Delgado-Jiménez, J., López, L., Alonso-Pulpón, L., González-Vilchez, F., Almenar-Bonet, L., Rábago, G., Pérez-Villa, F., Martín, Paniagua M. J., del Prado, Arizón J. M., Sousa-Casasnovas, I., Manito-Lorite, N., Díaz-Molina, B., Pascual-Figal, D., Lage-Galle, E., Blasco-Peiró, T., De la Fuente-Galán, L., and Muñiz, J.

Published
2014
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13. Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

Author

Kapelios, CJ, Laroche, C, Crespo-Leiro, MG, Anker, SD, Coats, AJS, Díaz-Molina, B, Filippatos, G, Lainscak, M, Maggioni, AP, McDonagh, T, Mebazaa, A, Metra, M, Moura, B, Mullens, W, Piepoli, MF, Rosano, GMC, Ruschitzka, F, Seferovic, PM, Lund, LH, and Heart Failure Long-Term Registry Investigators Group

Abstract

AIMS: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. METHODS AND RESULTS: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25-80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363-419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12-2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96-1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33-1.07; P = 0.083) and cardiovascular mortality (HR 0.62, 95% CI 0.38-1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01-1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09-0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29-0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37-0.87; P = 0.008) were independently associated with successful decrease. CONCLUSION: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease.

Published
2020

14. Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

Author

Kapelios, C.J. Laroche, C. Crespo-Leiro, M.G. Anker, S.D. Coats, A.J.S. Díaz-Molina, B. Filippatos, G. Lainscak, M. Maggioni, A.P. McDonagh, T. Mebazaa, A. Metra, M. Moura, B. Mullens, W. Piepoli, M.F. Rosano, G.M.C. Ruschitzka, F. Seferovic, P.M. Lund, L.H. Gale, C.P. Beleslin, B. Budaj, A. Chioncel, O. Dagres, N. Danchin, N. Erlinge, D. Emberson, J. Glikson, M. Gray, A. Kayikcioglu, M. Maggioni, A. Nagy, K.V. Nedoshivin, A. Petronio, A.-S. Roos-Hesselink, J. Wallentin, L. Zeymer, U. Anker, S. Mebazaa, A. Coats, A. Filippatos, G. Ferrari, R. Maggioni, A.P. Goda, A. Diez, M. Fernandez, A. Fruhwald, F. Gatzov, P. Kurlianskaya, A. Hullin, R. Christodoulides, T. Hradec, J. Nielsen, O.W. Nedjar, R. Uuetoa, T. Jimenez, J.F.D. Harjola, V.-P. Logeart, D. Tousoulis, D. Milicic, D. Merkely, B. Amir, O. Shotan, A. Shafie, D. Mirrakhimov, E. Kavoliuniene, A. Erglis, A. Otljanska, M. Kostovska, E.S. DeMarco, D.C. Drozdz, J. Fonseca, C. Chioncel, O. Dekleva, M. Dahlstrom, U. Lainscak, M. Goncalvesova, E. Estrago, V. Bajraktari, G. Auer, J. Ablasser, K. Fruhwald, F. Dolze, T. Brandner, K. Gstrein, S. Poelzl, G. Moertl, D. Reiter, S. Muslibegovic, A. Vasilj, M. Fazlibegovic, E. Cesko, M. Zelenika, D. Palic, B. Pravdic, D. Cuk, D. Vitlianova, K. Katova, T. Kurteva, T. Gatzov, P. Kamenova, D. Antova, M. Krejci, J. Spinar, J. Krupicka, J. Malek, F. Hegarova, M. Lazarova, M. Monhart, Z. Hassanein, M. El Messiry, F. El Shazly, A.H. Elrakshy, Y. Youssef, A. Moneim, A.A. Noamany, M. Dayem, T.K.A. Farag, N. Halawa, S.I. Hamid, M.A. Saleh, A. Ebeid, H. Hanna, R. Louis, O. Enen, M.A. Ibrahim, B.S. Nasr, G. Elbahry, A. Sobhy, H. Ashmawy, M. Gouda, M. Aboleineen, W. Bernard, Y. Meneveau, N. Pillot, M. Morel, M. Seronde, M.-F. Schiele, F. Briand, F. Delahaye, F. Damy, T. Eicher, J.-C. de Groote, P. Fertin, M. Lamblin, N. Isnard, R. Thevenin, S. Hagege, A. Logeart, D. Le Marcis, V. Ly, J.-F. Coisne, D. Lequeux, B. Le Moal, V. Mascle, S. Lotton, P. Behar, N. Donal, E. Ridard, C. Reynaud, A. Basquin, A. Bauer, F. Codjia, R. Galinier, M. Tourikis, P. Stavroula, M. Stefanadis, C. Chrysohoou, C. Kotrogiannis, I. Matzaraki, V. Karavidas, A. Tsitsinakis, G. Kapelios, C. Nanas, J. Kampouri, H. Nana, E. Kaldara, E. Eugenidou, A. Vardas, P. Saloustros, I. Tsaknakis, T. Evangelou, S. Tziourganou, H. Tsaroucha, A. Papadopoulou, A. Douras, A. Polgar, L. Kosztin, A. Nyolczas, N. Nagy, A.C. Halmosi, R. Elber, J. Shotan, A. Fuhrmann, A.V. Amir, O. Romano, S. Marcon, S. Penco, M. Di Mauro, M. Lemme, E. Carubelli, V. Rovetta, R. Bulgari, M. Quinzani, F. Bosi, S. Schiavina, G. Squeri, A. Di Tano, G. Pirelli, S. Ferrari, R. Fucili, A. Passero, T. Musio, S. Di Biase, M. Correale, M. Salvemini, G. Brognoli, S. Zanelli, E. Giordano, A. Agostoni, P. Salvioni, E. Copelli, S. Modena, M.G. Valenti, C. Olaru, A. Bandino, S. Deidda, M. Mercuro, G. Marino, P.N. Di Ruocco, M.V. Piccinino, C. Parrinello, G. Licata, G. Torres, D. Giambanco, S. Busalacchi, S. Arrotti, S. Novo, S. Inciardi, R.M. Pieri, P. Galifi, M.A. Teresi, G. Buccheri, D. Minacapelli, A. Veniani, M. Frisinghelli, A. Priori, S.G. Cattaneo, S. Opasich, C. Gualco, A. Pagliaro, M. Mancone, M. Fedele, F. Cinque, A. Vellini, M. Scarfo, I. Romeo, F. Ferraiuolo, F. Sergi, D. Anselmi, M. Melandri, F. Leci, E. Iori, E. Bovolo, V. Frea, S. Bergerone, S. Botta, M. Canavosio, F.G. Gaita, F. Merlo, M. Cinquetti, M. Sinagra, G. Ramani, F. Fabris, E. Artico, J. Miani, D. Fresco, C. Daneluzzi, C. Proclemer, A. Cicoira, M. Zanolla, L. Marchese, G. Torelli, F. Vassanelli, C. Voronina, N. Tamakauskas, V. Smalinskas, V. Karaliute, R. Petraskiene, I. Rumbinaite, E. Kavoliuniene, A. Brazyte-Ramanauskiene, R. Petraskiene, D. Sinkiewicz, W. Gilewski, W. Pietrzak, J. Orzel, T. Kardaszewicz, P. Lazorko-Piega, M. Mosakowska, K. Bellwon, J. Rynkiewicz, A. Raczak, G. Lewicka, E. Dabrowska-Kugacka, A. Bartkowiak, R. Wozakowska-Kaplon, B. Krzeminski, A. Zabojszcz, M. Grzegorzko, A. Bury, K. Nessler, J. Zalewski, J. Furman, A. Poliwczak, A. Bala, A. Zycinski, P. Rudzinska, M. Jankowski, L. Kasprzak, J.D. Michalak, L. Soska, K.W. Drozdz, J. Huziuk, I. Flis, P. Weglarz, J. Bodys, A. Grajek, S. Straburzynska-Migaj, E. Dankowski, R. Szymanowska, K. Szyszka, A. Nowicka, A. Samcik, M. Wolniewicz, L. Komorowska, K. Poprawa, I. Komorowska, E. Sajnaga, D. Zolbach, A. Abdulkarim, A.-F. Lauko-Rachocka, A. Kaminski, L. Kostka, A. Cichy, A. Ruszkowski, P. Splawski, M. Fitas, G. Szymczyk, A. Serwicka, A. Fiega, A. Zysko, D. Krysiak, W. Szabowski, S. Skorek, E. Pruszczyk, P. Bienias, P. Ciurzynski, M. Welnicki, M. Mamcarz, A. Folga, A. Zielinski, T. Rywik, T. Leszek, P. Sobieszczanska-Malek, M. Kozar-Kaminska, K. Komuda, K. Wisniewska, J. Tarnowska, A. Marchel, M. Opolski, G. Kaplon-Cieslicka, A. Gil, R.J. Mozenska, O. Gil, K. Pawlak, A. Michalek, A. Krzesinski, P. Piotrowicz, K. Stanczyk, A. Skrobowski, A. Ponikowski, P. Jankowska, E. Rozentryt, P. Polonski, L. Nowalany-Kozielska, E. Kuczaj, A. Kalarus, Z. Szulik, M. Klys, J. Prokop-Lewicka, G. Kleinrok, A. TavaresAguiar, C. Ventosa, A. Pereira, S. Faria, R. Chin, J. DeJesus, I. Santos, R. Silva, P. Moreno, N. Lourenço, C. Pereira, A. Castro, A. Andrade, A. OliveiraGuimaraes, T. Martins, S. Placido, R. Lima, G. Brito, D. Francisco, A.R. Proenca, M. Araujo, I. Marques, F. Fonseca, C. Moura, B. Campelo, M. Silva-Cardoso, J. Rodrigues, J. Rangel, I. Martins, E. Peres, M. Marta, L. Severino, D. Durao, D. Leao, S. Magalhaes, P. Moreira, I. Ferreira, C. Araujo, C. Ferreira, A. Baptista, A. Radoi, M. Bicescu, G. Vinereanu, D. Sinescu, C.-J. Macarie, C. Popescu, R. Daha, I. Dan, G.-A. Stanescu, C. Dan, A. Craiu, E. Nechita, E. Christodorescu, R. Otasevic, P. Seferovic, P.M. Simeunovic, D. Ristic, A.D. Celic, V. Pavlovic-Kleut, M. Stojcevski, B. Pencic, B. Stevanovic, A. Andric, A. Simić, D. Ašanin, M. Iric-Cupic, V. Jovic, M. Milanov, S. Mitic, V. Atanaskovic, V. Antic, S. Pavlovic, M. Stanojevic, D. Stoickov, V. Ilic, S. DeljaninIlic, M. Petrovic, D. Stojsic, S. Kecojevic, S. Dodic, S. Adic, N.C. Cankovic, M. Stojiljkovic, J. Mihajlovic, B. Radin, A. Radovanovic, S. Krotin, M. Klabnik, A. Pernicky, M. Murin, J. Kovar, F. Kmec, J. Strasek, M. Iskra, M.S. Ravnikar, T. Suligoj, N.C. Fras, Z. Jug, B. Glavic, T. Losic, R. Bombek, M. Krunic, B. Horvat, S. Kovac, D. Rajtman, D. Letonja, M. Winkler, R. Melihen-Bartolic, C. Bartolic, A. Kladnik, M. Pusnik, C.S. Marolt, A. Klen, J. Drnovsek, B. Leskovar, B. Anguita, M.J.F. GallegoPage, J.C. Martinez, F.M.S. Andres, J. Bayes-Genis, A. Mirabet, S. Mendez, A. Garcia-Cosio, L. Leon, V. Gonzalez-Costello, J. Muntane, G. Garay, A. Alcade-Martinez, V. Fernandez, S.L. Rivera-Lopez, R. Fernandez-Alvarez, M. Serrano-Martinez, J.L. Grille-Cancela, Z. Marzoa-Rivas, R. Paniagua-Martin, M.J. Barge-Caballero, E. Gonzalez-Gallarza, R.D. SalvadorMontanes, O. Manjavacas, A.M.I. Conde, A.C. Araujo, A. Soria, T. Gomez-Bueno, M. Cobo-Marcos, M. Alonso-Pulpon, L. SegoviaCubero, J. Sayago, I. Gonzalez-Segovia, A. Briceno, A. Subias, P.E. Cano, M.J.R. Sanchez, M.A.G. Jimenez, J.F.D. Pinilla, J.M.G. de la Villa, B.G. Sahuquillo, A. Marques, R.B. Calvo, F.T. Perez-Martinez, M.T. Garrido-Bravo, I.P. Pastor-Perez, F. Pascual-Figal, D.A. Molina, B.D. Orus, J. Gonzalo, F.E. Bertomeu, V. Valero, R. Martinez-Abellan, R. Quiles, J. Mateo, I. ElAmrani, A. Fernandez-Vivancos, C. Valero, D.B. Almenar-Bonet, L. Sanchez-Lazaro, I.J. Marques-Sule, E. Facila-Rubio, L. Perez-Silvestre, J. Garcia-Gonzalez, P. Garcia-Escriva, D. Pellicer-Cabo, A. de laFuente Galan, L. Diaz, J.L. Platero, A.R. Arias, J.C. Blasco-Peiro, T. Julve, M.S. Sanchez-Insa, E. Portoles-Ocampo, A. Melin, M. Hägglund Lindahl, I.-M. Asserlund, B. Olsson, L. Dahlström, U. Afzelius, M. Karlström, P. Tengvall, L. Olsson, B. Kalayci, S. Cavusoglu, Y. Gencer, E. Yilmaz, M.B. Gunes, H.

Abstract

Aims: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62,. 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease. © 2020 European Society of Cardiology

Published
2020

15. Spanish Heart Transplant Registry. 31th Official Report of the Heart Failure Association of the Spanish Society of Cardiology

Author

González-Vilchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, Delgado-Jiménez J, Arizón Del Prado JM, Sobrino-Márquez JM, Sousa Casasnovas I, Spanish Heart Transplant Teams, Segovia-Cubero J, Hernández-Pérez F, Martínez Penades S, Cebrián Pinar M, López Vilella R, Sánchez-Lázaro I, Martínez-Dolz L, Paniagua-Martín MJ, Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, López Granados A, Segura Saintgerons C, Menjíbar Pareja V, Carrasco Ávalos F, Cobo M, Llano-Cardenal M, Vázquez de Prada JA, Nistal Herrera F, Blázquez Z, Jesús Valero M, Ortiz C, Zataraín E, Villa A, Navas P, Martínez-Sellés M, Dolores García Cosío M, Morán Fernández L, Caravaca P, Brossa Loidi V, Roig Minguell E, Mirabet Pérez S, López López L, Zegrí I, Rangel Sousa D, Manito Lorite N, Díez Lopez C, Roca Elias J, García Romero E, Rábago Juan-Aracil G, Castel MÁ, Farrero M, Lambert Rodríguez JL, Díaz Molina B, Bernardo Rodríguez MJ, Fidalgo Muñiz C, Camino López M, Gil Jaurena JM, Gil Villanueva N, Garrido-Bravo I, Pascual Figal DA, Pastor Pérez FJ, Blasco-Peiró T, Portoles Ocampo A, Sanz Julve M, de la Fuente Galán L, Tobar Ruiz J, Recio Platero A, García-Guereta Silva L, González Rocafort Á, Labradero de Lera C, Polo López L, Gran Ipiña F, Albert Brotons DC, Abella Antón R, García Quintana A, and Groba Marco MDV

Subjects
Cardiac transplant, Registro, Registry, Supervivencia, Survival, Trasplante cardiaco
Abstract

The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019.

Published
2020

21. Neoplasia after Heart Transplantation. Differences in Incidence and Prognosis between Genders. Data from the Spanish Post-Heart Transplant Tumor Registry

Author

Crespo-Leiro, M.G., primary, Segovia Cubero, J., additional, Delgado-Jiménez, J.F., additional, Roig-Minguell, E., additional, Barge-Caballero, E., additional, Sousa-Casasnovas, I., additional, Almenar-Bonet, L., additional, González-Vilchez, F., additional, González-Costello, J., additional, Díaz-Molina, B., additional, Sobrino-Márquez, J.M., additional, Rábago, G., additional, Arizón del Prado, J.M., additional, Pérez-Villa, F., additional, Blasco Peiró, T., additional, de la Fuente-Galán, L., additional, Garrido Bravo, I.P., additional, and Muñiz, J., additional

Published
2016
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23. The Incidence of Solid Tumours After Heart Transplantation Has Not Declined in the Last Decade. Data from the Spanish Post-Heart Transplant Tumor Registry

Author

Crespo-Leiro, M.G., primary, Paniagua-Martín, M.J., additional, Almenar Bonet, L., additional, Alonso-Pulpón, L., additional, González-Vilchez, F., additional, Delgado-Jiménez, J.F., additional, Díez Villanueva, P., additional, López Granados, A., additional, Mirabet Pérez, S., additional, Manito Lorite, N., additional, Lage-Galle, E., additional, Díaz-Molina, B., additional, Rábago Juan-Aracil, G., additional, Pérez Villa, F., additional, Blasco-Peiró, T., additional, Garrido-Bravo, I.P., additional, de la Fuente Galán, L., additional, and Muñiz-García, J., additional

Published
2014
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25. (287) - Neoplasia after Heart Transplantation. Differences in Incidence and Prognosis between Genders. Data from the Spanish Post-Heart Transplant Tumor Registry

Author

Crespo-Leiro, M.G., Segovia Cubero, J., Delgado-Jiménez, J.F., Roig-Minguell, E., Barge-Caballero, E., Sousa-Casasnovas, I., Almenar-Bonet, L., González-Vilchez, F., González-Costello, J., Díaz-Molina, B., Sobrino-Márquez, J.M., Rábago, G., Arizón del Prado, J.M., Pérez-Villa, F., Blasco Peiró, T., de la Fuente-Galán, L., Garrido Bravo, I.P., and Muñiz, J.

Published
2016
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26. 666 Prostate Cancer after Heart Transplantation: Incidence and Prognosis. Data from the Spanish Post-Heart-Transplant Tumour Registry

Author

Díaz-Molina, B., primary, Brossa, V., additional, Rábago, G., additional, Alonso-Pulpón, L., additional, Vilchez, F., additional, Palomo, J., additional, Manito, N., additional, Almenar, L., additional, Delgado, J., additional, Arizón, J.M., additional, Lage, E., additional, Lambert, J.L., additional, Pérez-Villa, F., additional, Blasco, T., additional, Pascual, D., additional, Fuente, L., additional, and Crespo-Leiro, M., additional

Published
2012
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30. (359) - The Incidence of Solid Tumours After Heart Transplantation Has Not Declined in the Last Decade. Data from the Spanish Post-Heart Transplant Tumor Registry

Author

Crespo-Leiro, M.G., Paniagua-Martín, M.J., Almenar Bonet, L., Alonso-Pulpón, L., González-Vilchez, F., Delgado-Jiménez, J.F., Díez Villanueva, P., López Granados, A., Mirabet Pérez, S., Manito Lorite, N., Lage-Galle, E., Díaz-Molina, B., Rábago Juan-Aracil, G., Pérez Villa, F., Blasco-Peiró, T., Garrido-Bravo, I.P., de la Fuente Galán, L., and Muñiz-García, J.

Published
2014
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32. 672 The Incidence of Hematologic Cancer after Heart Transplantation Has Declined in the Last Decade. Data from the Spanish Post-Heart Transplant Tumor Registry

Author

Crespo-Leiro, M.G., Gonzalez-Vilchez, F., Lopez, L., Delgado-Jimenez, J., Alonso-Pulpón, L., Almenar-Bonet, L., Paniagua-Martin, M.J., Rábago, G., Manito, N., Perez-Villa, F., Arizon, J.M., Sousa, I., Diaz-Molina, B., Pascual-Figal, D.A., Lage, E., Sanz, M., de la Fuente, L., and Muñiz, J.

Published
2012
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38. 571: Prevalence and Severity of Renal Dysfunction among 1059 Heart Transplant Patients According to Criteria Based on Serum Creatinine and Estimated Glomerular Filtration Rate: A Cross-Sectional Study

Author

Crespo-Leiro, M.G., Delgado, J.F., Paniagua, M.J., Almenar, L., Martinez-Doltz, L., Gonzalez-Vilchez, F., Gomez-Sanchez, M.A., Fernandez-Yanez, J., Diaz-Molina, B., Roig, E., Arizon, J.M., Pulpon, L., Garrido, I., de la Fuente, L., Brossa, V., Blasco, T., Manito, N., and Muniz, J.

Published
2009
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42. 179: The influence of induction therapy, immunosuppressive regimen and antiviral prophylaxis on the development of lymphomas after heart transplantation: Data from the Spanish Heart Transplant Tumour Registry

Author

Crespo-Leiro, M.G., Alonso-Pulpón, L., Arizón, J.M., Almenar, L., Delgado, J., Palomo, J., Camprecios, M., Manito, N., Rabago, G., Lage, E., Diaz-Molina, B., Roig, E., Pascual, D., Blasco, T., De la Fuente, L., Valls, M., and Muñiz, J.

Published
2007
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45. Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert.

Author

de Juan Bagudá J, Cózar León R, Gavira Gómez JJ, Pachón M, Goirigolzarri Artaza J, Martínez Mateo V, Escolar Pérez V, Iniesta Manjavacas ÁM, Rivas Gándara N, Álvarez-García J, Sánchez Ramos JG, Aguilera Agudo C, Rubín López JM, Macías Gallego A, López Fernández S, González Torres L, Martínez JG, Marrero Negrín N, Ramos Maqueda J, Cabrera Ramos M, Medina Gil JM, De Diego Rus C, Bermúdez Jiménez FJ, Madrazo I, Díaz Molina B, Cobo Marcos M, Ruiz Duthil AD, Cordero D, Méndez Fernández AB, Peña Conde L, Arcocha Torres MF, Pérez Castellano N, Arias MÁ, García Bolao I, Díaz Infante E, Campari M, Arribas Ynsaurriaga F, Delgado Jiménez JF, Valsecchi S, and Salguero Bodes R

Subjects
Humans, Male, Female, Aged, Spain epidemiology, Hospitalization statistics & numerical data, Follow-Up Studies, Algorithms, Telemedicine, Disease Management, Cardiac Resynchronization Therapy methods, Heart Failure therapy, Heart Failure diagnosis, Defibrillators, Implantable
Abstract

Introduction and Objectives: The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts., Methods: The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol., Results: We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001)., Conclusions: A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2024
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46. Donor-derived cell-free DNA as a new biomarker for cardiac allograft rejection: A prospective study (FreeDNA-CAR).

Author

Jiménez-Blanco M, Crespo-Leiro MG, García-Cosío Carmena MD, Gómez Bueno M, López-Vilella R, Ortiz-Bautista C, Farrero-Torres M, Zegrí-Reiriz I, Díaz-Molina B, García-Romero E, Rangel-Sousa D, Salterain N, Garrido Bravo I, and Segovia-Cubero J

Abstract

Background: There is a long-standing need for a noninvasive biomarker that allows monitoring of cardiac allograft rejection, avoiding the need for periodic endomyocardial biopsies (EMB)., Methods: Multicenter, observational, prospective study, performed between 2019 and 2023 (NCT04973943). All patients underwent 7 per-protocol surveillance EMB during the first postheart transplantation year. Donor-derived cell-free DNA (dd-cfDNA) levels were determined before each EMB, using Next Generation Sequencing Technology (Allonext assay, Eurofins Genome). The primary end-point was the association between dd-cfDNA levels and the presence of acute cellular rejection (ACR) in EMB., Results: The study included 206 patients from 12 centers, with 1,090 pairs of EMB/dd-cfDNA determinations available for analysis. EMB with ACR (n = 49) were associated with dd-cfDNA levels significantly higher than those without, median 0.189% (interquartilic range 0.05-0.70) vs 0.095% (0.04-0.23), p = 0.013. A dd-cfDNA threshold of 0.10% showed a negative predictive value for ACR of 97%. A statistically significant association between N-terminal prohormone of brain (NTProBNP) and dd-cfDNA was also found, with an increase of 0.007% dd-cfDNA (95% confidence interval 0.003-0.011) for every 500 units of NTproBNP, p 0.001. The combination of both biomarkers for diagnosis of ACR showed an area under the receiver operating characteristic (ROC) curve of 0.681, and this combined approach was significantly better than dd-cfDNA alone (area under the ROC curve 0.603), p = 0.016. Using a cut-off point of 0.10% for dd-cfDNA and 1,000 UI/ml for NTproBNP, negative predictive value increased to 98.1%., Conclusions: dd-cfDNA may be a useful biomarker to rule out significant ACR in a low-risk population. However, a dd-cfDNA value above normal threshold does not correlate robustly with the presence of disease. The combination with NTproBNP, a readily available biomarker, increased the discrimination power of dd-cfDNA alone., Clinical Trial Notation: Donor-derived Cell-Free DNA as a New Biomarker in Cardiac Acute Rejection, NCT04973943., Competing Interests: Disclosure statement M.J.B reports support for attending meetings from Eurofins Megalab, M.F.T. reports a travel grant from Eurofins Megalab. All other authors have no conflicts of interest regarding this article. We are very thankful to Ana Royuela for her support with the statistical analysis, and Eurofins Megalab team for their contribution to the handling and analysis of dd-cfDNA determinations. The study was supported by a national Spanish grant from Instituto de Salud Carlos III (PI19/01664). All dd-cfDNA determinations were provided by Eurofins Megalab through a nonconditioned grant., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2024
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47. Management of heart disease in renal transplant recipients: a national Delphi survey-based SET/SEC/SEN consensus document.

Author

García-Cosío MD, Cruzado JM, Farrero M, Blasco Peiró MT, Crespo M, Delgado Jiménez JF, Díaz Molina B, Fernández Rivera C, Garrido Bravo IP, López Jiménez V, Melilli E, Mirabet Pérez S, Pérez Tamajón ML, Rangel Sousa D, Rodrigo Calabia E, and Hernández Marrero D

Abstract

Renal transplantation improves the survival and quality of life of patients with end-stage renal disease. Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant recipients. The bidirectional relationship between renal and heart disease creates a unique clinical scenario that demands a comprehensive and personalized approach. This expert consensus, drafted by the Spanish Society of Transplantation, the Spanish Society of Cardiology, and the Spanish Society of Nephrology, aims to assess current practices and propose strategies for the management of heart disease in renal transplant recipients. A panel of Spanish nephrologists and cardiologists with expertise in renal and heart transplantation reviewed the scientific evidence concerning the current management of heart disease in renal transplant recipients. Subsequently, consensus statements were created through a 2-round Delphi methodology, resulting in 30 statements covering key topics such as the identification of renal transplant candidates, the management of heart disease in renal transplant recipients, and eligibility for combined heart-kidney transplantation in patients with both end-stage renal disease and cardiac disease. These consensus statements provide expert guidance for the management of heart disease in renal transplant recipients, an area where published clinical evidence remains limited., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2024
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48. Structural heart transcatheter interventions in orthotopic cardiac transplant and left ventricular assist devices recipients: A nationwide study.

Author

Blasco-Turrión S, Crespo-Leiro MG, Donoso Trenado V, Chi Hion PL, Díaz Molina B, Roura G, Álvarez-Osorio MP, Gómez-Bueno M, Ortiz Bautista C, Diaz JF, Garrido Bravo IP, Moreno R, Sarnago-Cebada F, Salterain González N, de la Torre Hernandez JM, García Del Blanco B, Farrero M, Ortas Nadal R, Martin P, de La Fuente L, Sanz-Sánchez J, Mirabet Pérez S, Alonso Fernández V, Gómez Hospital JA, López Granados A, Couto-Mallon D, Del Trigo Espinosa M, Rangel Sousa D, Zatarain-Nicolás E, Arzamendi Aizpurua D, López Vilella R, San Román JA, and Amat-Santos IJ

Subjects
Humans, Male, Female, Middle Aged, Spain epidemiology, Aged, Cardiac Catheterization methods, Adult, Heart Failure surgery, Heart Failure therapy, Heart Failure epidemiology, Heart-Assist Devices, Heart Transplantation, Registries
Abstract

Background: The current incidence and outcomes of structural transcatheter procedures in heart transplant (HTx) recipients and left-ventricular assist devices (LVAD) carriers is unknown., Aims: To provide insights on structural transcatheter procedures performed across HTx and LVAD patients in Spain., Methods: Multicenter, ambispective, observational nationwide registry., Results: Until May/2023, 36 percutaneous structural interventions were performed (78% for HTx and 22% for LVAD) widely varying among centers (0%-1.4% and 0%-25%, respectively). Percutaneous mitral transcatheter edge-to-edge (TEER) was the most common (n = 12, 33.3%), followed by trancatheter aortic valve replacement (n = 11, 30.5%), and tricuspid procedures (n = 9, 25%). Mitral TEER resulted in mild residual mitral regurgitation in all but one case, mean gradient was <5 mmHg in 75% of them at 1-year, with no mortality and 8.3% re-admission rate. Tricuspid TEER resulted in 100% none/mild residual regurgitation with a 1-year mortality and readmission rates of 22% and 28.5%, respectively. Finally, trancatheter aortic valve replacement procedures (n = 8 in LVADs due to aortic regurgitation and n = 3 in HTx), were successful in all cases with one prosthesis degeneration leading to severe aortic regurgitation at 1-year, 18.2% mortality rate and no re-admissions. Globally, major bleeding rates were 7.9% and 12.5%, thromboembolic events 3.7% and 12.5%, readmissions 37% and 25%, and mortality 22% and 25%, in HTx and LVADs respectively. No death was related to the implanted transcatheter device., Conclusions: Most centers with HTx/LVAD programs perform structural percutaneous procedures but with very inconsistent incidence. They were associated with good safety and efficacy, but larger studies are required to provide formal recommendations., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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49. Impact of left ventricular unloading on postheart transplantation outcomes in patients bridged with VA-ECMO.

Author

Enríquez-Vázquez D, Barge-Caballero E, González-Vílchez F, Almenar-Bonet L, García-Cosío Carmena MD, González-Costello J, Gómez-Bueno M, Castel-Lavilla MÁ, Díaz-Molina B, Martínez-Sellés M, Mirabet-Pérez S, de la Fuente-Galán L, Hervás-Sotomayor D, Rangel-Sousa D, Garrido-Bravo IP, Blasco-Peiró T, Rábago Juan-Aracil G, Muñiz J, and Crespo-Leiro MG

Abstract

Introduction and Objectives: The impact of preoperative left ventricular (LV) unloading on postoperative outcomes in patients bridged with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to heart transplantation (HT) is unknown. Our aim was to compare posttransplant outcomes in patients bridged to HT with VA-ECMO, with or without the use of different mechanical strategies for LV decompression., Methods: We conducted a retrospective analysis of the postoperative outcomes of consecutive HT candidates bridged with VA-ECMO, with or without concomitant LV unloading. Patients were included from 16 Spanish centers from 2010 to 2020. The primary endpoint was 1-year post-HT survival, which was assessed using Cox regression., Results: Overall, 245 patients underwent high-emergency HT while supported with VA-ECMO. A mechanical strategy for LV unloading was used in 133 (54.3%) patients, with the intra-aortic balloon pump being the most commonly used method (n=112; 84.2%). One-year posttransplant survival was 74.4% in the LV unloading group and 59.8% in the control group (P=.025). In multivariate analyses, preoperative LV unloading was independently associated with lower 1-year mortality (adjusted HR, 0.50; 95%CI, 0.32-0.78; P=.003). This association was observed both in patients managed with an intra-aortic balloon pump alone (adjusted HR, 0.52; 95%CI, 0.32-0.84; P=.007) and with other strategies for mechanical LV unloading (adjusted HR, 0.43; 95%CI, 0.19-0.97; P=.042). No significant differences were found between groups regarding other postoperative complications., Conclusions: Preoperative LV unloading was independently associated with increased 1-year posttransplant survival in candidates bridged with VA-ECMO., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2024
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50. iCardioMonitor Digital Monitoring System for People with Heart Failure: Development and Evaluation of Its Accessibility and Usability.

Author

Perez-Gonzalez S, Fernandez-Alvarez MDM, Gutierrez-Iglesias N, Díaz-Molina B, Alonso-Fernandez V, and Martin-Payo R

Abstract

Background/Objectives: The use of eHealth as a monitoring system in people with heart failure (HF) has been shown to be effective in promoting self-care and reducing re-admissions and mortality. The present study develops and evaluates the accessibility and usability of the web app iCardioMonitor HF monitoring system. Methods: This study consisted of two stages. The first stage (co-design) comprised two phases: (1) analysis of the scientific literature and expert opinions and (2) co-design of the iCardioMonitor (web app plus a knowledge-base algorithm) and definition of alert criteria. The second stage (cross-sectional descriptive study) analyzed system accessibility (% of people using the iCardioMonitor and % of parameters recorded) and usability, employing the Spanish version of the System Usability Scale for the Assessment of Electronic Tools. Results: The iCardioMonitor was configured by a web app and an algorithm with the capacity to detect decompensated HF automatically. A total of 45 patients with an average age of 55.8 years (standard deviation [SD] = 10.582) and an average time since diagnosis of 7.1 years (SD = 7.471) participated in the second stage. The percentage of iCardioMonitor use was 83.2%. The average usability score was 77.2 points (SD = 21.828), higher in women than men (89.2; SD = 1.443-76.0; SD = 1.443) ( p = 0.004). The usability score was higher the shorter the time since diagnosis (r = 0.402; p = 0.025) and the higher the number of responses (r = 0.377; p = 0.031). Conclusions: The results obtained show that iCardioMonitor is a tool accepted by patients and has obtained a remarkable score on the usability scale. iCardioMonitor was configured by a web app and an algorithm with the capacity to detect decompensated HF automatically.

Published
2024
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