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1. Subclinical atherosclerosis burden in carotid and femoral territories in HIV subjects: relationships with HIV and non-HIV related factors

Author

Pedro Ferrer, Laura López, Juncal Pérez, Noemi Cabello, María José Núñez, Iñigo Sagastagoitia, Manuel Cotarelo, Leopoldo Pérez de Isla, and Vicente Estrada

Subjects
HIV infection, Subclinical atherosclerosis, Vacular Elastography, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Cardiovascular disease is a major cause of morbidity in an aging HIV population. However, risk estimation with the most frequent equations usually classifies HIV patients as having a low or moderate risk. Several studies have described a very high prevalence of subclinical atherosclerosis in a middle-aged, non-HIV population. There is insufficient body of knowledge to understand if this is the case in people living with HIV (PLWH). We aim to calculate the proportion of patients with subclinical atherosclerosis in a single site cohort of HIV-infected subjects. Methods We have analyzed chronically HIV infected adults (≥ 18 years) who were on active follow-up in an HIV unit specialized in the care of cardiovascular health. The most recent clinical visit and vascular ultrasonography were used to assess the objectives of our research. Our primary objective was to describe the proportion of participants with subclinical atherosclerosis (focal protrusion into the lumen > 0.5 mm or > 50% of the surrounding IMT or a diffuse thickness > 1.5 mm) in a single site cohort of PLWH. Carotid and iliofemoral territories were evaluated. As a secondary objective we have run a multivariate analysis to determine which HIV and non-HIV factors might be related with the presence of atherosclerotic plaques. Findings We included a total of 463 participants between November 2017 to October 2019. Subjects were predominantly male (84.2%) with a mean age of 48.8 years (SD 10.7). Hypercholesterolemia (36%) was the most prevalent comorbidity followed by Hypertension (18%) and Hypertriglyceridemia (16%). Mean duration of HIV infection is 12.3 years. Overall, participants had been receiving cART for a median of 9.5 years. Subclinical atherosclerosis was found in 197 subjects (42.5%; CI 95% [38.0–47.2]). The disease was found more frequently in the femoral arteries (37.8%) than in the carotid vascular bed (18.6%). Despite some HIV factors correlated with the presence of plaques in a univariate analysis (e.g., time with HIV-1 RNA > 50 copies/mL or time from HIV diagnosis), the only two explanatory factors that remained associated with the presence of atherosclerotic plaques in the multivariate analysis were smoking (OR 5.47, 95% CI 3.36 – 8.90) and age (OR 1.13, 95%CI 1.10 – 1.16). Interpretation We have found a very high prevalence of subclinical atherosclerosis among our cohort of PLWH. Despite having analyzed several HIV factors, age and smoking have been found to be the only factors associated with the development of atherosclerotic plaques.

Published
2024
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2. Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

Author

Irene Carrión, Carmen Olmos, María Luaces, Ana Isabel Cortés, Carlos Real, Alberto de Agustín, Roberta Bottino, Eduardo Pozo, Leopoldo Pérez de Isla, and Fabián Islas

Subjects
Medicine, Science
Abstract

Abstract More than 91,000 fatalities due to Coronavirus Disease 2019 (COVID-19) have occurred in Spain. Several factors are associated with increased mortality in this disease, including cardiovascular risk factors (CVRF). However, information on the cardiac function of patients prior to the onset of COVID-19 is scarce and the potential impact it may have is uncertain. The aim of the EchoVID study was to describe the potential association between CVRF and cardiac function status prior to SARS-CoV-2 infection and in-hospital mortality. We studied clinical characteristics and cardiac function of patients admitted during the first wave of COVID-19. All patients had a transthoracic echocardiogram performed in the previous 12 months prior to diagnosis; conventional systolic and diastolic function parameters were analyzed. Logistic regression analysis was performed to identify predictors of in-hospital mortality. We included 296 individuals. Median age was higher in the group of patients who died (81.0 vs 76.1 years; p = 0.007). No significant differences were found in CVRF. Survivors were more frequently receiving anticoagulation therapy (52.9% vs 70.8%; p = 0.003). LVEF, although preserved on average in both groups, was significantly lower in the group of deceased patients (56.9% vs 61.1%; p = 0.017). Average E/e′ ratio was higher in the deceased group (11.1 vs 10.1; p = 0.049). Five variables were found to be independently associated with in-hospital mortality due to COVID-19: Age, male gender, LVEF, E/e′ ratio and anticoagulation therapy. A model including these variables had an area under the ROC curve of 0.756 (CI 0.669–0.843). The echocardiographic variables included in the model significantly improved the discriminative power, compared to a model including only demographic data. Left ventricular ejection fraction and E/e′ ratio prior to SARS-CoV-2 infection are two easily-obtained echocardiographic parameters that provide additional prognostic information over clinical factors when assessing patients admitted for SARS-CoV-2 infection.

Published
2022
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3. Circumflex Artery Arising From the Pulmonary Artery

Author

Susana P. Cabrera-Huerta, MD, Irene Martín-Lores, MD, Beatriz Cabeza, MD, José Juan Gómez de Diego, MD, PhD, Leopoldo Pérez de Isla, MD, PhD, Isidre Vilacosta, MD, PhD, and Eduardo Pozo-Osinalde, MD, PhD

Subjects
ALCAPA, anomalous circumflex artery, coronary anomaly, sudden cardiac death, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Some coronary artery anomalies are associated with increased risk of sudden cardiac death and myocardial infarction in young patients. There are few data on the clinical and prognostic relevance of isolated origin of the left circumflex artery from the pulmonary artery, an extraordinarily rare variant of anomalous left coronary artery from the pulmonary artery. (Level of Difficulty: Intermediate.)

Published
2020
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4. Curva de aprendizaje en ecocardioscopia. Utilidad de un programa docente interespecialidad

Author

Leopoldo Pérez de Isla, Adriana Saltijeral, Jesus Millán Nuñez-Cortes, José Angel García Saez, Fernando Moreno, Joaquín Millan-Perez, and Rocío Toro

Subjects
Education (General), L7-991, Medicine (General), R5-920
Abstract

Resumen: Objetivo: Comprobar los resultados de un entrenamiento en habilidad para realizar ecocardioscopias para oncólogos por parte de cardiólogos y estudiar la variabilidad en las mediciones y la significación clínica de esa variabilidad. Métodos: Se incluyeron pacientes consecutivos que habían sido atendidos en las consultas de oncología previamente. Un oncólogo les realizó una ecocardioscopia con un equipo portátil. Por otro lado, un cardiólogo realizó un ecocardiograma reglado con un equipo de gama alta. Todos los oncólogos participantes recibieron un entrenamiento básico en ecocardioscopia por parte de cardiólogos especializados en imagen cardiovascular. Resultados: Se incluyeron 101 pacientes (31,7% varones; edad media 56,03 ± 16,88 años). Los resultados mostraron una clara curva de aprendizaje durante el periodo de reclutamiento, alcanzando a los dos meses una buena similitud entre oncólogo y cardiólogo para las medidas de los diámetros ventriculares, pero sin alcanzar la misma similitud hasta pasados 4 meses las medidas de la fracción de eyección del ventrículo izquierdo. De la misma manera, se produjo una importante reducción de las diferencias clínicamente significativas de la fracción de eyección del ventrículo izquierdo a partir del cuarto mes. Conclusiones: Un entrenamiento breve dirigido a Facultativos Especialistas en Oncología en ecocardioscopia dirigido por cardiólogos expertos en imagen cardiovascular permite al oncólogo obtener las habilidades necesarias para evaluar las dimensiones del ventrículo izquierdo y la fracción de eyección del ventrículo izquierdo de una forma precisa. El tiempo de entrenamiento se estima en una semana de formación teórico-práctica intensa, y adicionalmente cuatro meses de realización de ecocardioscopias supervisadas estrechamente por los cardiólogos. Abstract: Objective: To assess the results of a training to perform echocardioscopic studies to oncologists by cardiologists, and to study the variability in measurements, as well as the clinical significance of this variability. Methods: Participant oncologists received basic training in echocardioscopy by cardiologists specialised in cardiovascular imaging. Consecutive patients attending the oncology outpatient clinic were included in the study. Every patient underwent an echocardioscopic study performed by an oncologist with a portable device and an echocardiogram performed by a cardiologist using high-end equipment. Results: The study included 101 patients, with a mean age of 56.03 ± 16.88 years, and 31.7% were males. The results showed a clear learning curve over time, with a good similarity in ventricular diameters measurements between oncologists and cardiologist being reached in two months, but it took 4 months to reach the same similarity for left ventricular ejection fraction (LVEF) measurements. Likewise, there was a significant reduction in clinically significant differences in LVEF after the fourth month. Conclusions: A brief training in echocardioscopy for oncologists, led by cardiology experts in cardiovascular imaging, allows the oncologist to obtain the necessary skills to accurately assess left ventricular ejection fraction and diameters. The training time proposed is a week of intensive theoretical and practical training, followed by four months of completion of echocardioscopic examinations closely monitored by the cardiologist. Palabras clave: Ecocardiografía portátil, Oncología, Quimioterapia, Cardiotoxicidad, Entrenamiento, Keywords: Portable echocardiography, Oncology, Chemotherapy, Cardiotoxicity, Training

Published
2018
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5. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy: the MATURE prospective study (MSCT to Assess ThrombUs REsolution)

Author

Eduardo Pozo Osinalde, Teresa Bastante, Alberto Cecconi, Álvaro Montes Muñiz, Marcos García-Guimaraes, Fernando Rivero, Antonio Rojas-González, María José Olivera, Jorge Salamanca, Leopoldo Pérez de Isla, Jose Alberto De Agustín, Paloma Caballero, Rio Aguilar Torres, Luis Jesús Jiménez-Borreguero, and Fernando Alfonso

Subjects
General Medicine, Cardiology and Cardiovascular Medicine
Published
2023
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6. Fusión de ecocardiografía 2D/3D–fluoroscopia: nueva herramienta en el intervencionismo cardiaco

Author

José Julián Carvajal-Rivera, Miguel Ángel García Fernández, Johanna Carolina López-Quintero, Leopoldo Pérez-de Isla, and Gustavo Restrepo Molina

Subjects
Imágenes de fusión, Fluoroscopia, Ecocardiograma transesofágico, Enfermedades estructurales del corazón, Guía intervencionista, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

La evolución en el intervencionismo estructural percutáneo ha generado un desarrollo paralelo en las técnicas de imagen avanzada. Teniendo en cuenta que este tipo de procedimientos requiere un entendimiento total de la anatomía cardiaca y con el fin de garantizar los mejores resultados y seguridad para el paciente durante procedimientos complejos, se desarrolló un software capaz de fusionar la fluoroscopia y la ecocardiografía 3 D en una sola imagen. La tecnología del Echonavigator® integra dos técnicas de imágenes dinámicas de un corazón en movimiento; el adecuado co-registro y visualización de fluoroscopia y ecocardiografía transesofágica 2D/3D es la clave en la obtención de resultados óptimos. La fusión de dos imágenes dinámicas en tiempo real es una herramienta factible y segura en los procedimientos de intervencionismo estructural del corazón; los estudios iniciales han logrado disminuir el tiempo de realización de los procedimientos y las dosis de radiación al paciente. El futuro es prometedor y su progresiva expansión de uso teniendo en cuenta su reciente aparición, aportará más datos en el crecimiento de esta tecnología.

Published
2018
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7. Avances en el diagnóstico por imagen de la endocarditis infecciosa izquierda

Author

Eduardo Pozo, Carmen Olmos, José Alberto de Agustín, Ana Jiménez-Ballvé, Leopoldo Pérez de Isla, and Carlos Macaya

Subjects
Endocarditis infecciosa, Ecocardiografía transesofágica tridimensional, Tomografía computarizada cardiaca, Medicina nuclear, Cardiorresonancia magnética, Medicine, Surgery, RD1-811
Abstract

La endocarditis infecciosa continúa siendo una entidad clínica de elevada mortalidad, que precisa de una detección precoz. El diagnóstico se fundamenta en los hallazgos clínicos, microbiológicos y ecocardiográficos. Sin embargo, en algunos escenarios, como la endocarditis protésica, la ecocardiografía ve reducido su rendimiento diagnóstico. Por este motivo las recientes guías de práctica clínica recomiendan la utilización de técnicas de imagen alternativas para asistir en la evaluación de casos dudosos. La ecocardiografía transesofágica tridimensional ha mostrado su utilidad al mejorar la precisión en la medida y localización de los signos de endocarditis. De forma similar, la ausencia de la limitación inherente a la ventana acústica convierte a la tomografía computarizada cardiaca en una técnica con valor en la evaluación de las complicaciones perianulares de la endocarditis. En medicina nuclear se han utilizado diferentes radiotrazadores para la detección de actividad inflamatoria/infecciosa en endocarditis. La tomografía por emisión de positrones con 18-fluorodesoxiglucosa ha demostrado una gran sensibilidad para evidenciar signos de infección en prótesis valvulares, aunque por el momento no se ha mostrado útil en válvulas nativas. En lo que respecta a la escintigrafía con leucocitos marcados, aunque es una técnica muy laboriosa, ha presentado una excelente especificidad en los estudios realizados. Por último, actualmente no existe evidencia para la utilización rutinaria de la cardiorresonancia magnética en endocarditis, pero la caracterización tisular constituye una interesante área de investigación.

Published
2017
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8. Telemedicina como instrumento de consulta cardiológica durante la pandemia COVID-19

Author

Francisco J. Roldán-Gómez, Antonio Jordán-Ríos, Amada Álvarez-Sangabriel, Carlos Guízar-Sánchez, Leopoldo Pérez-de-Isla, Luis A. Lasses-Ojeda, David U. Domínguez- Rivera, Ramiro P. Correa-Carrera, and Jorge E. Cossío-Aranda

Subjects
Telemedicina. COVID19., Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.

Published
2020
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11. The Added Value of Coronary Calcium Score in Predicting Cardiovascular Events in Familial Hypercholesterolemia

Author

Antonio Gallo, Leopoldo Pérez de Isla, Sybil Charrière, Alexandre Vimont, Rodrigo Alonso, Ovidio Muñiz-Grijalvo, José L. Díaz-Díaz, Daniel Zambón, Philippe Moulin, Eric Bruckert, Pedro Mata, Sophie Béliard, Denis Angoulvant, Sophie Beliard, Franck Boccara, Bertrand Cariou, Valérie Carreau, Alain Carrie, Sybil Charrieres, Yves Cottin, Mathilde Di Filippo, Pierre Henri Ducluzeau, Sonia Dulong, Vincent Durlach, Michel Farnier, Emile Ferrari, Dorota Ferrieres, Jean Ferrieres, Philippe Giral, Sophie Gonbert, Regis Hankard, Jocelyn Inamo, Olga Kalmykova, Michel Krempf, Julie Lemale, François Paillard, Noel Peretti, Agnes Perrin, Alain Pradignac, Jean Pierre Rabes, Vincent Rigalleau, François Schiele, Ariane Sultan, Patrick Tounian, René Valero, Bruno Verges, Cecile Yelnik, Olivier Ziegler, Rocío Aguado, Ma Pilar Álvarez-Baños, Rosa Argüeso, Francisco Arrieta, Miguel Ángel Barba, Marta Casañas, José María Cepeda, Raimundo De Andrés, Gonzalo Díaz-Soto, Jose Luis Díaz-Diaz, Marta Dieguez, Ceferino Faedo, Francisco Fuentes, Juan A. Garrido, Aurora González, Pablo González-Bustos, Ma Dolores Mañas, Marta Mauri, Juan Diego Mediavilla, Alfredo Michán, Pablo Miramontes, Ovidio Muñiz, Leire Pérez, Leopoldo Perez De Isla, Xavier Pintó, Manuel J. Romero, Patricia Rubio, Juan F. Sánchez Muñoz-Torrero, Jose I. Vidal-Pardo, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire d'Imagerie Biomédicale (LIB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Public Health Expertise [Paris, France], Hospital Universitario Virgen del Rocío [Sevilla], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire d'Imagerie Biomédicale [Paris] (LIB), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Hospital Abente y Lago, Fundación Hipercolesterolemia Familiar, and ANR-16-RHUS-0007,CHOPIN,CHOPIN(2016)

Subjects
Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Coronary Artery Disease, Disease, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Risk Assessment, Sudden death, Cohort Studies, Hyperlipoproteinemia Type II, risk prediction, 03 medical and health sciences, 0302 clinical medicine, cardiovascular disease, genetic disease, Predictive Value of Tests, Risk Factors, Interquartile range, Internal medicine, Humans, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Vascular Calcification, Stroke, coronary artery calcium, ComputingMilieux_MISCELLANEOUS, familial hypercholesterolemia, business.industry, Proportional hazards model, nutritional and metabolic diseases, Middle Aged, Atherosclerosis, medicine.disease, 3. Good health, Coronary Calcium Score, Cardiology, Calcium, Cardiology and Cardiovascular Medicine, business, coronary imaging, Cohort study
Abstract

International audience; ObjectivesThis study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH).BackgroundCommon cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD).MethodsREFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death.ResultsWe included 1,624 patients (mean age: 48.5 ± 12.8 years; men: 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range: 0.4-5.0 years), ASCVD occurred in 81 subjects. The presence of a CAC score of >100 was associated with an HR of 32.05 (95% CI: 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC: 0.860 [95% CI: 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC: 0.884 [95% CI: 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC: 0.793 [95% CI: 0.779-0.818] for SAFEHEART-RE; P < 0.001). These results were confirmed also when considering only hard cardiovascular endpoints. The addition of CAC score was associated with an estimated overall net reclassification improvement of 45.4%.ConclusionsCAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statin-treated HeFH.

Published
2021
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12. M-mode apical systolic excursion: A new and simple method to evaluate global left ventricular longitudinal strain

Author

José Amado, Fabián Islas, Islas Leopoldo Pérez de Isla, Jose Juan Gómez de Diego, Alberto de Agustín, and Miguel Angel García-Fernandez

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction: Since M-mode measurements can assess deformation of specific regions of the left ventricle, we hypothesized that M-mode measurements like M-mode apical systolic excursion (MMASE) and mitral annular plane systolic excursion (MAPSE) may be correlated with left ventricular longitudinal strain (LVLS). Methods: All subjects of the study underwent a full echocardiographic evaluation and MMASE and MAPSE measurement. Three-dimensional wall motion tracking (3D-WMT) was performed. Results: Thirty-one patients were evaluated. Significant correlations between MAPSE and LVLS (−0.372; p=0.04) and between MMASE and LVLS (−0.398; p=0.027) were found. LVLS was linearly related to MAPSE and MMASE (in mm) as follows: ST=−10.6 −0.4 * MAPSE (r2=0.14) and ST=−13.1 −0.5 * MMASE (r2=0.16). Conclusions: Our results demonstrate that simpler and faster methods than strain based on complex speckle analysis can also have a role in predicting subclinical left ventricular systolic dysfunction. Resumo: Introdução: Uma vez que as medições em Modo-M podem determinar a deformação de regiões específicas do ventrículo esquerdo, neste trabalho é colocada a hipótese de que medidas como a excursão sistólica apical em modo-M (MMASE) e a MAPSE podem ser correlacionadas com o Strain Longitudinal do Ventrículo Esquerdo (SLVE). Métodos: Todos os indivíduos do estudo foram submetidos a uma avaliação ecocardiográfica completa, à medição da MMASE e da MAPSE. Foi ainda realizado o 3D-wall motion tracking (3D-WMT). Resultados: Foram avaliados 31 pacientes, tendo sido obtida uma correlação estatisticamente significativa entre a MAPSE e o SLVE (−0.372; p=0.04) e entre a MMASE e o SLVE (−0,398; p=0,027). Estas medidas apresentaram uma correlação linear: ST=−10,6 -0,4 * MAPSE (r2=0.14) and ST=−13,1 −0,5 * MMASE (r2=0,16). Conclusão: Os nossos resultados demonstram que métodos mais simples e rápidos que o strain podem também ser úteis na determinação da disfunção subclínica sistólica do ventrículo esquerdo. Keywords: M-mode echocardiography, Longitudinal strain, 3D wall motion tracking, Palavras-chave: Ecocardiograma Modo-M, Strain longitudinal, 3D wall motion tracking

Published
2015
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13. Is it Time for Single-Pill Combinations in Dyslipidemia?

Author

Charalambos Vlachopoulos, Marcello Arca, Francois Schiele, and Leopoldo Pérez de Isla

Subjects
medicine.medical_specialty, Statin, medicine.drug_class, law.invention, Pharmacotherapy, Ezetimibe, Randomized controlled trial, law, Internal medicine, medicine, Humans, Pharmacology (medical), Adverse effect, Dyslipidemias, business.industry, Anticholesteremic Agents, PCSK9, Cholesterol, LDL, General Medicine, medicine.disease, Pill, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Proprotein Convertase 9, Cardiology and Cardiovascular Medicine, business, Dyslipidemia, medicine.drug
Abstract

Despite the availability of lipid-lowering therapies (LLTs) that are safe and effective, the overall rate of low-density lipoprotein cholesterol (LDL-C) control at a population level in real-life studies is low. Higher-intensity treatment, earlier intervention, and longer-term treatment have all been shown to improve outcomes. However, in clinical practice, actual exposure to LLT is a product of the duration and intensity of, and adherence to, the treatment. To increase exposure to LLTs, the European Society of Cardiology guidelines recommended a stepwise optimization of LLTs by increasing statin intensity to the maximally tolerated dose, with subsequent addition of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Evidence from randomized controlled trials performed in a range of patients suggested that adding ezetimibe to statins rather than doubling the statin dose resulted in significantly more patients at LDL-C goal and significantly fewer patients discontinuing treatment because of adverse events. In addition, data showed that combination treatments effectively increased exposure to LLT. Despite these data and recommendations, optimization of LLT is often limited to increasing statin dose. Therapeutic inertia and poor treatment adherence are significant and prevalent barriers to increasing treatment exposure. They are known to be influenced by pill burden and complexity of treatment. Single-pill combinations provide a strategic approach that supports the intensification of treatment without increasing pill burden or treatment complexity. Single-pill combinations, compared with free associations, have been shown to increase the adherence to LLT and the percentage of patients at LDL-C goal.

Published
2021
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14. Myocardial strain in nonischemic dilated cardiomyopathy with feature tracking. Feasibility and prognostic implications

Author

Javier Urmeneta Ulloa, Pedro Marcos-Alberca, Eduardo Pozo Osinalde, Carlos Macaya, Miguel Ángel Cobos, Paula Hernández Mateo, José Juan Gómez de Diego, Juan Lizandro Rodríguez-Hernández, José Angel Cabrera, Hugo Martínez Fernández, Leopoldo Pérez de Isla, María Luaces Méndez, Fabián Islas, Ana Bustos, Alberto de Agustín, and P Mahia

Subjects
Cardiomyopathy, Dilated, Male, medicine.medical_specialty, Concordance, Magnetic Resonance Imaging, Cine, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Humans, Cutoff, Aged, Retrospective Studies, Aged, 80 and over, Ejection fraction, business.industry, Reproducibility of Results, Stroke Volume, Dilated cardiomyopathy, General Medicine, Middle Aged, Prognosis, medicine.disease, Magnetic Resonance Imaging, Heart failure, Myocardial strain, cardiovascular system, Cardiology, Feasibility Studies, Feature tracking, Female, business, Radial stress
Abstract

Myocardial strain analysis could provide additional information to left ventricular ejection fraction (LVEF) in nonischemic dilated cardiomyopathy (NIDC). Our aim was to analyze the feasibility of left ventricular strain evaluation using cardiac magnetic resonance feature tracking (FT) in NIDC, and to determine its clinical and prognostic impact.We retrospectively included consecutive patients with NIDC who underwent cardiac magnetic resonance. Left ventricular global longitudinal, circumferential and radial strain were obtained from standard cine sequences using FT analysis software. We evaluated their association with a composite endpoint (heart failure, implantable cardioverter-defibrillator in secondary prevention, or death).FT analysis could be performed in all of the 98 patients (mean age 68±13 years, 72% men). Intra- and interobserver concordance was good for global longitudinal and circumferential strain but was worse for radial strain. Global circumferential strain was independently associated (OR, 1.16; P=.045) with LVEF normalization during follow-up and was the only morphological parameter independently associated with the composite endpoint (OR, 1.15; P=.038). A cutoff value-8.2% was able to predict the incidence of this event during follow-up (log-rank 4.6; P=.032).Left ventricular strain analysis with FT is feasible and reproducible in NIDC. Global circumferential strain was able to predict LVEF recovery and the appearance of major cardiovascular events during follow-up.

Published
2021
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15. Deformación miocárdica en miocardiopatía dilatada no isquémica mediante feature tracking. Factibilidad e implicaciones pronósticas

Author

Eduardo Pozo Osinalde, Paula Hernández Mateo, Hugo Martínez Fernández, Juan Lizandro Rodríguez-Hernández, Leopoldo Pérez de Isla, María Luaces Méndez, Fabián Islas, Pedro Marcos-Alberca, Carlos Macaya, José Juan Gómez de Diego, Miguel Ángel Cobos, Javier Urmeneta Ulloa, Ana Bustos, José Angel Cabrera, P Mahia, and Alberto de Agustín

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos El analisis de la deformacion miocardica puede aportar informacion adicional a la fraccion de eyeccion del ventriculo izquierdo (FEVI) en la miocardiopatia dilatada no isquemica (MDNI). El objetivo es analizar la factibilidad del estudio del strain del ventriculo izquierdo mediante feature tracking (FT) de cardiorresonancia magnetica en la MDNI y determinar su relevancia clinica y pronostica. Metodos Se incluyo retrospectivamente a los pacientes consecutivos con MDNI sometidos a cardiorresonancia magnetica. Se obtuvieron el strain global longitudinal, circunferencial y radial del ventriculo izquierdo de secuencias convencionales de cine mediante un software de analisis de FT. Se evaluo su asociacion con el evento combinado (insuficiencia cardiaca, implante de desfibrilador en prevencion secundaria y muerte). Resultados Se pudo realizar el FT en los 98 pacientes evaluados (edad, 68 ± 13 anos; el 72% varones). La concordancia intraobservador e interobservadores fue buena para el strain global longitudinal y circunferencial, y mas limitada para el radial. El strain global circunferencial se asocio de manera independiente (OR = 1,16; p = 0,045) con la normalizacion de la FEVI en el seguimiento y fue el unico parametro morfologico con asociacion independiente (OR = 1,15; p = 0,038) con el evento combinado. Un valor Conclusiones El analisis del strain del ventriculo izquierdo mediante FT es factible y reproducible en MDNI. El strain global circunferencial fue capaz de predecir la recuperacion de la FEVI y la aparicion de eventos cardiovasculares mayores en el seguimiento.

Published
2021
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16. Coronary plaque burden, plaque characterization and their prognostic implications in familial hypercholesterolemia: A computed tomographic angiography study

Author

José Juan Gómez de Diego, Teresa Padró, Raimundo de Andrés, Leopoldo Pérez de Isla, Safeheart Investigators, Daniel Zambón, José Werenitzky, Pedro Mata, José Pablo Miramontes, Rodrigo Alonso, José Luis Díaz-Díaz, Francisco Fuentes, Ovidio Muñiz-Grijalvo, and Adriana Saltijeral

Subjects
0301 basic medicine, medicine.medical_specialty, Computed Tomography Angiography, Coronary Artery Disease, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Coronary Angiography, Asymptomatic, Hyperlipoproteinemia Type II, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Coronary plaque, Internal medicine, medicine, Humans, Coronary atherosclerosis, business.industry, Middle Aged, Prognosis, medicine.disease, Plaque, Atherosclerotic, Coronary Calcium Score, Computed tomographic angiography, 030104 developmental biology, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Cohort study
Abstract

Heterozygous familial hypercholesterolemia (FH) is associated with premature atherosclerotic cardiovascular disease. Semi-automated plaque characterization (SAPC) by coronary computed tomographic angiography (CTA) provides information regarding coronary plaque burden and plaque characterization. Our aim was to quantify and characterize the coronary plaque burden of patients with FH using SAPC analysis and to identify which factors are related to plaque burden and plaque characteristics. A second aim was to analyse the prognostic implications of these parameters.Two hundred and fifty-nine asymptomatic individuals with molecularly determined FH were enrolled in this follow-up cohort study and underwent a coronary CTA analysed with SAPC.Mean follow-up time after coronary CTA was 3.9 ± 2 years. Mean age was 46.9 (10.7) years (130 women, 50.2%). Median plaque burden was 25.0% (19.0-29.0), non-calcified plaque burden 22.83% (17.94-26.88), calcified plaque-burden 1.12% (0.31-2.86) and CCS 8.9 (0-93). Five-year risk was independently related to plaque burden, non-calcified plaque burden, calcified plaque burden and coronary calcium score (B:3.75, 95%CI:2.92-4.58; p 0.001, B:2.9, 95%CI:2.15-3.66; p 0.001, B:0.75, 95%CI 0.4-1.1; p 0.001 and B:82.2, 95%CI:49.28-115.16; p 0.001 respectively). During follow-up, there were 15 (5.81%) nonfatal events and 1 (0.4%) fatal event. Plaque burden was significantly related to event-free survival during follow-up (HR:1.11; 95%CI:1.05-1.18; p 0.001).Coronary atherosclerosis and its qualitative components may be quantified by means of SAPC in patients with FH. Plaque burden, calcified plaque burden and non-calcified plaque burden were independently related to the estimated cardiovascular risk. Plaque burden was also related to prognosis.

Published
2021
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17. Incidencia de eventos cardiovasculares y cambios en el riesgo estimado y en el tratamiento de la hipercolesterolemia familiar: registro SAFEHEART

Author

Leopoldo Pérez de Isla, Raquel Arroyo-Olivares, Rodrigo Alonso, Ovidio Muñiz-Grijalvo, José Luis Díaz-Díaz, Daniel Zambón, Francisco Fuentes, Nelva Mata, Mar Piedecausa, M. Dolores Mañas, Juan F. Sánchez Muñoz-Torrero, José Pablo Miramontes-González, Raimundo de Andrés, Marta Mauri, Rocío Aguado, Ángel Brea, José M. Cepeda, José I. Vidal-Pardo, Ceferino Martínez-Faedo, Miguel Ángel Barba, Rosa Argüeso, Enrique Ruiz-Pérez, Alfredo Michán, Francisco Arrieta, María Riestra Fernández, Leire Pérez, José M. Pinilla, Gonzalo Díaz-Soto, Xavier Pintó, Teresa Padró, Lina Badimón, Pedro Mata, Begoña Perez-Corral, Fátima Almagro, Raquel Arroyo, Adriana Saltijeral, Daniel Mosquera, Marta Casañas, Julio Carbayo, Jose María Cepeda, Raimundo De Andrés, José L. Díaz, Marta Diéguez, María Riestra, José López-Miranda, Jesús Galiana, Jesús García-Cruces, Juan Antonio Garrido, Luis Irigoyen, Pedro L. Martínez, Lorena Suárez, Rosa M. Borrallo, Juan Diego Mediavilla, Fernando Jaén, Pablo González, Patricia Rubio, Pablo Miramontes, Juan L. Morera, Ovidio Muñiz, Aurora González, Francisca Pereyra, José Pastor, José Miguel Pinilla, Manuel J. Romero, Enrique Ruiz, M. Pilar Álvarez, Pedro Sáenz, Juan F. Sánchez, Consuelo Sanz, and Jose I. Vidal

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos El estudio SAFEHEART se diseno para analizar la situacion y mejorar el conocimiento de la hipercolesterolemia familiar heterocigota (HFH) en Espana. Nuestro objetivo es determinar la tasa de incidencia de eventos cardiovasculares, el riesgo estimado de sufrir un evento y su modificacion, el empleo de tratamiento hipolipemiante y la consecucion de objetivos de colesterol unido a lipoproteinas de baja densidad en pacientes con HFH. Metodos El SAFEHEART es un estudio prospectivo de cohorte, abierto, multicentrico, de escala nacional, con seguimiento protocolizado a largo plazo en una poblacion de HFH caracterizada molecularmente. Se analizo a los pacientes mayores de 18 anos con seguimiento completo. Resultados El analisis en este estudio se hizo con 2.648 pacientes con HFH. La mediana de seguimiento fue de 6,6 (4,8-9,7) anos. La tasa de incidencia general de eventos cardiovasculares fue de 1,3 eventos/100 pacientes-ano. El riesgo estimado de sufrir un evento cardiovascular a 10 anos se redujo en el seguimiento, y paso del 1,6 al 1,3% (p Conclusiones En este estudio se muestra la tasa de incidencia de eventos cardiovasculares, el riesgo estimado de sufrir un evento cardiovascular en la mayor poblacion de pacientes con HF en Espana, asi como su modificacion, la consecucion de objetivos en colesterol unido a lipoproteinas de baja densidad y su tratamiento. Aunque el riesgo cardiovascular de la HFH es elevado, un adecuado tratamiento reduce la probabilidad de sufrir un evento. Estudio registrado en ClinicalTrials.gov (Identificador: NCT02693548).

Published
2020
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18. Comentarios a la guía ESC 2019 sobre taquicardia supraventricular

Author

Ignacio Ferreira-González, Manuel Jiménez Navarro, Rafael Vázquez, Fernando Alfonso, Miquel Fiol, Enrique Rodríguez Font, Fernando Arribas, Carlos Escobar, Arturo Evangelista, Gemma Berga Congost, Francisco Marcos Marín, Gonzalo Barón, Ricardo Ruiz Granel, Esteban González Torrecilla, Ana Andrés Lahuerta, Héctor Bueno, Antonia Sambola, Alonso Pedrote, Borja Ibanez, Leopoldo Pérez de Isla, Elena Fortuny, and Ana Viana-Tejedor

Subjects
business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Published
2020
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19. Comments on the 2019 ESC guidelines on supraventricular tachycardia

Author

Fernando Arribas, Josep Brugada, Jesús Almendral, Elena Arbelo, Ernesto Díaz Infante, Francisco García-Cosío, Sara Lospitao, José Luis Merino, José Miguel Ormaetxe, Joaquín Osca, Luis Tercedor, Alonso Pedrote, Ana Andrés Lahuerta, Gonzalo Barón, Carlos Escobar, Miquel Fiol, Elena Fortuny, Esteban González Torrecilla, Enrique Rodríguez Font, Ricardo Ruiz Granel, Gemma Berga Congost, Héctor Bueno, Arturo Evangelista, Ignacio Ferreira-González, Manuel Jiménez Navarro, Francisco Marín, Leopoldo Pérez de Isla, Antonia Sambola, Rafael Vázquez, Ana Viana-Tejedor, Borja Ibáñez, and Fernando Alfonso

Subjects
medicine.medical_specialty, business.industry, Internal medicine, medicine, Cardiology, General Medicine, Supraventricular tachycardia, medicine.disease, business
Published
2020
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20. Comentarios a la guía ESC 2019 sobre embolia pulmonar aguda

Author

Fernando Alfonso, Pablo Díez Villanueva, Ana Viana-Tejedor, Arturo Evangelista, Clara Bonanad Lozano, Inmaculada Roldán Rabadán, Antonio Romero, Francisco Marcos Marín, Ana Isabel Huelmos Rodrígo, Ignacio Ferreira-González, Roberto Martín Asenjo, Manuel Jiménez Navarro, Esteban López de Sá, Rafael Vázquez, Héctor Bueno, Gemma Berga Congost, Antonia Sambola, Borja Ibanez, Teresa López Fernández, Leopoldo Pérez de Isla, and Fernando Arribas

Subjects
business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Published
2020
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21. Comments on the 2019 ESC guidelines on chronic coronary syndromes

Author

Antonia Sambola, Borja Ibáñez, Rut Andrea, Gemma Berga, José Antonio Blázquez, Victoria Delgado, José Luis Ferreiro, Felipe Navarro, Sergio Raposeiras-Roubin, Rafael Rodríguez Lecoq, Albert Ariza Solé, Manuel Barreiro Pérez, Esteban López de Sá, Amparo Martínez Monzonis, Raúl Moreno, Carolina Ortiz, Armando Pérez de Prado, Javier Torres Llergo, Fernando Arribas, Gemma Berga Congost, Héctor Bueno, Arturo Evangelista, Ignacio Ferreira-González, Manuel Jiménez Navarro, Francisco Marín, Leopoldo Pérez de Isla, Rafael Vázquez, Ana Viana-Tejedor, and Fernando Alfonso

Subjects
medicine.medical_specialty, business.industry, medicine, General Medicine, Intensive care medicine, business
Published
2020
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22. Comments on the 2019 ESC/EAS guidelines for the management of dyslipidemias

Author

Leopoldo Pérez de Isla, Lluís Masana, Rosa Argüeso, Raquel Campuzano, Isabel Egocheaga, Carlos Escobar, Lorenzo Fácila, Pedro Mata López, Miriam Rossi, Carmen Rus Mansilla, José Antonio Alarcón Duque, Vicente Arrarte, Gonzalo Barón, Vivencio Barrios, Amelia Carro, Almudena Castro, Juan Cosin-Sales, Rosa Fernández Olmo, José Gámez Martínez, Ana Huelmos, Miriam Sandín, Adriana Saltijeral, Alfonso Valle, Fernando Arribas, Gemma Berga Congost, Héctor Bueno, Arturo Evangelista, Ignacio Ferreira-González, Manuel Jiménez Navarro, Francisco Marín, Antonia Sambola, Rafael Vázquez, Ana Viana-Tejedor, Borja Ibáñez, and Fernando Alfonso

Subjects
medicine.medical_specialty, business.industry, Family medicine, MEDLINE, Medicine, General Medicine, business
Published
2020
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23. Comments on the 2019 ESC guidelines on diabetes, prediabetes, and cardiovascular disease

Author

Manuel Jiménez Navarro, Almudena Castro, Sara Ballesteros Pradas, Concepción Cruzado Álvarez, Juan José Gómez Doblas, Domingo Marzal Martín, Susana del Prado, Félix Valencia Serrano, Irene Bretón, Fernando Gómez Peralta, Didac Mauricio, Alfonso Soto González, Vivencio Barrios, Alberto Cordero, Juan Cosin-Sales, Xavier García-Moll, José María García Pinilla, Pilar Jiménez Quevedo, Julio Núñez Villota, Rafael Romaguera Torres, Fernando Arribas, Gemma Berga Congost, Héctor Bueno, Arturo Evangelista, Ignacio Ferreira-González, Francisco Marín, Leopoldo Pérez de Isla, Antonia Sambola, Rafael Vázquez, Ana Viana-Tejedor, Borja Ibáñez, and Fernando Alfonso

Subjects
medicine.medical_specialty, business.industry, Diabetes mellitus, Internal medicine, medicine, General Medicine, Disease, Prediabetes, medicine.disease, business
Published
2020
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24. Prognostic impact of pericardial drainage and anti-inflammatory drug treatment in severe idiopathic pericardial effusion

Author

Carlos Ferrera, Carlos Macaya, Marcos Ferrández-Escarabajal, Cristina Sánchez-Enrique, Francisco J. Noriega, Pablo Salinas, Leopoldo Pérez de Isla, Ana Viana-Tejedor, Antonio Fernández-Ortiz, Alejandro Cruz-Utrilla, and Iván J. Núñez-Gil

Subjects
medicine.medical_specialty, Pericardial drainage, Multivariate analysis, business.industry, Idiopathic pericardial effusion, medicine.disease, Pericardial effusion, Drug treatment, Heart failure, Internal medicine, Medicine, Population study, Cardiology and Cardiovascular Medicine, business, Lower mortality
Abstract

Introduction and objectives Severe pericardial effusion (PE) is a potentially severe clinical entity. Idiopathic PE accounts for one-third of patients with severe PE. However, evidence-based treatments are scarce. The aim of the study was to investigate whether pericardial drainage is associated with prognostic improvement, and to evaluate the influence of anti-inflammatory treatment on prognosis. Methods All severe PE diagnosed between 2003 and 2017 were retrospectively collected. Of them, those classified as idiopathic were selected (N = 153). Patients were divided in 2 groups: those who underwent pericardial drainage (N = 105) and patients who did not (N = 48). In addition, the study population was divided according to the anti-inflammatory drug (AD) administration. Median follow-up was 47.7 months. Results There were no significant differences in 2-year mortality between patients who underwent pericardial drainage and those who did not. There were also no significant differences in the number of hospitalizations for heart failure between the 2 study groups. However, mortality was significantly lower among patients who received AD compared to those who did not receive these agents. Only treatment with AD (HR, 0.24; P = .002) remained independently associated with lower mortality in the multivariate analysis. AD treatment was associated with a 70% reduction in mortality (HR, 0.30; 95%CI, 0.10–0.90; P Conclusions Pericardial drainage was not associated with a better prognosis of patients with severe idiopathic PE, in terms of 2-year mortality, heart failure admissions, or the combined endpoint. AD treatment was found to be an independent protective factor for mortality in this patient population.

Published
2020
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25. Predicting resilience in heterozygous familial hypercholesterolaemia: A cohort study of octogenarian patients

Author

Leopoldo Pérez de Isla, Rodrigo Alonso, Rosa Argüeso, Ovidio Muñiz-Grijalvo, Pilar Álvarez-Baños, Lina Badimón, Gerald F. Watts, and Pedro Mata

Subjects
Aged, 80 and over, Male, Cohort Studies, Hyperlipoproteinemia Type II, Nutrition and Dietetics, Octogenarians, Risk Factors, Endocrinology, Diabetes and Metabolism, Internal Medicine, Humans, Female, Cardiology and Cardiovascular Medicine, Atherosclerosis
Abstract

Defining patients with familial hypercholesterolemia (FH) destined not to develop clinical atherosclerotic cardiovascular disease (ASCVD) has significant implications for precision and discovery medicine. We investigated the predictors of resilience to ASCVD in a cohort of 248 octogenarian patients with FH enrolled in the SAFEHEART study. Median age at the time of analysis was 84.7 years (82.3-88.1) and 83.6 years (81.9-86.4) in the octogenarian resilient FH (OR-FH) and octogenarian controls non-resilient FH (OCNoR-FH) groups, respectively (p=0.073); 92 (80.0%) and 68 (51.1%) patients were female in the first compared with the second group (p0.001). Multivariate logistic regression showed that a low 10-year score in SAFEHEART-Risk Equation was the only independent predictor of OR-FH. Application of this simple and validated risk equation may potentially be useful for predicting patients ultra-resilient to the ASCVD sequelae of FH who may require less intensive use of healthcare resources.

Published
2022

26. Estrategias de colaboración para la red de Revistas Cardiovasculares Iberoamericanas

Author

Manlio F. Márquez, Magda Heras, María del Pilar Aguilar, Fernándo Alfonso, Kaduo Arai, Carlos Barrero, César Belzeti, Sofía Berman, Nedina Coromoto, Alejandro Cuesta, Ismael Guzmán, Bey Mario Lombana, Ricardo López Santi, Hector Lucas Luciardi, Washinton Macías, Felipe Moreira, María Paniagua, Leopoldo Pérez de Isla, Walter Reyes Caorsi, and Ana Salvati

Subjects
colaboración interrevistas, revistas, iberoamérica, Internal medicine, RC31-1245, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

La necesidad de colaboración entre las diferentes revis¬tas cardiológicas de Iberoamérica es evidente. Por ello, en 2009 se conformó la Red de Revistas Cardiovasculares Iberoamericanas (RCVIB) con el auspicio de la Sociedad Española de Cardiología y con el liderazgo del Dr. Fernan¬do Alfonso, entonces Editor-Jefe de la Revista Española de Cardiología. Para dar continuidad con dicho impulso, la III Reunión de Editores de Revistas Cardiovasculares Iberoamericanas tuvo lugar en el marco del LX Congreso Americano de Cardiología (American College of Cardiolo¬gy) en la ciudad de Nueva Orleans el 3 de abril de 2011. A continuación enumeramos y exponemos cada uno de los acuerdos tomados en esa reunión.

Published
2012

27. Collaboration strategies for the Iberoamerican Cardiovascular Journals network.

Author

Manlio Fabio Márquez, Magda Heras, María del Pilar Aguilar, Fernando Alfonso, Kaduo Arai, Carlos Barrero, César Belzeti, Sofía Berman, Nedina Coromoto, Alejandro Cuesta, Ismael Guzmán, Bey Mario Lombana, Ricardo López Santi, Héctor Lucas Luciardi, Washington Macías, Felipe Moreira, María Paniagua, Leopoldo Pérez de Isla, Walter Reyes Caorsi, and Ana Salvati

Subjects
Internal medicine, RC31-1245, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2012

28. Knowledge and Implementation of the New European Guide in the Management of Arterial Hypertension. The Cigema Survey

Author

Leopoldo Pérez de Isla, Luis Miguel Ruilope, Alejandro de la Sierra, and José Zamorano

Subjects
arterial hypertension, Delphi method, guidelines, Medicine, Pharmacy and materia medica, RS1-441
Abstract

Knowledge of guideline implementation pitfalls allows anticipation and solving of problems and may help to promote implementation. The aims of this study were: 1) to find out how much is known among medical professionals about the recommendations for the Management of Arterial Hypertension; 2) to study in depth the extent of implementation and 3) to evaluate the manner in which this guide will be applied to daily medical practice. The Delphi method was used for this work. The total estimated sample size was 2,250 physicians. The carefully selected experts answered questionnaires in two or more rounds. The final sample size was 2,475 physicians. Results of the study are detailed in the article. Among the resultsIt is noteworthy that the guide is viewed as needed among all those who have been interviewed and this agreement about its need is generalised and that the improvement in medical practice, together with individual treatment and cardiovascular risk stratification are viewed positively in opinions reached by consensus by the majority of physicians, regardless of whether they are specialists or general practitioners. The main results of this study emphasize the fact that physicians need a guideline for the management of hypertensive patients and that most of physicians agree with them. The new guidelines on arterial hypertension management are widely known among physicians and there appears to be a global agreement regarding the need for the implementation of the new recommendations.

Published
2009
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29. Relevance of Subclinical Right Ventricular Dysfunction Measured by Feature-Tracking Cardiac Magnetic Resonance in Non-Ischemic Dilated Cardiomyopathy

Author

Javier Urmeneta Ulloa, Eduardo Pozo Osinalde, José Ángel Cabrera, Vicente Martínez de Vega, Israel John Thuissard-Vasallo, Cristina Andreu-Vázquez, Fabian Islas, Leopoldo Pérez de Isla, Pedro Marcos-Alberca, Patricia Mahía, Miguel Ángel Cobos, Beatriz Cabeza, Juan Lizandro Rodríguez-Hernández, María Luaces Méndez, José Juan Gómez de Diego, Ana Bustos, Julián Pérez-Villacastín, and José Alberto de Agustín Loeches

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022
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31. Dyslipidemia and aortic valve disease

Author

Pedro Mata, Lina Badimon, Leopoldo Pérez de Isla, and Rodrigo Alonso

Subjects
Adult, Endocrinology, Diabetes and Metabolism, Hypercholesterolemia, Bioinformatics, Aortic valve replacement, Mendelian randomization, Genetics, medicine, Humans, Heart valve, Molecular Biology, Dyslipidemias, Nutrition and Dietetics, business.industry, Cell Biology, Aortic Valve Stenosis, Cholesterol, LDL, Proprotein convertase, medicine.disease, Stenosis, medicine.anatomical_structure, Kexin, Observational study, Proprotein Convertase 9, Cardiology and Cardiovascular Medicine, business, Dyslipidemia, Lipoprotein(a)
Abstract

Purpose of review Degenerative aortic stenosis (AS) is one of the most prevalent heart valve diseases in the adult population. The understanding of AS pathophysiology and involved risk factors have recently undergone a great advance, with low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) [Lp(a)] and other clinical conditions taking on a relevant role. Although little is known about the prevention of AS, we can progressively find more evidence of the possible use of drugs to control risk factors as tools that may delay the progression to severe AS and aortic valve replacement. Recent findings Several factors have shown to be solid predictors of the development of AS. Mendelian randomization and observational studies on risk factors specifically lipid factors, such as hypercholesterolemia, Lp(a), proprotein convertase subtilisin/kexin type 9 and hypertension have provided meaningful new information. The SAFEHEART study has significantly contributed to define the role of LDL-C and Lp(a) in AS. Summary In this review we discuss the interrelationship of dyslipidemia, especially hypercholesterolemia and Lp(a) in the development and prognosis of valvular AS. New imaging tools may contribute to its early detection. Future studies with proprotein convertase subtilisin/kexin type 9 inhibitors and specific therapies to lower Lp(a) might contribute to delay AS development.

Published
2021

32. Recomendaciones para mejorar el control lipídico. Documento de consenso de la Sociedad Española de Cardiología

Author

Vivencio Barrios, José Ramón González Juanatey, Angel Cequier, Esteban López de Sá, Leopoldo Pérez de Isla, Vicente Arrarte, Luis Masana, Xavier Pintó, Manuel Anguita, Carlos Escobar, José Luis Zamorano, Vicente Pallarés, Juan Cosín-Sales, and Isabel Egocheaga

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen El control actual de la concentracion de colesterol unido a lipoproteinas de baja densidad en el paciente con enfermedad cardiovascular ateroesclerotica es muy escaso y esto se asocia con un aumento del riesgo de que se presenten complicaciones cardiovasculares. Ademas, cuanto mas tarde se logren dichos objetivos, el riesgo sera mayor. Esto se debe principalmente a un uso insuficiente de las terapias hipolipemiantes actualmente disponibles. De hecho, con los tratamientos actuales (estatinas, ezetimiba e inhibidores de la proteina PCSK9), la mayoria de los pacientes en prevencion secundaria deberia lograr los objetivos de control del colesterol unido a lipoproteinas de baja densidad. Por estos motivos, en el presente documento promovido por la Sociedad Espanola de Cardiologia se proponen 3 algoritmos de abordaje sencillos y facilmente aplicables, que abarcan la mayoria de las situaciones clinicas que nos podemos encontrar en los pacientes con cardiopatia isquemica, con el doble objetivo de lograr controlar a la mayoria de los pacientes y hacerlo lo antes posible, ya que el beneficio en prevencion secundaria depende del riesgo y del tiempo.

Published
2020
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33. Barriers to Early Diagnosis and Treatment of Familial Hypercholesterolemia: Current Perspectives on Improving Patient Care

Author

Ovidio Muñiz-Grijalvo, Leopoldo Pérez de Isla, Rodrigo Alonso, and Pedro Mata

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Patient care, Pharmacological treatment, 03 medical and health sciences, 0302 clinical medicine, Ezetimibe, medicine, Pharmacology (medical), 030212 general & internal medicine, Intensive care medicine, PCSK9 Inhibitors, Genetic testing, medicine.diagnostic_test, business.industry, Public Health, Environmental and Occupational Health, Hematology, General Medicine, medicine.disease, Risk perception, Clinical diagnosis, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Familial hypercholesterolemia (FH) is a frequent disorder associated with premature atherosclerotic cardiovascular disease. Different clinical diagnosis criteria are available, and cost of genetic testing has been reduced in the last years; however, most cases are not diagnosed worldwide. Patients with FH are at high cardiovascular risk and the risk can be reduced with lifelong lifestyle and pharmacological treatment. Statins and ezetimibe are available as generic drugs in most countries reducing the cost of treatment. However, the use of high-intensity statins combined with ezetimibe and PCSK9 inhibitors, if necessary, is low for different reasons that contribute to a high number of patients not reaching LDL-C targets according to guidelines. On the other hand, cardiovascular risk varies greatly in families with FH; therefore, risk stratification strategies including cardiovascular imaging is another element to consider for improving care and management of FH. There are numerous barriers depending on the awareness, knowledge, perception of risk, management and care of patients living with FH that impact in the diagnosis and treatment of the disorder. In this contemporary review, we analyze different barriers in the diagnosis and care of patients to improve patients' care and prevention of atherosclerotic cardiovascular disease and describe recent advances and strategies to improve the gaps in the care of FH, including global collaboration and advocacy.

Published
2020
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35. Medida tridimensional del área del anillo tricúspide. Un nuevo criterio en la selección de candidatos a anuloplastia

Author

María Teresa Nogales, Patricia Mahía, José Juan Gómez de Diego, Gabriela Tirado, María Luaces, Leopoldo Pérez de Isla, Jose Alberto de Agustin, Pedro Marcos-Alberca, Carlos Macaya, José Luis Rodrigo, Fabián Islas, Miguel Ángel Cobos, and Rio Aguilar

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos El desarrollo tardio de insuficiencia tricuspide funcional tras cirugia valvular izquierda de origen reumatico es un importante predictor de mal pronostico. Este estudio investiga la utilidad y precision diagnostica del area tricuspide evaluada por ecocardiografia transtoracica tridimensional en comparacion con el diametro bidimensional (D2D) convencional para evaluar la dilatacion significativa del anillo tricuspide, proporcionando puntos de corte que podrian utilizarse en la practica clinica para mejorar la seleccion de pacientes para cirugia. Metodos Se incluyeron prospectivamente 109 pacientes con valvulopatia reumatica en ausencia de reemplazo valvular previo. La insuficiencia tricuspide se dividio en tres grupos: leve, moderado y grave. Se obtuvieron los puntos de corte optimos del area tridimensional (A3D) y del D2D para la identificacion de la dilatacion significativa del anillo tricuspide y se compararon con los umbrales de las guias actuales. Tambien se evaluaron los factores predictivos de la dilatacion del A3D. Resultados Se identificaron los puntos de corte optimos, absolutos y ajustados por el area de superficie corporal (ASC), de ambos parametros (A3D: 10,4 cm2, 6,5 cm2/m2, D2D: 35 mm, 21 mm/m2) siendo el parametro A3D/ASC el que obtuvo el mejor rendimiento diagnostico (ABC = 0,83). El area tricuspide por ecocardiografia transtoracica tridimensional ayudo a reclasificar la indicacion quirurgica en el 14% de pacientes con insuficiencia tricuspide leve (IC95%, 1-15%; p = 0,03) y en el 37% con insuficiencia tricuspide moderada (IC95%, 22-37%; p Conclusiones El umbral del D2D actual propuesto de 40 mm infraestima la dilatacion del anillo tricuspide. Aunque 21 mm/m2 podria ser un criterio de seleccion razonable, la combinacion con la evaluacion del A3D mejora la seleccion de pacientes candidatos para cirugia.

Published
2019
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36. Potential utility of the SAFEHEART risk equation for rationalising the use of PCSK9 monoclonal antibodies in adults with heterozygous familial hypercholesterolemia

Author

Ovidio Muñiz-Grijalvo, Kausik K. Ray, Pedro Mata, Lina Badimon, José Luis Díaz-Díaz, Gerald F. Watts, Alberico L. Catapano, Leopoldo Pérez de Isla, Raul D. Santos, Rodrigo Alonso, and Instituto de Salud Carlos III

Subjects
0301 basic medicine, Heterozygote, medicine.medical_specialty, medicine.drug_class, Familial hypercholesterolemia, Population, SAFEHEART, 030204 cardiovascular system & hematology, Monoclonal antibody, Risk Assessment, NNT, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Immunologic Factors, Prospective Studies, education, 1102 Cardiorespiratory Medicine and Haematology, Risk equation, education.field_of_study, business.industry, PCSK9, Absolute risk reduction, Antibodies, Monoclonal, 1103 Clinical Sciences, Cardiovascular risk assessment, Cholesterol, LDL, Mathematical Concepts, PCSK9 mAb, medicine.disease, 030104 developmental biology, Cardiovascular System & Hematology, Number needed to treat, lipids (amino acids, peptides, and proteins), Proprotein Convertase 9, Cardiology and Cardiovascular Medicine, Risk assessment, business, CTT
Abstract

[Background and aims]: Patients with familial hypercholesterolaemia (FH) may require proprotein convertase subtilisin/kexin-type 9 (PCSK9) mAb as add-on therapy to achieve LDL-cholesterol (LDL-C) goals. However, the current cost of these therapies means that choosing suitable patients is based on consensus or clinical judgement rather than a quantitative risk assessment. We used the SAFEHEART Risk Equation (RE) to estimate the number needed to treat (NNT) at different risk thresholds and baseline LDL-C to identify those FH patients more likely to derive the greatest benefit from PCSK9 mAb., [Methods]: Five-year event rates were calculated using the SAFEHEART-RE for every patient, overall and across LDL-C strata. A 60% reduction of LDL-C after theoretical treatment with PCSK9 mAb was assumed. Individual absolute risk simulating the effects of PCSK9 inhibition was calculated using the SAFEHEART-RE and, in a similar way, by using the Cholesterol Treatment Trialists’ (CTT) Collaboration criteria. Absolute risk reduction and NNTs were calculated., [Results]: Of the total SAFEHEART population, 2,153 were FH cases aged 18 years or older, on maximum tolerated lipid lowering treatment. NNTs were dependent of both baseline predicted risk and baseline LDL-C level ranging from 44 to 17 for those with 5-year risk of ≥1 to ≥5. The smallest NNT (12) was observed among those with 5-year risk of ≥5% and LDL-C ≥160 mg/dl. Using the CTT criteria produced similar results., [Conclusions]: The SAFEHEART-RE may provide a useful quantitative tool for rationalising the selection of FH patients who might derive greater absolute benefits from PCSK9 mAb., This work was supported by Fundación Hipercolesterolemia Familiar; Grant G03/181 and FIS PI12/01289 from Instituto de Salud Carlos III (ISCIII), Grant 08-2008 Centro Nacional de Investigaciones Cardiovasculares (CNIC).

Published
2019
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37. VEGFR2 and OPG genes modify the risk of subclinical coronary atherosclerosis in patients with familial hypercholesterolemia

Author

Ricardo Usategui-Martín, José Pablo Miramontes-González, David Jiménez, Ovidio Muñiz-Grijalvo, Teresa Padró, Ana Elisa Rodríguez Gude, Francisco Fuentes Jiménez, Leopoldo Pérez de Isla, José Luis Díaz-Díaz, Pedro Mata, Rodrigo Alonso, Rogelio González-Sarmiento, Javier Martín-Vallejo, and Daniel Zambón

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Genotype, Coronary Artery Disease, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Risk Assessment, Gastroenterology, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Prospective Studies, Allele, Genotyping, Coronary atherosclerosis, Subclinical infection, Polymorphism, Genetic, business.industry, Homozygote, Osteoprotegerin, Genetic disorder, Middle Aged, medicine.disease, Vascular Endothelial Growth Factor Receptor-2, Coronary Calcium Score, 030104 developmental biology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background and aims Heterozygous familial hypercholesterolemia (FH) is a genetic disorder characterized by high levels of low-density lipoprotein cholesterol (LDL-C). The magnitude of atherosclerotic cardiovascular disease (ASCVD) risk in FH patients is highly variable, and this can result from genetic factors. The aim of our study was to characterize whether polymorphisms in VEGFR2 and OPG genes could influence the expression of ASCVD in FH patients. Methods We studied 318 FH patients from the SAFEHEART registry, without clinical diagnosis of ASCVD. A coronary tomographic angiography (CTA) was performed to determine and evaluate the presence of coronary stenosis and coronary artery calcium, as measured by coronary calcium score (CCS). Genotyping of OPG rs2073618 and VEGFR2 rs2071559 polymorphisms was performed using TaqMan 5′-exonuclease allelic discrimination assays. Results Homozygous GG genotype and G allele of VEGFR2 rs2071559 polymorphism were associated with decreased risk of developing coronary artery stenosis. In the analysis of OPG rs2073618 and VEGFR2 rs2071559 polymorphisms, according to the presence of coronary artery calcium, we found significant differences in both polymorphisms. Homozygous GG genotype and G allele of VEGFR2 rs2071559 polymorphism were associated with decreased risk of accumulation of coronary artery calcium measured by CCS in CTA. Moreover, being a carrier of the GG genotype and G allele of the OPG rs2073618 polymorphism increased the risk of the presence of coronary artery calcium measured by CCS in CTA. Conclusions Polymorphisms in VEGFR2 and OPG genes modify the risk of ASCVD in FH patients.

Published
2019
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38. Screening of extra-coronary arteriopathy with magnetic resonance angiography in patients with spontaneous coronary artery dissection: a single-centre experience

Author

Manuel Moreu, Carlos Macaya, Javier Escaned, María José Pérez-Vizcayno, Carlos H. Salazar, Leopoldo Pérez de Isla, Santiago Rosati, Juan Arrazola, Antonio Fernández-Ortiz, David Adlam, Pablo Salinas, Virginia Ruiz-Pizarro, Eduardo Pozo, Andrés Aldazábal, Reddy Guerra, Fernando Macaya, and Nieves Gonzalo

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Fibromuscular dysplasia, 030204 cardiovascular system & hematology, Spontaneous coronary artery dissection (SCAD), Splenic artery, medicine.disease, Trunk, Magnetic resonance angiography, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Medicine, Original Article, In patient, Radiology, Cardiology and Cardiovascular Medicine, business, Scad, Artery dissection, 030217 neurology & neurosurgery
Abstract

Background: Current consensus recommends extended vascular investigation in patients with spontaneous coronary artery dissection (SCAD). We here report our experience with the use of magnetic resonance angiography (MRA) for screening extra-coronary arteriopathy in patients presenting with SCAD. Methods: Patients presenting with SCAD in a Spanish centre underwent prospective contrast-enhanced MRA to assess the cephalic and abdominopelvic arterial territories. Fibromuscular dysplasia (FMD) was diagnosed following European consensus criteria. Other vascular abnormalities were recorded separately. Two vascular radiologists supervised the acquisitions and independently analysed the results for all cases. Results: Forty patients with SCAD [mean age 50.9±8.6 years, 90% (n=36) women] were included in the study, 12 patients declined to participate and 5 were excluded (metallic implanted devices). All enrolled patients underwent the screening protocol without complications. MRA demonstrated at least one extra-coronary vascular abnormality in 16 patients (40%): 5 (12.5%) were diagnosed with FMD, 6 (15%) showed arterial tortuosity, 3 (7.5%) had non-FMD focal stenoses, and 2 (5%) were found to have small aneurysms at the celiac trunk and splenic artery. No intracranial aneurysms were detected. At a mean follow-up of 4±3 years from the index episode, two cases experienced SCAD recurrences, one in a patient with FMD and the other one in a patient with arterial tortuosity. No deaths or strokes occurred. Conclusions: Systematic extended vascular study with MRA was feasible and demonstrated associated extra-coronary arteriopathy in a substantial proportion of patients presenting with SCAD; however, none required additional intervention or led to vascular events. MRA, being a radiation-free modality, may be the preferred method for screening extracoronary arteriopathy in SCAD, a condition primarily affecting young and middle-age women sensitive to the risks of radiation.

Published
2019
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39. Liquid Biopsy of Extracellular Microvesicles Maps Coronary Calcification and Atherosclerotic Plaque in Asymptomatic Patients With Familial Hypercholesterolemia

Author

Pedro Mata, Leopoldo Pérez de Isla, Gemma Chiva-Blanch, Lina Badimon, Rodrigo Alonso, Javier Crespo, and Teresa Padró

Subjects
0301 basic medicine, medicine.medical_specialty, business.industry, Area under the curve, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Granulocyte, medicine.disease, Gastroenterology, Asymptomatic, Coronary Calcium Score, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, medicine, Biomarker (medicine), Platelet, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Calcification
Abstract

Objective— Heterozygous familial hypercholesterolemia (FH) is the most common genetic disorder associated with premature atherosclerotic cardiovascular disease. Circulating microvesicles (cMV) are released when cells are activated. We investigated whether cMV could provide information on coronary calcification and atherosclerosis in FH patients. Approach and Results— Eighty-two patients (mean of 44±9 years old) with molecular diagnosis of heterozygous FH and asymptomatic cardiovascular disease were investigated. Atherosclerotic plaque characterization was performed by computed tomography angiography, and Agatston coronary calcium score and plaque composition sum were calculated. cMV were quantified by flow cytometry using AV (annexin V) and cell surface-specific antibodies. Of the 82 FH patients, 48 presented atherosclerotic plaque. Patients with atherosclerosis were men and older in a higher percentage than patients without atherosclerotic plaque. FH patients with atherosclerotic plaque showed higher levels of total AV + cMV, cMV AV + from platelet origin, from granulocytes and neutrophils, and cMV AV +/− from endothelial cells than FH-patients without atherosclerotic plaque. Plaque composition sum correlated with platelet- and endothelial-derived cMV, and Agatston coronary calcium score correlated with granulocyte-, platelet-, and endothelial-derived cMV. Receiver operating characteristic curve analyses indicated that the cluster of platelet-, granulocyte-, neutrophil, and endothelial-derived cMV considered together, added significant predictive value to the specific SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) risk equation for plaque presence (area under the curve=0.866, 95% CI, 0.775–0.958; P P =0.030 for the increment of the area under the curve). Conclusions— Endothelial-, granulocyte-, neutrophil- and platelet-derived cMV discriminate and map coronary atherosclerotic plaque and calcification in asymptomatic patients with FH. Liquid biopsy of cMV may be a surrogate biomarker of coronary atherosclerotic plaque burden in FH patients.

Published
2019
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40. Value of Measuring Lipoprotein(a) During Cascade Testing for Familial Hypercholesterolemia

Author

Leopoldo Pérez de Isla, Gerald F. Watts, Pedro Mata, Rodrigo Alonso, Katrina L. Ellis, and Francisco Fuentes

Subjects
Adult, Male, Proband, medicine.medical_specialty, Cascade testing, cascade screening, DNA Mutational Analysis, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, lipoprotein(a), Risk Factors, Internal medicine, Prevalence, medicine, Humans, Genetic Testing, Prospective Studies, 030212 general & internal medicine, familial hypercholesterolemia, biology, Atherosclerotic cardiovascular disease, business.industry, Hazard ratio, atherosclerotic cardiovascular disease, DNA, Lipoprotein(a), Middle Aged, medicine.disease, Pedigree, Receptors, LDL, Spain, Mutation, biology.protein, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Follow-Up Studies, Cohort study, Lipoprotein
Abstract

Background Familial hypercholesterolemia (FH) and elevated lipoprotein(a) [Lp(a)] are inherited disorders associated with premature atherosclerotic cardiovascular disease (ASCVD). Cascade testing is recommended for FH, but there are no similar recommendations for elevated Lp(a). Objectives This study investigated whether testing for Lp(a) was effective in detecting and risk stratifying individuals participating in an FH cascade screening program. Methods Family members (N = 2,927) from 755 index cases enrolled in SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) were tested for genetic FH and elevated Lp(a) via an established screening program. Elevated Lp(a) was defined as levels ≥50 mg/dl. The authors compared the prevalence and yield of new cases of high Lp(a) in relatives of FH probands both with and without high Lp(a), and prospectively investigated the association between elevated Lp(a) and ASCVD events among family members. Results Systematic screening from index cases with both FH and elevated Lp(a) identified 1 new case of elevated Lp(a) for every 2.4 screened. Opportunistic screening from index cases with FH, but without elevated Lp(a), identified 1 individual for 5.8 screened. Over 5 years’ follow-up, FH (hazard ratio [HR]: 2.47; p = 0.036) and elevated Lp(a) (HR: 3.17; p = 0.024) alone were associated with a significantly increased risk of experiencing an ASCVD event or death compared with individuals with neither disorder; the greatest risk was observed in relatives with both FH and elevated Lp(a) (HR: 4.40; p Conclusions Testing for elevated Lp(a) during cascade screening for FH is effective in identifying relatives with high Lp(a) and heightened risk of ASCVD, particularly when the proband has both FH and elevated Lp(a).

Published
2019
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41. Comentarios a la guía ESC 2017 sobre el diagnóstico y tratamiento de la enfermedad arterial periférica

Author

L. Pérez de Isla, Leopoldo Pérez de isla, Guillermo Moñux, Ángel Galindo García, Sergio Revuelta Suero, Óscar Diaz Castro, Vivencio Barrios, Vicente Arrarte, Carlos Escobar, Marisol Bravo, Juan Cosín Sales, Juan José Gómez Doblas, Martín Ruiz Ortiz, Adriana Saltijeral, M. Rosa Fernández Olmo, Pablo Toledo Frías, Paola Beltrán Troncoso, Raquel Campuzano Ruiz, José Antonio Alarcón Duque, Manuel Abeytua, Alberto San Román, Fernando Alfonso, Arturo Evangelista, Ignacio Ferreira-González, Manuel Jiménez Navarro, Francisco Marín, Leopoldo Pérez de Isla, Luis Rodríguez Padial, Pedro Luis Sánchez Fernández, Alessandro Sionis, and Rafael Vázquez García

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business
Published
2018
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42. Comments on the 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases

Author

Leopoldo Pérez de isla, Guillermo Moñux, Ángel Galindo García, Sergio Revuelta Suero, Óscar Diaz Castro, Vivencio Barrios, Vicente Arrarte, Carlos Escobar, Marisol Bravo, Juan Cosín Sales, Juan José Gómez Doblas, Martín Ruiz Ortiz, Adriana Saltijeral, M. Rosa Fernández Olmo, Pablo Toledo Frías, Paola Beltrán Troncoso, Raquel Campuzano Ruiz, José Antonio Alarcón Duque, Manuel Abeytua, Alberto San Román, Fernando Alfonso, Arturo Evangelista, Ignacio Ferreira-González, Manuel Jiménez Navarro, Francisco Marín, Leopoldo Pérez de Isla, Luis Rodríguez Padial, Pedro Luis Sánchez Fernández, Alessandro Sionis, and Rafael Vázquez García

Subjects
medicine.medical_specialty, business.industry, MEDLINE, General Medicine, 030204 cardiovascular system & hematology, Peripheral Arterial Diseases, Europe, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Practice Guidelines as Topic, medicine, Humans, Intensive care medicine, business, Vascular Surgical Procedures, Societies, Medical
Published
2018
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43. Evaluation of Myocardial Function Following SADI-S

Author

Andrés Sánchez-Pernaute, Alejandro Cruz-Utrilla, Leopoldo Pérez de Isla, Antonio José Torres García, Maria Luaces, Leyre López-Antoñanzas, Adriana Ruano-Campos, and Miguel Angel Rubio Herrera

Subjects
medicine.medical_specialty, Sleeve gastrectomy, Duodenum, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Speckle tracking echocardiography, Anastomosis, 03 medical and health sciences, 0302 clinical medicine, Weight loss, Gastrectomy, Internal medicine, Weight Loss, medicine, Humans, Subclinical infection, Retrospective Studies, Nutrition and Dietetics, business.industry, Myocardial function, Obesity, Morbid, medicine.anatomical_structure, Ventricle, Cardiology, 030211 gastroenterology & hepatology, Surgery, medicine.symptom, business, Body mass index
Abstract

The aim of this study was to compare myocardial mechanics using global longitudinal strain (GLS) before and after single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). A total of 21 obese patients undergoing SADI-S were prospectively included. Transthoracic echocardiography was performed before and after the procedure, and left ventricle (LV) and right ventricle (RV) strain was assessed by two-dimensional speckle-tracking imaging (2DST). Mean time between pre-procedural and post-procedural echocardiograms was 9.2 ± 3.3 months. Postoperatively, %total weight loss (%TWL) was 33.0 ± 1.7 and % excess weight loss (%EWL) was 75.5 ± 3.6. Body mass index (BMI) significantly decreased after surgery (45.6 ± 1.2 vs 29.6 ± 1.0; p < 0.001). Postoperatively, LV GLS experienced a significant improvement (−19.8% ± 0.5 vs −22.2% ± 0.4; p < 0.001). Regarding other relevant functional parameters, RV free-wall strain was equally recovered (−19.1% ± 0.7 vs −21.0% ± 0.8; p 0.047). This study demonstrates important and favourable changes in cardiac deformation parameters after performing SADI-S. Malabsorptive bariatric techniques such as SADI-S induce significant weight loss, leading to an improvement in subclinical myocardial function in patients with obesity.

Published
2021

44. New treatments for dyslipidemia

Author

Leopoldo, Pérez de Isla and Pedro, Valdivielso

Subjects
Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dyslipidemias
Published
2021

45. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Author

Jie Lin, Snejana Tisheva, Ishwar C. Verma, Francesco Cipollone, Liam R. Brunham, Florentina Predica, Perla A.C. Gonzalez, Jocelyne Inamo, André R. Miserez, Belma Pojskic, Michel Farnier, Avishay Ellis, Katia Bonomo, Ibrahim Al-Zakwani, Maria Grazia Zenti, Humberto A. Lopez, Khairul Shafiq Ibrahim, Erkin M. Mirrakhimov, Alexey Meshkov, Jose P. de Moura, Muthukkaruppan Annamalai, Raul D. Santos, F. Paillard, Maria Del Ben, Jan Lacko, Miguel T. Rico, Ximena Reyes, Laura E.G. de Leon, Noor Shafina Mohd Nor, Ulrich Julius, Mohammed A. Batais, Dieter Böhm, Ta-Chen Su, Takuya Kobayashi, Magdalena Chmara, Marco Gebauer, Marcos M. Lima-Martínez, Ravshanbek D. Kurbanov, Daisaku Masuda, Amro El-Hadidy, Melanie Schüler, Francisco Fuentes, Florian J. Mayer, Helena Vaverkova, F. Ulrich Beil, Juraj Bujdak, Mario Stoll, Isabelle Ruel, Elena Dorn, Thomas M. Stulnig, Abubaker Elfatih, Rano B. Alieva, Jiri Vesely, Valérie Carreau, Cristina M. Sibaja, Sophie Béliard, Olivier Ziegler, Adriana Branchi, Daniel Schurr, G.B. John Mancini, Tai E. Shyong, Eric L.T. Siang, Mafalda Bourbon, Zerrin Yigit, Meral Kayıkçıoğlu, Jacques Genest, Wei Yu, Michal Vrablík, Shavkat U. Hoshimov, Dan Gaita, Antonio Pipolo, Ashraf H.A. AlQudaimi, Walter Speidl, Gianfranco Parati, Zaliha Ismail, Victoria M. Zubieta, René Valéro, Tomas Salek, Hana Halamkova, Gustavs Latkovskis, Nicole Allendorf-Ostwald, Agnes Perrin, Vladimir Soska, Anastasia Garoufi, Francisco Araujo, Nacu C. Portilla, Thomas Segiet, Charalambos Koumaras, Hila Knobler, Fatih Sivri, Hani Altaradi, Ivan Pećin, Long Jiang, Alexander Dressel, Marlena Woś, Jana Franekova, D. Agapakis, Quitéria Rato, Dirk J. Blom, Marcin A. Bartlomiejczyk, Krzysztof Dyrbuś, Maurizio Averna, Phivos Symeonides, Yung A. Chua, Asim Rana, András Nagy, Juan C.G. Cuellar, Alexander Jäkel, Maya Safarova, Neama Luqman, Amalia-Despoina Koutsogianni, Patrick Tounian, Jose A. Alvarez, Ada Cuevas, Corinna Richter, Sybil Charrieres, Vitaliy Zafiraki, Michalis Doumas, Angela Lux, Thanh Huong Truong, Elaine Chow, José Luis Díaz-Díaz, Jesus R.H. Almada, Sabine Füllgraf-Horst, Gustavo G. Retana, Claudio Borghi, Gianni Biolo, Ivajlo Tzvetkov, Patrícia Pais, Mehmet Akbulut, Kumiko Nagahama, Oner Ozdogan, Frank Leistikow, Jianxun He, Alexander R.M. Lyons, Poranee Ganokroj, Luis E.S. Mendia, Ann-Cathrin Koschker, Gabriela A.G. Ramirez, Dainus Gilis, Karin Balinth, José Ramiro Cruz, Paolo Calabrò, Alberico L. Catapano, Emmanouil Skalidis, Hamida Al-Barwani, Genovefa Kolovou, Carolyn S.P. Lam, Yoto Yotov, Yaacov Henkin, Gabriella Iannuzzo, Aimi Z. Razman, Alma B.M. Rodriguez, Hans Dieplinger, Darlington E. Obaseki, Ursulo J. Herrera, Arcangelo Iannuzzi, Christoph Säly, Elena Olmastroni, Francisco G. Padilla, S.A. Nazli, Ioanna Gouni-Berthold, Miriam Kozárová, Urh Groselj, Igor Shaposhnik, Lorenzo Iughetti, Nawal Rwaili, Cinthia E. Jannes, Andrea Bartuli, Mikhail Voevoda, Marat V. Ezhov, Yanyu Duan, Alper Sonmez, Mustafa Yenercag, Ariane Sultan, Natasza Gilis-Malinowska, Tavintharan Subramaniam, Mohamed Ashraf, Jing Pang, Kota Matsuki, Tao Jiang, Gerald Klose, Eduardo A.R. Rodriguez, Lucie Solcova, Riccardo Sarzani, Mahmoud Traina, Alejandra Vázquez Cárdenas, Gordon A. Francis, Adolat V. Ziyaeva, Ronen Durst, Maciej Banach, Francisco Silva, Heribert Schunkert, Børge G. Nordestgaard, Ziyou Liu, Ahmad Bakhtiar Md Radzi, Hana Rosolova, Andrea Bäßler, Abdulhalim Jamal Kinsara, Noël Peretti, Victor Gurevich, Margarita T. Tamayo, Abdullah Tuncez, Florian Höllerl, Ljubica Stosic, Jianguang Qi, Anja Kirschbaum, Jitendra P.S. Sawhney, Michael Scholl, Kausik K. Ray, Mohamed Bendary, Hapizah Nawawi, Adrienne Tarr, Barbora Nussbaumerova, B.C. Brice, Kurt Huber, Noor Alicezah Mohd Kasim, A. Rahman A. Jamal, Vaclava Palanova, Giacomo Biasucci, Pucong Ye, Eva Cubova, Roopa Mehta, Rüdiger Schweizer, Veronica Zampoleri, Jacek Jóźwiak, Alyaa Al-Khateeb, Jing Hong, Katarina Raslova, Kirsten B. Holven, Tatiana Rozkova, Reinhold Busch, Alexander Klabnik, Konrad Hein, Eloy A.Z. Carrillo, Robin Urbanek, Livia Pisciotta, Fatma Y. Coskun, Jose J.G. Garcia, Valerio Pecchioli, Azra D. Nalbantic, Weerapan Khovidhunkit, Jernej Kovac, Michaela Kadurova, Mohammed Al-Jarallah, Vita Saripo, Christos V. Rizos, Jie Peng, Ang L. Chua, Dorothee Deiss, Nor A.A. Murad, Aneta Stróżyk, See Kwok, Gökhan Alici, Gillian J. Pilcher, John J.P. Kastelein, Dmitry Duplyakov, Calin Lengher, Milena Budikova, C. Azzopardi, Christina Antza, Luis E.V. Arroyo, Khalid Al-Jumaily, Ahmad Al-Sarraf, Carlos A. Aguilar-Salinas, Erkayim Bektasheva, Arta Upena-RozeMicena, Qian Wang, Xumin Wang, Leah Leavit, Radzi Rahmat, Selim Topcu, Željko Reiner, Lorenzo Maroni, Matija Cevc, Elizabeth R. Cooremans, Masatsune Ogura, Tevfik Sabuncu, Ruy D Arjona Villicaña, Andrea Giaccari, Xuesong Fan, Auryan Szalat, Sanjaya Dissanayake, Etienne Khoury, Anja Vogt, Hermann Toplak, Alexis Baass, Isabel Palma, Gaelle Sablon, Dana A. Hay, Ya Yang, Margus Viigimaa, Erik S.G. Stroes, Dror Harats, Konstantin Krychtiuk, Zesen Liu, Aleksandra Parczewska, Yves Cottin, Yichen Qu, Mathilde Di-Fillipo, Agnieszka Konopka, Lamija Pojskic, Guadalupe J. Dominguez, Ahmet Temizhan, Roberto C. Chacon, Ibrahim E. Dural, Qiang Yong, G. Kees Hovingh, Kang Meng, Sandra Kutkiene, Julie Lemale, Reinhold Innerhofer, Alexandros D. Tselepis, Handrean Soran, Wolfgang König, Bassam Atallah, Olena Mitchenko, Jana Cepova, Eduardo M. Rodriguez, Ulrich Laufs, Norhidayah Rosman, Alena Lubasova, V. Durlach, Frederick J. Raal, Elyor Khodzhiboboev, Cristina Pederiva, Hui Yuan, Ashraf Reda, Fahad Alnouri, Konstantinos Tziomalos, Thanh T. Le, Jana Sirotiakova, Régis Hankard, Hector E.A. Cazares, Betsabel Rodriguez, Lenka Pavlickova, Assen Goudev, Julius Katzmann, Diana Boger, Wael Almahmeed, Katarina T. Podkrajsek, Sabina Zambon, Fahri Bayram, Nadia Citroni, Samir Rafla, Vincent Rigalleau, Aleksandr B. Shek, Hani Sabbour, Berenice G. Guzman, Shoshi Shpitzen, Eric Tarantino, Ahmed Bendary, Fedya Nikolov, Jean Bergeron, Stefan Kopf, Iva Rasulic, Gerald F. Watts, Muhammad I.A. Hafidz, Mehmet B. Yilmaz, Kathrin Biolik, Ira A. Haack, Robert A. Hegele, Sonia Dulong, Bartosz Wasąg, Osama Sanad, Susana Correia, Zhenjia Wang, Dana Biedermann, Christel König, Helena Podzimkova, Ihab Daoud, Mohammad Alghamdi, Dražen Perica, László Márk, Iosif Koutagiar, Volkan Dogan, Vladimir Blaha, Chandrashekhar K. Ponde, Katerina Valoskova, Amer A. Jabbar, Azhari Rosman, Sazzli Kasim, Mesut Demir, Ulugbek I. Nizamov, Aldo Ferreira-Hermosillo, Dilek Yesilbursa, Atef Elbahry, Arshad Abdulrasheed, Omer A. Elamin, Vasileios Athyros, Joanna Lewek, Gergely Nagy, Ursula Kassner, Jian Jiao, Klaus G. 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J., Stevens, C. A. T., Lyons, A. R. M., Dharmayat, K. I., Freiberger, T., Hovingh, G. K., Mata, P., Raal, F. J., Santos, R. D., Soran, H., Watts, G. F., Abifadel, M., Aguilar-Salinas, C. A., Alhabib, K. F., Alkhnifsawi, M., Almahmeed, W., Alnouri, F., Alonso, R., Al-Rasadi, K., Al-Sarraf, A., Al-Sayed, N., Araujo, F., Ashavaid, T. F., Banach, M., Beliard, S., Benn, M., Binder, C. J., Bogsrud, M. P., Bourbon, M., Chlebus, K., Corral, P., Davletov, K., Descamps, O. S., Durst, R., Ezhov, M., Gaita, D., Genest, J., Groselj, U., Harada-Shiba, M., Holven, K. B., Kayikcioglu, M., Khovidhunkit, W., Lalic, K., Latkovskis, G., Laufs, U., Liberopoulos, E., Lima-Martinez, M. M., Lin, J., Maher, V., Marais, A. D., Marz, W., Mirrakhimov, E., Miserez, A. R., Mitchenko, O., Nawawi, H., Nordestgaard, B. G., Panayiotou, A. G., Paragh, G., Petrulioniene, Z., Pojskic, B., Postadzhiyan, A., Raslova, K., Reda, A., Sadiq, F., Sadoh, W. E., Schunkert, H., Shek, A. B., Stoll, M., Stroes, E., Su, T. -C., Subramaniam, T., Susekov, A. V., Tilney, M., Tomlinson, B., Truong, T. H., Tselepis, A. D., Tybjaerg-Hansen, A., Vazquez Cardenas, A., Viigimaa, M., Wang, L., Yamashita, S., Kastelein, J. J. P., Bruckert, E., Vohnout, B., Schreier, L., Pang, J., Ebenbichler, C., Dieplinger, H., Innerhofer, R., Winhofer-Stockl, Y., Greber-Platzer, S., Krychtiuk, K., Speidl, W., Toplak, H., Widhalm, K., Stulnig, T., Huber, K., Hollerl, F., Rega-Kaun, G., Kleemann, L., Maser, M., Scholl-Burgi, S., Saly, C., Mayer, F. J., Sablon, G., Tarantino, E., Nzeyimana, C., Pojskic, L., Sisic, I., Nalbantic, A. D., Jannes, C. E., Pereira, A. C., Krieger, J. E., Petrov, I., Goudev, A., Nikolov, F., Tisheva, S., Yotov, Y., Tzvetkov, I., Baass, A., Bergeron, J., Bernard, S., Brisson, D., Brunham, L. R., Cermakova, L., Couture, P., Francis, G. A., Gaudet, D., Hegele, R. A., Khoury, E., Mancini, G. B. J., Mccrindle, B. W., Paquette, M., Ruel, I., Cuevas, A., Asenjo, S., Wang, X., Meng, K., Song, X., Yong, Q., Jiang, T., Liu, Z., Duan, Y., Hong, J., Ye, P., Chen, Y., Qi, J., Li, Y., Zhang, C., Peng, J., Yang, Y., Yu, W., Wang, Q., Yuan, H., Cheng, S., Jiang, L., Chong, M., Jiao, J., Wu, Y., Wen, W., Xu, L., Zhang, R., Qu, Y., He, J., Fan, X., Wang, Z., Chow, E., Pecin, I., Perica, D., Symeonides, P., Vrablik, M., Ceska, R., Soska, V., Tichy, L., Adamkova, V., Franekova, J., Cifkova, R., Kraml, P., Vonaskova, K., Cepova, J., Dusejovska, M., Pavlickova, L., Blaha, V., Rosolova, H., Nussbaumerova, B., Cibulka, R., Vaverkova, H., Cibickova, L., Krejsova, Z., Rehouskova, K., Malina, P., Budikova, M., Palanova, V., Solcova, L., Lubasova, A., Podzimkova, H., Bujdak, J., Vesely, J., Jordanova, M., Salek, T., Urbanek, R., Zemek, S., Lacko, J., Halamkova, H., Machacova, S., Mala, S., Cubova, E., Valoskova, K., Burda, L., Bendary, A., Daoud, I., Emil, S., Elbahry, A., Rafla, S., Sanad, O., Kazamel, G., Ashraf, M., Sobhy, M., El-Hadidy, A., Shafy, M. A., Kamal, S., Bendary, M., Talviste, G., Angoulvant, D., Boccara, F., Cariou, B., Carreau, V., Carrie, A., Charrieres, S., Cottin, Y., Di-Fillipo, M., Ducluzeau, P. H., Dulong, S., Durlach, V., Farnier, M., Ferrari, E., Ferrieres, D., Ferrieres, J., Gallo, A., Hankard, R., Inamo, J., Lemale, J., Moulin, P., Paillard, F., Peretti, N., Perrin, A., Pradignac, A., Rabes, J. P., Rigalleau, V., Sultan, A., Schiele, F., Tounian, P., Valero, R., Verges, B., Yelnik, C., Ziegler, O., Haack, I. A., Schmidt, N., Dressel, A., Klein, I., Christmann, J., Sonntag, A., Stumpp, C., Boger, D., Biedermann, D., Usme, M. M. N., Beil, F. U., Klose, G., Konig, C., Gouni-Berthold, I., Otte, B., Boll, G., Kirschbaum, A., Merke, J., Scholl, J., Segiet, T., Gebauer, M., Predica, F., Mayer, M., Leistikow, F., Fullgraf-Horst, S., Muller, C., Schuler, M., Wiener, J., Hein, K., Baumgartner, P., Kopf, S., Busch, R., Schomig, M., Matthias, S., Allendorf-Ostwald, N., Fink, B., Bohm, D., Jakel, A., Koschker, A. -C., Schweizer, R., Vogt, A., Parhofer, K., Konig, W., Reinhard, W., Bassler, A., Stadelmann, A., Schrader, V., Katzmann, J., Tarr, A., Steinhagen-Thiessen, E., Kassner, U., Paulsen, G., Homberger, J., Zemmrich, C., Seeger, W., Biolik, K., Deiss, D., Richter, C., Pantchechnikova, E., Dorn, E., Schatz, U., Julius, U., Spens, A., Wiesner, T., Scholl, M., Rizos, C. V., Sakkas, N., Elisaf, M., Skoumas, I., Tziomalos, K., Rallidis, L., Kotsis, V., Doumas, M., Athyros, V., Skalidis, E., Kolovou, G., Garoufi, A., Bilianou, E., Koutagiar, I., Agapakis, D., Kiouri, E., Antza, C., Katsiki, N., Zacharis, E., Attilakos, A., Sfikas, G., Koumaras, C., Anagnostis, P., Anastasiou, G., Liamis, G., Koutsogianni, A. -D., Karanyi, Z., Harangi, M., Bajnok, L., Audikovszky, M., Mark, L., Benczur, B., Reiber, I., Nagy, G., Nagy, A., Reddy, L. L., Shah, S. A. V., Ponde, C. K., Dalal, J. J., Sawhney, J. P. S., Verma, I. C., Altaey, M., Al-Jumaily, K., Rasul, D., Abdalsahib, A. F., Jabbar, A. A., Al-ageedi, M., Agar, R., Cohen, H., Ellis, A., Gavishv, D., Harats, D., Henkin, Y., Knobler, H., Leavit, L., Leitersdorf, E., Rubinstein, A., Schurr, D., Shpitzen, S., Szalat, A., Casula, M., Zampoleri, V., Gazzotti, M., Olmastroni, E., Sarzani, R., Ferri, C., Repetti, E., Sabba, C., Bossi, A. C., Borghi, C., Muntoni, S., Cipollone, F., Purrello, F., Pujia, A., Passaro, A., Marcucci, R., Pecchioli, V., Pisciotta, L., Mandraffino, G., Pellegatta, F., Mombelli, G., Branchi, A., Fiorenza, A. M., Pederiva, C., Werba, J. P., Parati, G., Carubbi, F., Iughetti, L., Iannuzzi, A., Iannuzzo, G., Calabro, P., Averna, M., Biasucci, G., Zambon, S., Roscini, A. R., Trenti, C., Arca, M., Federici, M., Del Ben, M., Bartuli, A., Giaccari, A., Pipolo, A., Citroni, N., Guardamagna, O., Bonomo, K., Benso, A., Biolo, G., Maroni, L., Lupi, A., Bonanni, L., Zenti, M. G., Matsuki, K., Hori, M., Ogura, M., Masuda, D., Kobayashi, T., Nagahama, K., Al-Jarallah, M., Radovic, M., Lunegova, O., Bektasheva, E., Khodzhiboboev, E., Erglis, A., Gilis, D., Nesterovics, G., Saripo, V., Meiere, R., Upena-RozeMicena, A., Terauda, E., Jambart, S., Khoury, P. E., Elbitar, S., Ayoub, C., Ghaleb, Y., Aliosaitiene, U., Kutkiene, S., Kasim, N. A. M., Nor, N. S. M., Ramli, A. S., Razak, S. A., Al-Khateeb, A., Kadir, S. H. S. A., Muid, S. A., Rahman, T. A., Kasim, S. S., Radzi, A. B. M., Ibrahim, K. S., Razali, S., Ismail, Z., Ghani, R. A., Hafidz, M. I. A., Chua, A. L., Rosli, M. M., Annamalai, M., Teh, L. K., Razali, R., Chua, Y. A., Rosman, A., Sanusi, A. R., Murad, N. A. A., Jamal, A. R. A., Nazli, S. A., Razman, A. Z., Rosman, N., Rahmat, R., Hamzan, N. S., Azzopardi, C., Mehta, R., Martagon, A. J., Ramirez, G. A. G., Villa, N. E. A., Vazquez, A. V., Elias-Lopez, D., Retana, G. G., Rodriguez, B., Macias, J. J. C., Zazueta, A. R., Alvarado, R. M., Portano, J. D. M., Lopez, H. A., Sauque-Reyna, L., Herrera, L. G. G., Mendia, L. E. S., Aguilar, H. G., Cooremans, E. R., Aparicio, B. P., Zubieta, V. M., Gonzalez, P. A. C., Ferreira-Hermosillo, A., Portilla, N. C., Dominguez, G. J., Garcia, A. Y. R., Cazares, H. E. A., Gonzalez, J. R., Valencia, C. V. M., Padilla, F. G., Prado, R. M., De los Rios Ibarra, M. O., Villicana, R. D. A., Rivera, K. J. A., Carrera, R. A., Alvarez, J. A., Martinez, J. C. A., de los Reyes Barrera Bustillo, M., Vargas, G. C., Chacon, R. C., Andrade, M. H. F., Ortega, A. F., Alcala, H. G., de Leon, L. E. G., Guzman, B. G., Garcia, J. J. G., Cuellar, J. C. G., Cruz, J. R. G., Garcia, A. H., Almada, J. R. H., Herrera, U. J., Sobrevilla, F. L., Rodriguez, E. M., Sibaja, C. M., Rodriguez, A. B. M., Oyervides, J. C. M., Vazquez, D. I. P., Rodriguez, E. A. R., Osorio, M. L. R., Saucedo, J. R., Tamayo, M. T., Talavera, L. A. V., Arroyo, L. E. V., Carrillo, E. A. Z., Isara, A., Obaseki, D. E., Al-Waili, K., Al-Zadjali, F., Al-Zakwani, I., Al-Kindi, M., Al-Mukhaini, S., Al-Barwani, H., Rana, A., Shah, L. S. U., Starostecka, E., Konopka, A., Lewek, J., Bartlomiejczyk, M., Gasior, M., Dyrbus, K., Jozwiak, J., Gruchala, M., Pajkowski, M., Romanowska-Kocejko, M., Zarczynska-Buchowiecka, M., Chmara, M., Wasag, B., Parczewska, A., Gilis-Malinowska, N., Borowiec-Wolna, J., Strozyk, A., Wos, M., Michalska-Grzonkowska, A., Medeiros, A. M., Alves, A. C., Silva, F., Lobarinhas, G., Palma, I., de Moura, J. P., Rico, M. T., Rato, Q., Pais, P., Correia, S., Moldovan, O., Virtuoso, M. J., Salgado, J. M., Colaco, I., Dumitrescu, A., Lengher, C., Mosteoru, S., Meshkov, A., Ershova, A., Rozkova, T., Korneva, V., Yu, K. T., Zafiraki, V., Voevoda, M., Gurevich, V., Duplyakov, D., Ragino, Y., Safarova, M., Shaposhnik, I., Alkaf, F., Khudari, A., Rwaili, N., Al-Allaf, F., Alghamdi, M., Batais, M. A., Almigbal, T. H., Kinsara, A., Alqudaimi, A. H. A., Awan, Z., Elamin, O. A., Altaradi, H., Rajkovic, N., Popovic, L., Singh, S., Stosic, L., Rasulic, I., Lalic, N. M., Lam, C., Le, T. J., Siang, E. L. T., Dissanayake, S., I-Shing, J. T., Shyong, T. E., Jin, T. C. S., Balinth, K., Buganova, I., Fabryova, L., Kadurova, M., Klabnik, A., Kozarova, M., Sirotiakova, J., Battelino, T., Kovac, J., Mlinaric, M., Sustar, U., Podkrajsek, K. T., Fras, Z., Jug, B., Cevc, M., Pilcher, G. J., Blom, D. J., Wolmarans, K. H., Brice, B. C., Muniz-Grijalvo, O., Diaz-Diaz, J. L., de Isla, L. P., Fuentes, F., Badimon, L., Martin, F., Lux, A., Chang, N. -T., Ganokroj, P., Akbulut, M., Alici, G., Bayram, F., Can, L. H., Celik, A., Ceyhan, C., Coskun, F. Y., Demir, M., Demircan, S., Dogan, V., Durakoglugil, E., Dural, I. E., Gedikli, O., Hacioglu, A., Ildizli, M., Kilic, S., Kirilmaz, B., Kutlu, M., Oguz, A., Ozdogan, O., Onrat, E., Ozer, S., Sabuncu, T., Sahin, T., Sivri, F., Sonmez, A., Temizhan, A., Topcu, S., Tuncez, A., Vural, M., Yenercag, M., Yesilbursa, D., Yigit, Z., Yildirim, A. B., Yildirir, A., Yilmaz, M. B., Atallah, B., Traina, M., Sabbour, H., Hay, D. A., Luqman, N., Elfatih, A., Abdulrasheed, A., Kwok, S., Oca, N. D., Reyes, X., Alieva, R. B., Kurbanov, R. D., Hoshimov, S. U., Nizamov, U. I., Ziyaeva, A. V., Abdullaeva, G. J., Do, D. L., Nguyen, M. N. T., Kim, N. T., Le, T. T., Le, H. A., Tokgozoglu, L., Catapano, A. L., Ray, K. K., and EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Borghi C

Subjects
Male, Settore MED/09 - Medicina Interna, Arterial disease, Cross-sectional study, Adult population, Coronary Disease, Disease, Global Health, Medical and Health Sciences, Doenças Cardio e Cérebro-vasculares, Anticholesteremic Agent, Monoclonal, Prevalence, Registries, Familial Hypercholesterolemia, Humanized, Stroke, 11 Medical and Health Sciences, LS2_9, Studies Collaboration, Anticholesteremic Agents, General Medicine, Heart Disease Risk Factor, Middle Aged, FHSC global registry data, Europe, Treatment Outcome, Lower prevalence, Guidance, lipids (amino acids, peptides, and proteins), Female, Proprotein Convertase 9, Familial hypercholesterolaemia, Life Sciences & Biomedicine, Human, Adult, medicine.medical_specialty, Combination therapy, FHSC global registry, heterozygous familial hypercholesterolaemia, Cardiovascular risk factors, Antibodies, Monoclonal, Humanized, Insights, Antibodies, NO, Hyperlipoproteinemia Type II, Clinician, Medicine, General & Internal, Internal medicine, General & Internal Medicine, Health Sciences, medicine, Humans, EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Cross-Sectional Studie, Science & Technology, Global Perspective, business.industry, Cholesterol, LDL, medicine.disease, Cross-Sectional Studies, Heart Disease Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitor, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53.6%] women) from 56 countries were included in the study. Of these, 31 798 (75.4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84.2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46.2 years (IQR 34.3-58.0); median age at diagnosis of familial hypercholesterolaemia was 44.4 years (32.5-56.5), with 40.2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17.4% (2.1% for stroke and 5.2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81.1%) were receiving statins and 3691 (21.2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5.43 mmol/L (IQR 4.32-6.72) among patients not taking lipid-lowering medications and 4.23 mmol/L (3.20-5.66) among those taking them. Among patients taking lipid-lowering medications, 2.7% had LDL cholesterol lower than 1.8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1.8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p, Pfizer Independent Grant for Learning Change [16157823]; Amgen; Merck Sharp Dohme; Sanofi-Aventis; Daiichi Sankyo; Regeneron; National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK; NIHR; Czech Ministry of Health [NU20-02-00261]; Canadian Institutes of Health Research; Austrian Heart Foundation; Tyrolean Regional Government; Gulf Heart Association, The EAS FHSC is an academic initiative that has received funding from a Pfizer Independent Grant for Learning & Change 2014 (16157823) and from investigator-initiated research grants to the European Atherosclerosis Society-Imperial College London from Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron. KKR acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK. KID acknowledges support from a PhD Studentship from NIHR under the Applied Health Research programme for Northwest London, UK (the views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health). TF was supported by a grant from the Czech Ministry of Health (NU20-02-00261). JG receives support from the Canadian Institutes of Health Research. The Austrian Familial Hypercholesterolaemia registry has been supported by funds from the Austrian Heart Foundation and the Tyrolean Regional Government. The Gulf Familial Hypercholesterolaemia registry was done under the auspices of the Gulf Heart Association.

Published
2021
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46. Imaging techniques in atherosclerosis

Author

Carlos, Escobar Cervantes and Leopoldo, Pérez de Isla

Subjects
Diagnostic Imaging, Humans, Coronary Artery Disease, Prognosis
Abstract

Cardiovascular imaging techniques have revolutionized the management of coronary atherosclerosis. Due to this, the assessment of the presence and extension of atherosclerotic disease in the different arterial territories is much simpler, with the advantage that they are non-invasive techniques. This chapter summarises the usefulness of the different cardiovascular imaging modalities in the diagnosis and prognostic stratification of the cardiovascular patient.

Published
2020

47. Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis

Author

Alejandro Jiménez Sosa, Amelia Duque-González, Belén Marí-López, Flor Baeza-Garzón, Ignacio Laynez-Cerdeña, Juan Lacalzada-Almeida, Leopoldo Pérez de Isla, and María Manuela Izquierdo-Gómez

Subjects
medicine.medical_specialty, exercise testing, business.industry, General Engineering, Cardiology, Speckle tracking echocardiography, speckle tracking imaging, Odds ratio, medicine.disease, left ventricular strain, Asymptomatic, Confidence interval, body regions, Stenosis, paradoxical aortic stenosis, medicine.anatomical_structure, Ventricle, Internal medicine, Cohort, medicine, echocardiography, medicine.symptom, business, Speckle tracking imaging
Abstract

Background The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET).Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients’ clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval [CI]=1.01-1.06, pConclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identifies PLGAS as a completely different entity from MAS.

Published
2020
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48. Tetralogy of Fallot: cardiac imaging evaluation

Author

Carlos Jerjes Sánchez Ramírez and Leopoldo Pérez de Isla

Subjects
medicine.medical_specialty, education.field_of_study, medicine.diagnostic_test, Adult patients, business.industry, Review Article on Structural Heart Disease: The Revolution, Population, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Pulmonary valve, Angiography, medicine, Cardiology, education, Cardiac magnetic resonance, business, Pediatric cardiology, Cardiac imaging, Tetralogy of Fallot
Abstract

Thanks to advances in pediatric cardiology, most infants with tetralogy of Fallot (TOF) now survive into adulthood. This relatively new population of adult patients may face long-term complications, including pulmonary regurgitation (PR), right ventricular (RV) tract obstruction, residual shunts, RV dysfunction, and arrythmias. They will often need to undergo pulmonary valve (PV) replacement and other invasive re-interventions. However, the optimal timing for these procedures is challenging, largely due to the complexity of evaluating RV volume and function. The options for the follow-up of these patients have rapidly evolved from an angiography-based approach to the surge of advanced imaging techniques, mainly echocardiography, cardiac magnetic resonance (CMR), and computer tomography (CT). In this review, we outline the indications, strengths and limitations of these modalities in the adult TOF population.

Published
2020

49. Lipoprotein(a), LDL-cholesterol, and hypertension: predictors of the need for aortic valve replacement in familial hypercholesterolaemia

Author

Raimundo de Andrés, Pedro Mata, Leopoldo Pérez de Isla, Daniel Zambón, José Luis Díaz-Díaz, Gerald F. Watts, Rodrigo Alonso, Teresa Padró, Francisco Fuentes, Ovidio Muñiz-Grijalvo, and Jose Lopez-Miranda

Subjects
medicine.medical_specialty, Population, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, education, Aged, education.field_of_study, biology, business.industry, valvular heart disease, Lipoprotein(a), Odds ratio, Cholesterol, LDL, medicine.disease, Aortic valve stenosis, Aortic Valve, Hypertension, biology.protein, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Familial hypercholesterolaemia (FH) and elevated lipoprotein(a) [Lp(a)] are inherited disorders associated with premature atherosclerotic cardiovascular disease (ASCVD). Aortic valve stenosis (AVS) is the most prevalent valvular heart disease and low-density lipoprotein cholesterol (LDL-C) and Lp(a) may be involved in its pathobiology. We investigated the frequency and predictors of severe AVS requiring aortic valve replacement (AVR) in molecularly defined patients with FH. Methods and results SAFEHEART is a long-term prospective cohort study of a population with FH and non-affected relatives (NAR). We analysed the frequency and predictors of the need for AVR due to AVS in this cohort. Five thousand and twenty-two subjects were enrolled (3712 with FH; 1310 NAR). Fifty patients with FH (1.48%) and 3 NAR (0.27%) required AVR [odds ratio 5.71; 95% confidence interval (CI): 1.78–18.4; P = 0.003] after a mean follow-up of 7.48 (3.75) years. The incidence of AVR was significantly higher in patients with FH (log-rank 5.93; P = 0.015). Cox regression analysis demonstrated an association between FH and AVR (hazard ratio: 3.89; 95% CI: 1.20–12.63; P = 0.024), with older age, previous ASCVD, hypertension, increased LDL-CLp(a)-years, and elevated Lp(a) being independently predictive of an event. Conclusion The need for AVR due to AVS is significantly increased in FH patients, particularly in those who are older and have previous ASCVD, hypertension, increased LDL-CLp(a)-years and elevated Lp(a). Reduction in LDL-C and Lp(a) together with control of hypertension could retard the progression of AVS in FH, but this needs testing in clinical trials. ClinicalTrials.gov number NCT02693548.

Published
2020

50. Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic

Author

Francisco J, Roldán-Gómez, Antonio, Jordán-Ríos, Amada, Alvarez-Sangabriel, Carlos, Guízar-Sánchez, Leopoldo, Pérez-de-Isla, Luis A, Lasses-Ojeda, David U, Domínguez-Rivera, Ramiro P, Correa-Carrera, and Jorge E, Cossío-Aranda

Subjects
Cardiovascular Diseases, Pneumonia, Viral, Cardiology, COVID-19, Humans, Coronavirus Infections, Pandemics, Telemedicine
Abstract

Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.

Published
2020

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