78 results on '"M. Sánchez-Marteles"'
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2. Utilidad pronóstica de la presión de pulso en pacientes con insuficiencia cardiaca con fracción de eyección preservada: Registro RICA
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I. Bravo Candela, N. Moya González, P. Salamanca Bautista, J. Pérez Silvestre, A. Conde Martel, S. Carrascosa García, M. Sánchez Marteles, J.M. Cerqueiro González, J. Casado Cerrada, and M. Montero-Pérez-Barquero
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General Medicine - Published
- 2023
3. Variación de la presión intraabdominal en los pacientes con insuficiencia cardíaca aguda según la fracción de eyección ventricular izquierda. Resultados del estudio PIA
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J. Rubio Gracia, J.I. Pérez Calvo, V. Garcés Horna, C. Josa Laorden, I. Giménez López, M.L. de la Rica Escuín, and M. Sánchez Marteles
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,General Medicine ,business - Abstract
Resumen Antecedentes El aumento de la presion intraabdominal (PIA) se ha correlacionado con elevacion de la creatinina en pacientes con insuficiencia cardiaca con fraccion de eyeccion ventricular izquierda gravemente deprimida (ICFEr). Sin embargo, dicha variable no se ha explorado en pacientes mas estables o con insuficiencia cardiaca y fraccion de eyeccion preservada (ICFEp). Pacientes y metodo Estudio observacional, prospectivo y descriptivo consistente en la medicion de la PIA en pacientes ingresados por insuficiencia cardiaca (IC) descompensada. Se estratifico la muestra segun la fraccion de eyeccion ventricular izquierda (FEVI) con un punto de corte del 50%, con el objetivo de analizar la PIA, asi como las caracteristicas basales y el grado de congestion empleando la ecografia clinica y la impedanciometria. Resultados Se incluyeron un total de 56 pacientes, 22 con ICFEr y 34 con ICFEp. Los pacientes con ICFEr presentaron una mayor prevalencia de cardiopatia isquemica (11 vs. 6; p = 0,010) y EPOC/asma (6 vs. 2%; p = 0,025). La PIA fue mas alta en pacientes con ICFEr (17,2 mmHg vs. 13,3 mmHg; p = 0,004), sin diferencias en la funcion renal al ingreso segun la FEVI (CKD-EPI creatinina) (ICFEr 55,0 mL/min/1,73 m2 [32,6-83,6] vs. ICFEp 55,0 mL/min/1,73 m2 [44,0-74,9]; p = 0,485). Los pacientes con ICFEr presentaron un perfil mas congestivo estimado por ecografia (colapso de la cava inferior [26% vs. 50%; p = 0,001]), impedanciometria (agua corporal total al ingreso: 46 L vs. 41 L; p = 0,052 y a las 72 horas 50,2 L vs. 39,1 L; p = 0,038) y concentracion de CA125 (68 U/mL vs. 39 U/mL; p = 0,037). Conclusiones Durante los episodios de descompensacion los pacientes con ICFEr tienen mayor elevacion de la PIA y un mayor grado de congestion sistemica.
- Published
- 2021
4. Variation in intraabdominal pressure in patients with acute heart failure according to left ventricular ejection fraction. Results of an intraabdominal pressure study
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I. Giménez López, M.L. de la Rica Escuín, V. Garcés Horna, C. Josa Laorden, J.I. Pérez Calvo, J. Rubio Gracia, and M. Sánchez Marteles
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medicine.medical_specialty ,Ventricular Ejection Fraction ,Renal function ,Cardiorenal syndrome ,Inferior vena cava ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Decompensation ,Prospective Studies ,030212 general & internal medicine ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,General Medicine ,Prognosis ,medicine.disease ,medicine.vein ,Heart failure ,Cardiology ,business ,Heart failure with preserved ejection fraction - Abstract
Background The increase in intraabdominal pressure (IAP) has been correlated with increased creatinine levels in patients with heart failure with severely reduced left ventricular ejection fraction (HFrEF). However, IAP has not been examined in more stable patients or those with heart failure with preserved ejection fraction (HFpEF). Patients and method We conducted an observational, prospective descriptive study that measured the IAP of patients hospitalised for decompensated heart failure (HF). The sample was stratified according to left ventricular ejection fraction (LVEF), with a cut-off of 50%. The objective was to analyse the IAP, the baseline characteristics and degree of congestion using clinical ultrasonography and impedance audiometry. Results The study included 56 patients, 22 with HFrEF and 34 with HFpEF. The patients with HFrEF presented a higher prevalence of ischaemic heart disease (11% vs. 6%; p = 0.010) and chronic obstructive pulmonary disease/asthma (6% vs. 2%; p = 0.025). The IAP was higher in the patients with HFrEF (17.2 vs. 13.3 mmHg; p = 0.004), with no differences in renal function at admission according to the LVEF (CKD-EPI creatinine) (HFrEF 55.0 mL/min/1.73 m2 [32.6–83.6] vs. HFpEF 55.0 mL/min/1.73 m2 [44.0–74.9]; p = 0.485). The patients with HFrEF presented a more congestive profile determined through ultrasonography (inferior vena cava collapse [26% vs. 50%; p = 0.001]), impedance audiometry (total body water at admission, 46 L vs. 41 L; p = 0.052; and at 72 h, 50.2 L vs. 39.1 L; p = 0.038) and CA125 concentration (68 U/mL vs. 39 U/mL; p = 0.037). Conclusions During the decompensation episodes, the patients with HFrEF had a greater increase in IAP and a higher degree of systemic congestion.
- Published
- 2021
5. Design and baseline characteristics of SALT‐HF trial: hypertonic saline therapy in ambulatory heart failure
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M. Cobo Marcos, J. Comín‐Colet, R. de laEspriella, J. Rubio Gracia, J. L. Morales‐Rull, I. Zegrí, P. Llacer, P. Diez‐Villanueva, S. Jiménez‐Marrero, J. deJuan Bagudá, C. Ortiz Cortés, J. Goirigolzarri‐Artaza, J. M. García‐Pinilla, E. Barrios, S. delPrado Díaz, E. Montero Hernández, M. Sanchez‐Marteles, and J. Nuñez
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Diuretic resistance ,Hypertonic saline solution ,Hypertonic therapy ,Outpatient with heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Hypertonic saline solution (HSS) plus intravenous (IV) loop diuretic appears to enhance the diuretic response in patients hospitalized for heart failure (HF). The efficacy and safety of this therapy in the ambulatory setting have not been evaluated. We aimed to describe the design and baseline characteristics of the SALT‐HF trial participants. Methods and results ‘Efficacy of Saline Hypertonic Therapy in Ambulatory Patients with HF’ (SALT‐HF) trial was a multicenter, double‐blinded, and randomized study involving ambulatory patients who experienced worsening heart failure (WHF) without criteria for hospitalization. Enrolled patients had to present at least two signs of volume overload, use ≥ 80 mg of oral furosemide daily, and have elevated natriuretic peptides. Patients were randomized 1:1 to treatment with a 1‐h infusion of IV furosemide plus HSS (2.6–3.4% NaCl depending on plasmatic sodium levels) versus a 1‐h infusion of IV furosemide at the same dose (125–250 mg, depending on basal loop diuretic dose). Clinical, laboratory, and imaging parameters were collected at baseline and after 7 days, and a telephone visit was planned after 30 days. The primary endpoint was 3‐h diuresis after treatment started. Secondary endpoints included (a) 7‐day changes in congestion data, (b) 7‐day changes in kidney function and electrolytes, (c) 30‐day clinical events (need of IV diuretic, HF hospitalization, cardiovascular mortality, all‐cause mortality or HF‐hospitalization). Results A total of 167 participants [median age, 81 years; interquartile range (IQR), 73–87, 30.5% females] were randomized across 13 sites between December 2020 and March 2023. Half of the participants (n = 82) had an ejection fraction >50%. Most patients showed a high burden of comorbidities, with a median Charlson index of 3 (IQR: 2–4). Common co‐morbidities included diabetes mellitus (41%, n = 69), atrial fibrillation (80%, n = 134), and chronic kidney disease (64%, n = 107). Patients exhibited a poor functional NYHA class (69% presenting NYHA III) and several signs of congestion. The mean composite congestion score was 4.3 (standard deviation: 1.7). Ninety per cent of the patients (n = 151) presented oedema and jugular engorgement, and 71% (n = 118) showed lung B lines assessed by ultrasound. Median inferior vena cava diameter was 23 mm, (IQR: 21–25), and plasmatic levels of N‐terminal‐pro‐B‐type natriuretic peptide (NTproBNP) and antigen carbohydrate 125 (CA125) were increased (median NT‐proBNP 4969 pg/mL, IQR: 2508–9328; median CA125 46 U/L, IQR: 20–114). Conclusions SALT‐HF trial randomized 167 ambulatory patients with WHF and will determine whether an infusion of hypertonic saline therapy plus furosemide increases diuresis and improves decongestion compared to equivalent furosemide administration alone.
- Published
- 2024
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6. Resultados del seguimiento en una consulta monográfica tras el alta por insuficiencia cardiaca
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C. Josa Laorden, M. Sánchez Marteles, P. Sampériz Legarre, M. Nadal Ibor, V. Garcés Horna, R. Torres Cabrero, F. Ruiz Laiglesia, J.I. Pérez Calvo, B. Amores Arriaga, and J. Rubio Gracia
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,General Medicine ,business ,Humanities - Abstract
Resumen Introduccion A pesar de los avances en el diagnostico y el tratamiento, la insuficiencia cardiaca (IC) sigue teniendo una alta morbimortalidad. El tratamiento de las comorbilidades y la educacion sanitaria se han demostrado eficaces, asi como la atencion multidisciplinar, en unidades especializadas, aunque ello implica un esfuerzo organizativo y estructural no siempre disponible. Presentamos los resultados de una consulta ambulatoria simple, centrada en la atencion monografica a la IC. Pacientes y metodos La consulta incluyo a pacientes dados de alta tras una hospitalizacion (ingreso indice) por descompensacion de IC en el servicio de Medicina Interna. El seguimiento se realizo por internistas con especial dedicacion (no exclusiva) en IC y una enfermera con dedicacion compartida. El seguimiento consistio en visitas fijas 1, 3, 6 y 12 meses tras el alta, mas visitas a demanda en caso de necesidad. Resultados Se incluyo a 250 pacientes con un seguimiento minimo de un ano. La disminucion de los ingresos y las visitas a Urgencias por IC fue del 56 y el 61% (p Conclusion Un modelo sencillo basado en la atencion monografica a la IC es eficaz en la reduccion de reingresos y la optimizacion del tratamiento. La carencia de recursos asistenciales no deberia suponer un obstaculo para una atencion monografica a pacientes con IC.
- Published
- 2020
7. Follow-up results in a specialized consultation after discharge for heart failure
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R. Torres Cabrero, J. Rubio Gracia, C. Josa Laorden, B. Amores Arriaga, V. Garcés Horna, M. Nadal Ibor, P. Sampériz Legarre, M. Sánchez Marteles, F. Ruiz Laiglesia, and J.I. Pérez Calvo
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medicine.medical_specialty ,business.industry ,Follow up results ,General Medicine ,Emergency department ,After discharge ,medicine.disease ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,Multidisciplinary approach ,Heart failure ,Emergency medicine ,Health care ,Medicine ,Health education ,030212 general & internal medicine ,business - Abstract
Background Despite advances in the diagnosis and treatment of heart failure (HF), the condition still has high morbidity and mortality. Health education and the treatment of comorbidities have been shown to be effective, as has multidisciplinary care in specialized units, although this involves organizational and structural efforts that are not always feasible. We present the results of a simple outpatient consultation, focused on the specialized care of HF. Patients and methods The consultation included patients discharged after hospitalization (index hospitalization) for decompensated HF from an internal medicine department. The follow-up was conducted by internists especially dedicated (not exclusively) to HF and a nurse partially dedicated to HF. The follow-up consisted of fixed visits 1, 3, 6 and 12 months after the discharge, with more visits on demand if needed. Results A total of 250 patients were included with a minimum follow-up of 1 year. The reduction in hospitalisations and emergency department visits was 56% and 61% (p Conclusion A simple model based on a specialized care consultation for HF is effective in reducing readmissions and optimizing the treatment. The lack of healthcare resources should not be an obstacle for specialized care for patients with HF.
- Published
- 2020
8. Intraabdominal pressure and worsening renal function during decompensations of heart failure. A preliminary report from the PIA study
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J. Rubio-Gracia, I. Giménez-López, K. Damman, M. Sánchez-Marteles, V. Garcés-Horna, C. Josa-Laorden, M.L. de la Rica-Escuin, and J.I. Pérez-Calvo
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03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,General Medicine - Published
- 2019
9. Hemoconcentration as a prognostic factor after hospital discharge in acute heart failure in the RICA registry
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J. Grau Amorós, F. Formiga, O. Aramburu Bodas, A. Armengou Arxe, A. Conde Martel, M.A. Quesada Simón, R. Oropesa Juanes, J.A. Satué Bartolomé, M.F. Dávila Ramos, M. Montero Pérez-Barquero, L. Anarte, O. Aramburu, J.C. Arévalo-Lorido, A. Armengou, A. Brase, S. Carrascosa, M. Carrera, J. Casado, J.M. Cerqueiro, A. Conde, M.F. Dávila, J. Díez-Manglano, F. Epelde, J. Franco, J. Gallego, D. García-Escrivá, A. González-Franco, J. Grau, M.E. Guisado, A. Herrero, P. Llacer, G. López-Castellanos, L. Manzano, A. Martínez-Zapico, M. Montero-Pérez-Barquero, A. Muela, R. Oropesa, C. Pérez-Bocanegra, J.I. Pérez-Calvo, J. Pérez-Silvestre, M.A. Quesada, R. Quirós, E.E. Rodríguez-Ávila, F. Ruiz-Laiglesia, R. Ruiz-Ortega, P. Salamanca, M. Sánchez-Marteles, J.A. Satué, A. Serrado, I. Suárez, and J.C. Trullàs
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Prognostic factor ,medicine.medical_specialty ,Multivariate analysis ,business.industry ,General Medicine ,Hemoconcentration ,Lower risk ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Quartile ,Statistical significance ,Internal medicine ,Heart failure ,Medicine ,030212 general & internal medicine ,business ,Prospective cohort study - Abstract
Objective Several studies have reported that a higher degree of hemoconcentration in patients admitted for the treatment of acute heart failure (HF) constitutes a favorable prognostic factor in the year following the index episode. The objective of this study was to evaluate whether the highest degree of hemoconcentration at 3 months after admission for HF is also a prognostic factor for mortality and/or readmission in the 12 months after admission. Patients and method The hemoconcentration group was the upper quartile of the sample distributed according to hemoglobin increase at month 3 after discharge with respect to hemoglobin at the time of admission for HF in a multicenter prospective cohort of 1659 subjects with HF. Results The mean follow-up until the first event was 294 days, and a total of 487 deaths and 1125 readmissions were recorded. The hemoconcentration group had a lower risk of mortality or readmission for any cause (RR = 0.75, 95% CI: 0.51–1.09 and RR = 0.86, 95% CI: 0.70–1.05), although statistical significance was lost after multivariate analysis, while it was retained for other factors with recognized negative impact on the prognosis of patients with HF, such as age and functional class. Conclusions The degree of hemoconcentration at 3 months after admission for HF is not prognostic of readmission or death in the subsequent year.
- Published
- 2019
10. Hemoconcentración como predictor de supervivencia al año de ingreso por insuficiencia cardiaca aguda en el registro RICA
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J. Grau Amorós, F. Formiga, O. Aramburu Bodas, A. Armengou Arxe, A. Conde Martel, M.A. Quesada Simón, R. Oropesa Juanes, J.A. Satué Bartolomé, M.F. Dávila Ramos, M. Montero Pérez-Barquero, L. Anarte, O. Aramburu, J.C. Arévalo-Lorido, A. Armengou, A. Brase, S. Carrascosa, M. Carrera, J. Casado, J.M. Cerqueiro, A. Conde, M.F. Dávila, J. Díez-Manglano, F. Epelde, J. Franco, J. Gallego, D. García-Escrivá, A. González-Franco, J. Grau, M.E. Guisado, A. Herrero, P. Llacer, G. López-Castellanos, L. Manzano, A. Martínez-Zapico, M. Montero-Pérez-Barquero, A. Muela, R. Oropesa, C. Pérez-Bocanegra, J.I. Pérez-Calvo, J. Pérez-Silvestre, M.A. Quesada, R. Quirós, E.E. Rodríguez-Ávila, F. Ruiz-Laiglesia, R. Ruiz-Ortega, P. Salamanca, M. Sánchez-Marteles, J.A. Satué, A. Serrado, I. Suárez, and J.C. Trullàs
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,General Medicine ,business ,Humanities - Abstract
Resumen Objetivo Diferentes estudios senalan que la consecucion de una mayor hemoconcentracion en pacientes ingresados por insuficiencia cardiaca (IC) aguda mejora el pronostico a lo largo del ano siguiente al episodio indice. El objetivo de este estudio es evaluar si el grado de hemoconcentracion a los 3 meses tras el ingreso por IC tambien tiene valor pronostico de reingreso y/o mortalidad en los 12 meses siguientes al ingreso. Pacientes y metodo Cohorte prospectiva multicentrica de 1.659 pacientes con IC. El grupo hemoconcentracion (305 pacientes) se situo en el cuartil superior de la muestra distribuida en funcion del aumento de la hemoglobina en el mes 3 tras el alta con respecto a la hemoglobina en el ingreso por IC. Resultados Seguimiento medio hasta el primer evento fue de 294 dias, fallecieron 487 pacientes y reingresaron 1.125. El grupo hemoconcentracion mostro un riesgo menor de mortalidad o de reingreso por cualquier causa (RR = 0,75; IC 95%: 0,51-1,09 y RR = 0,86; IC 95%: 0,70-1,05), si bien la significacion estadistica se perdio tras el analisis multivariado. Sin embargo, esta significacion se mantuvo para otros factores con reconocido efecto negativo sobre el pronostico en pacientes con IC, como son la edad y la clase funcional. Conclusiones El grado de hemoconcentracion a los 3 meses tras el ingreso por IC no tiene valor pronostico de reingreso o muerte en el ano siguiente.
- Published
- 2019
11. Implicación de la congestión venosa sistémica en la insuficiencia cardíaca
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M. Sánchez Marteles, J. Rubio Gracia, and J.I. Pérez Calvo
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medicine.medical_specialty ,Pulmonary interstitium ,business.industry ,Renal function ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Venous congestion ,Heart failure ,medicine ,030212 general & internal medicine ,Intensive care medicine ,business - Abstract
Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment.
- Published
- 2017
12. Involvement of systemic venous congestion in heart failure
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M. Sánchez Marteles, J.I. Pérez Calvo, and J. Rubio Gracia
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medicine.medical_specialty ,Pulmonary interstitium ,business.industry ,Renal function ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Venous congestion ,Heart failure ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Intensive care medicine ,business - Abstract
Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment.
- Published
- 2017
13. Prognostic significance of acute kidney injury and small increases in creatinine concentration during acute decompensation of heart failure
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C, Josa-Laorden, I, Giménez-López, J, Rubio-Gracia, V, Garcés Horna, M, Sánchez-Marteles, and J I, Pérez-Calvo
- Abstract
Diagnosis of acute kidney injury (AKI) during acute decompensations of heart failure (ADHF) remain challenging. We analysed the incidence and prognosis of AKI, and the significance of small increases of creatinine, during ADHF and after stabilization.Patients admitted for ADHF were prospectively included. Creatinine was measured at admission, 48h thereafter and 24h before discharge. AKI was diagnosed when creatinine increased≥50% in 7 days (RIFLE criteria) or≥0.3mg/dL in 48h (AKIN criteria) during admission. Changes between baseline creatinine (measured within 3-month before admission) and one month after discharge were assessed, to seek for residual impairment of renal function and its significance.Two hundred and four patients were included. Incidence of AKI was 28.4% (n=58). Creatinine peaked by day 5 in patients with AKI vs. non-AKI (1.9 vs. 1.1mg/dL; P.000) and remained significantly higher among patients with AKI 3 months after discharge (increase of 20 vs. 4%; P=.013). Twelve-months mortality was associated with increases in cystatin C, NT-proBNP and AKI (15.5 vs. 44.8%, P.000), being the latter the most powerful independent predictor of death ?Exp(B)=5.34; P=.009?. Minor increases in creatinine (20% or 0.2mg/dL) during admission associated lesser 12-months survival (P=.033 and P=.019, respectively). Increases in creatinine≥10% between baseline and one month after discharge are associated with higher mortality (12.6 vs. 22.5%, P=.044).AKI is a strong predictor of mortality after ADHF. Minor increments in creatinine concentrations, below the accepted threshold for AKI definition, are prognostically meaningful.
- Published
- 2019
14. Follow-up results in a specialised consultation after discharge for heart failure
- Author
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B, Amores Arriaga, C, Josa Laorden, V, Garcés Horna, M, Sánchez Marteles, P, Sampériz Legarre, F, Ruiz Laiglesia, J, Rubio Gracia, R, Torres Cabrero, M, Nadal Ibor, and J I, Pérez Calvo
- Abstract
Despite advances in the diagnosis and treatment of heart failure (HF), the condition still has high morbidity and mortality. Health education and the treatment of comorbidities have been shown to be effective, as has multidisciplinary care in specialised units, although this involves organisational and structural efforts that are not always feasible. We present the results of a simple outpatient consultation, focused on the specialised care of HF.The consultation included patients discharged after hospitalisation (index hospitalisation) for decompensated HF from an internal medicine department. The follow-up was conducted by internists especially dedicated (not exclusively) to HF and a nurse partially dedicated to HF. The follow-up consisted of fixed visits 1, 3, 6 and 12 months after the discharge, with more visits on demand if needed.A total of 250 patients were included with a minimum follow-up of 1 year. The reduction in hospitalisations and emergency department visits was 56% and 61% (P.05), respectively, for HF and 46% and 40% (P.05), respectively, for any cause. Treatment optimisation was also achieved, with a significant increase in the evidence-based drug prescription rate and the reduction of other drugs, such as calcium antagonists.A simple model based on a specialised care consultation for HF is effective in reducing readmissions and optimising the treatment. The lack of healthcare resources should not be an obstacle for specialised care for patients with HF.
- Published
- 2019
15. Ausencia de implicación de la cistatina C en el remodelado ventricular y la insuficiencia cardiaca
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M.C. Asensio López, I. Lacambra Blasco, D.A. Pascual Figal, M. Sánchez Marteles, T. Castiella Muruzábal, C. Josa Laorden, M. Búcar Barjud, and Juan Ignacio Pérez-Calvo
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,General Medicine ,030204 cardiovascular system & hematology ,business ,Humanities - Abstract
La cistatina C (CisC) es una proteasa codificada por genes de mantenimiento («housekeeping genes»). Aunque su valor pronóstico en la insuficiencia cardiaca (IC) es bien conocido, se debate si es debido a su mayor precisión en la estimación del filtrado glomerular, o a su implicación en el remodelado ventricular patológico. El propósito de este estudio fue comprobar si la expresión de CisC se modificaba en el miocardio de fetos de diferentes edades y en el de adultos con diversas enfermedades cardiovasculares, así como analizar la correlación entre sus concentraciones séricas y la estructura y morfología cardiaca en un grupo de pacientes con IC.Pacientes y métodosSe analizaron las correlaciones (test de Pearson y Spearman) entre la CisC sérica y los parámetros ecocardiográficos de 351 pacientes con IC. También se realizó una tinción inmunohistoquímica para CisC, metaloproteinasa 9 (MMP-9) y desmina en 9 muestras de tejido cardiaco procedentes de las autopsias de 4 fetos con diferente edad gestacional y 5 adultos sanos o con enfermedad cardiovascular.ResultadosEn pacientes con IC no se encontró correlación entre las concentraciones de CisC y los parámetros cardiacos medidos por ecocardiografía 2 D. La inmunohistoquímica mostró una débil tinción de fondo para CisC en todas las muestras, independientemente de la edad y la presencia o no de enfermedades cardiovasculares.ConclusionesNuestros resultados sugieren que la CisC no tiene un papel significativo en el remodelado patológico del ventrículo izquierdo en la IC. Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF. Patients and methods We analysed the correlations (Pearson''s r and Spearman''s test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease. Results For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2 D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases. Conclusions Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF.
- Published
- 2016
16. Absence of cystatin C involvement in ventricular remodelling and heart failure
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C. Josa Laorden, D.A. Pascual Figal, M. Sánchez Marteles, Juan Ignacio Pérez-Calvo, T. Castiella Muruzábal, I. Lacambra Blasco, M.C. Asensio López, and M. Búcar Barjud
- Subjects
Fetus ,medicine.medical_specialty ,biology ,business.industry ,Renal function ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Cystatin C ,Ventricle ,Internal medicine ,Heart failure ,medicine ,biology.protein ,Cardiology ,Desmin ,030212 general & internal medicine ,Ventricular remodeling ,business ,Pathological - Abstract
Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodeling. The aim of this study was to determine whether CysC expression changes in the myocardium of fetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyze the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF. Patients and methods We analyzed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 fetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease. Results For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases. Conclusions Our results suggest that CysC does not have a significant role in the pathological remodeling of the left ventricle in HF.
- Published
- 2016
17. Fisiopatología de la insuficiencia cardiaca aguda: un mundo por conocer
- Author
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J. Rubio Gracia, I. Giménez López, and M. Sánchez-Marteles
- Subjects
03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,General Medicine ,030204 cardiovascular system & hematology ,business ,Humanities - Abstract
Resumen La comprension de los mecanismos fisiopatologicos de la insuficiencia cardiaca (IC) ha evolucionado mucho en los ultimos anos, pasando de una vision meramente hemodinamica a un concepto de afectacion sistemica y multifactorial en la que interaccionan y se concatenan multiples mecanismos, con efectos mas alla del propio corazon, en organos de vital importancia como el rinon, el higado o el pulmon. A pesar de lo anterior, la fisiopatologia de la IC aguda presenta todavia aspectos que escapan a una profunda comprension. La sobrecarga hemodinamica, la congestion venosa, los sistemas neurohormonales, los peptidos natriureticos, la inflamacion, el estres oxidativo y su repercusion sobre el remodelado cardiaco y vascular se consideran hoy actores principales en la IC aguda. Partiendo del concepto de IC aguda, en esta revision se actualizan los distintos mecanismos implicados en la misma.
- Published
- 2016
18. Pathophysiology of acute heart failure: A world to know
- Author
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M. Sánchez-Marteles, I. Giménez López, and J. Rubio Gracia
- Subjects
medicine.medical_specialty ,business.industry ,Inflammation ,General Medicine ,Disease ,Cardiorenal syndrome ,030204 cardiovascular system & hematology ,medicine.disease ,Pathophysiology ,Vascular remodelling in the embryo ,03 medical and health sciences ,0302 clinical medicine ,Venous congestion ,Heart failure ,medicine ,030212 general & internal medicine ,medicine.symptom ,Intensive care medicine ,business - Abstract
Our understanding of the pathophysiological mechanisms of heart failure (HF) has changed considerably in recent years, progressing from a merely haemodynamic viewpoint to a concept of systemic and multifactorial involvement in which numerous mechanisms interact and concatenate. The effects of these mechanisms go beyond the heart itself, to other organs of vital importance such as the kidneys, liver and lungs. Despite this, the pathophysiology of acute HF still has aspects that elude our deeper understanding. Haemodynamic overload, venous congestion, neurohormonal systems, natriuretic peptides, inflammation, oxidative stress and its repercussion on cardiac and vascular remodelling are currently considered the main players in acute HF. Starting with the concept of acute HF, this review provides updates on the various mechanisms involved in this disease.
- Published
- 2016
19. Intraabdominal pressure and worsening renal function during decompensations of heart failure. A preliminary report from the PIA study
- Author
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J, Rubio-Gracia, I, Giménez-López, K, Damman, M, Sánchez-Marteles, V, Garcés-Horna, C, Josa-Laorden, M L, de la Rica-Escuin, and J I, Pérez-Calvo
- Abstract
An increase in intraabdominal pressure (IAP) during acute heart failure, seems to be directly related to worsening renal function, which leads to worse clinical outcomes. We aimed to analyze the relationship between IAP and determinants of renal function during admission for acute decompensation of heart failure (ADHF) in a conventional Internal Medicine Ward.Descriptive and prospective study. Patients admitted for ADHF with an estimated glomerular filtration rate 30mL/min/1.73 mWe hereby report the results of an interim analysis of the first 28 patients included. Patients were divided in 2groups according to the median of IAP measured during the first 24h after admission for ADHF, namely high IAP (IAP15mmHg) and low (IAP15mmHg). Fourteen patients were included in each group. No differences were found in baseline clinical characteristics, comorbidities or treatment between both groups. Patients with IAP above 15mmHg, showed a significant lower baseline estimated glomerular filtration rate (70.7 vs. 44.4mL/min/1.73 mThe increase in IAP seems to be a frequent finding in patients admitted for ADHF. Patients share similar clinical profile irrespective of IAP, although the increase in IAP is associated with a significant baseline impairment of renal function.
- Published
- 2018
20. 77-year-old woman with pulse abnormalities
- Author
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J, Rubio-Gracia, M, Sánchez-Marteles, and M P, Burillo-Fuertes
- Published
- 2017
21. 77-year-old woman with pulse abnormalities
- Author
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J. Rubio-Gracia, M.P. Burillo-Fuertes, and M. Sánchez-Marteles
- Subjects
medicine.medical_specialty ,Pulse (signal processing) ,business.industry ,MEDLINE ,Medicine ,General Medicine ,Radiology ,business - Published
- 2018
22. Mujer de 77 años con anomalías en el pulso
- Author
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J. Rubio-Gracia, M.P. Burillo-Fuertes, and M. Sánchez-Marteles
- Subjects
business.industry ,Medicine ,General Medicine ,business ,Humanities - Published
- 2018
23. Absence of cystatin C involvement in ventricular remodelling and heart failure
- Author
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J I, Pérez-Calvo, T, Castiella Muruzábal, M, Búcar Barjud, C, Josa Laorden, M, Sánchez Marteles, I, Lacambra Blasco, M C, Asensio López, and D A, Pascual Figal
- Abstract
Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF.We analysed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease.For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases.Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF.
- Published
- 2015
24. Pathophysiology of acute heart failure: a world to know
- Author
-
M, Sánchez-Marteles, J, Rubio Gracia, and I, Giménez López
- Abstract
Our understanding of the pathophysiological mechanisms of heart failure (HF) has changed considerably in recent years, progressing from a merely haemodynamic viewpoint to a concept of systemic and multifactorial involvement in which numerous mechanisms interact and concatenate. The effects of these mechanisms go beyond the heart itself, to other organs of vital importance such as the kidneys, liver and lungs. Despite this, the pathophysiology of acute HF still has aspects that elude our deeper understanding. Haemodynamic overload, venous congestion, neurohormonal systems, natriuretic peptides, inflammation, oxidative stress and its repercussion on cardiac and vascular remodelling are currently considered the main players in acute HF. Starting with the concept of acute HF, this review provides updates on the various mechanisms involved in this disease.
- Published
- 2015
25. [Results of implementing a programme to improve the quality of the contents in hospital discharge reports in cases of heart failure]
- Author
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M P, Martín-Fortea, B, Amores-Arriaga, M, Sánchez-Marteles, F, Ruiz-Laiglesia, E, Clemente-Roldán, and J I, Pérez-Calvo
- Subjects
Aged, 80 and over ,Heart Failure ,Male ,Adrenergic beta-Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,Continuity of Patient Care ,Length of Stay ,Middle Aged ,Patient Readmission ,Quality Improvement ,Patient Discharge ,Data Accuracy ,Humans ,Female ,Hospital Mortality ,Angiotensin II Type 1 Receptor Blockers ,Diagnosis-Related Groups ,Aged ,Mineralocorticoid Receptor Antagonists ,Program Evaluation ,Retrospective Studies - Abstract
To analyse the information collected in hospital discharge reports (HDR) that are given to patients with a diagnosis of heart failure (HF), and demonstrate the improvement in the content of these reports after the introduction of an intervention.HDR with HF as the main diagnosis issued by the Department of Internal Medicine were analysed, and the presence of the diagnosis, prognosis and therapeutic data in these HDR was compared in a sample before and after the intervention, which consisted of reporting the results of analysis of the initial sample to the physicians.A total of 651 HDR (371 pre-intervention and 280 post-intervention) were analysed. Most of the HDR (over 70%) did not include the functional class. Most of the HDR did not include information about echocardiogram performed before the hospitalization period analysed, and most of the HDR that collected this information did not determine if the HF was diastolic or systolic. In the post-intervention sample there was a lower percentage of HDR that prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blocker ii (26% vs 32%, P.001). In 30% of the pre-intervention sample and 38% of the post-intervention sample there was indication of beta-blockers (P=.027).A short discussion with the physicians responsible for patients with HF improves the inclusion of important data on the diagnosis, prognosis and treatment in the HDR.
- Published
- 2014
26. Signo del tres invertido y pirosis
- Author
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B. Sierra Bergua, M. Sánchez Marteles, B. Amores Arriaga, M. Amores Ferreras, M.A. Torralba Cabeza, and J.I. Pérez Calvo
- Subjects
business.industry ,Medicine ,General Medicine ,business ,Humanities - Abstract
Se trata de un paciente varon de 62 anos de edad que ingresa en nuestro servicio procedente de Urgencias por presentar desde hace 2 meses pirosis retroesternal, astenia, hiporexia y perdida de 5 kilos. A la exploracion fisica destaca la palidez y la hepatomegalia de dos traveses dolorosa. Entre sus antecedentes destacan linfoma mediastinico hace 19 anos, con buena respuesta al tratamiento quimioterapico. En la analitica inicial hay anemia microcitica (hemoglobina: 7,5 g/dl, volumen corpuscular medio: 75,5 fl), con leucocitos y plaquetas normales. La velocidad de sedimentacion es de 86 mm en la primera hora, y las GOT, GPT, LDH y fosfatasa alcalina eran normales. Dada la clinica predominante, se realiza una fibrogastroscopia que objetiva una estenosis de la segunda porcion del duodeno que impide el paso del endoscopio y que ocasiona un estomago retencionista. El aspecto de la mucosa duodenal en dicha zona es sugestivo de infiltracion, y se toman biopsias. El Servicio de Endoscopia recomienda la realizacion de un transito gastroduodenal que confirma la estenosis duodenal con traccion, descrito clasicamente como el signo del tres invertido (fig. 1) o signo de Frostberg, y una tomografia axial computarizada (TAC) abdominal.
- Published
- 2008
27. [NT-proBNP in chronic obstructive pulmonary disease patients]
- Author
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M, Sánchez-Marteles, A, Cecilio-Irazola, D, Vañó-Sanchis, R, Nuviala-Mateo, S, Serrano-Martínez, and J J, Pérez-Calvo
- Subjects
Aged, 80 and over ,Male ,Pulmonary Disease, Chronic Obstructive ,Natriuretic Peptide, Brain ,Humans ,Female ,Prospective Studies ,Middle Aged ,Peptide Fragments ,Aged - Abstract
Brain natriuretic peptide (BNP) is produced and released mainly from ventricles. It has several physiological actions. BNP has been shown to be useful for diagnosis and prognosis in heart failure. The aim of this study is to analyse NT-proBNP levels in chronic obstructive pulmonary disease (COPD) patients and to distinguish factors which could modify these levels.A descriptive and prospective study was made. COPD patients admitted due to acute exacerbation of this disease at the Hospital Universitario Lozano Blesa (Zaragoza, Spain) were included from November 1st 2004 to May 1st 2007. We included 99 patients; they had not suffered heart failure and they did not present any exclusion criteria. Blood samples were taken to determine NT-proBNP concentrations.Mean age was 74 years and 79% of patients were men. Medium value of NT-proBNP was 1289 pg/ml. Mean body mass index (BMI) was 27.19. There were significant differences between NT-proBNP in patients with or without atrial fibrillation and depending on their age, but there were no differences between men and women nor between patients with or without renal insufficiency.COPD patients present high serum levels of NT-proBNP during acute exacerbations and these are modified with age and atrial fibrillation. NT-proBNP could be a prognostic factor identifying COPD patients at special risk, or with a worsening clinical evolution.
- Published
- 2009
28. NT-proBNP en pacientes con enfermedad pulmonar obstructiva crónica
- Author
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S. Serrano-Martínez, M. Sánchez-Marteles, J.I. Pérez-Calvo, A. Cecilio-Irazola, D. Vañó-Sanchis, and R. Nuviala-Mateo
- Subjects
medicine.medical_specialty ,COPD ,Exacerbation ,business.industry ,Atrial fibrillation ,General Medicine ,Disease ,medicine.disease ,Brain natriuretic peptide ,Enfermedad pulmonar obstructiva crónica (EPOC) ,Heart failure ,Internal medicine ,medicine ,Cardiology ,cardiovascular diseases ,Prospective cohort study ,business ,Body mass index ,hormones, hormone substitutes, and hormone antagonists ,Insuficiencia cardiaca ,BNP - Abstract
Introducción. El péptido natriurético cerebral (BNP) es un péptido de producción fundamentalmente ventricular, con múltiples acciones fisiológicas, cuyo principal uso clínico es el diagnóstico y estratificación pronóstica de la insuficiencia cardiaca. El presente trabajo tiene por objeto analizar las concentraciones de NT-proBNP en una población con enfermedad pulmonar obstructiva crónica (EPOC) y su correlación con algunos parámetros que las modifican en condiciones normales. Material y métodos. Estudio descriptivo, prospectivo, en el que se incluyeron de forma consecutiva pacientes con EPOC ingresados en el servicio de Medicina Interna del H.C.U. "Lozano Blesa" de Zaragoza, del 1 de noviembre de 2004 al 1 de mayo de 2007, por una reagudización de su enfermedad, sin insuficiencia cardiaca y sin criterios de exclusión. Se incluyeron 99 pacientes, a los que se les extrajo sangre en las primeras 72 horas para analizar NT-proBNP. Resultados. La edad media fue de 74 años, el 79% fueron hombres. El valor medio del NT-proBNP fue de 1.289 pg/ml. El índice de masa corporal (IMC) medio fue de 27,19. Se encontraron diferencias estadísticamente significativas en las concentraciones de NT-proBNP en relación con la presencia o ausencia de fibrilación auricular y la edad, pero no hubo modificaciones con relación al sexo, IMC o la presencia de insuficiencia renal. Conclusiones. Los pacientes con EPOC presentan concentraciones elevadas de NT-proBNP durante las reagudizaciones, que se modifican en función de la edad y de la coexistencia o no de fibrilación auricular. Ello podría tener un valor pronóstico, constituyendo una herramienta de selección de los pacientes de riesgo o con peor evolución.
- Published
- 2009
29. [Inverted 3-sign and pyrosis]
- Author
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B, Amores Arriaga, M A, Torralba Cabeza, M, Sánchez Marteles, B, Sierra Bergua, J I, Pérez Calvo, and M, Amores Ferreras
- Subjects
Male ,Pancreatic Neoplasms ,Radiography ,Heartburn ,Carcinoma ,Humans ,Middle Aged - Published
- 2008
30. Hipernefroma sobre riñón en herradura
- Author
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J. Navarro Calzada, M. Sánchez Marteles, B Sierra Verruga, and J Navarro Gil
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Internal Medicine ,Carcinoma ,Medicine ,Horseshoe kidney ,business ,medicine.disease ,Kidney abnormalities - Published
- 2008
31. Tratamiento del tétanos con baclofeno intratecal
- Author
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B. Zalba Etayo, J. L. Cabrerizo García, C. Homs Gimeno, G. Pacheco Arancibia, and M. Sánchez Marteles
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Internal Medicine ,medicine ,business - Published
- 2008
32. Combining Loop and Thiazide Diuretics Across the Left Ventricular Ejection Fraction Spectrum: The CLOROTIC Trial.
- Author
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Sánchez-Marteles M, Garcés-Horna V, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Conde-Martel A, Dávila-Ramos MF, Llácer P, Salamanca-Bautista P, Ruiz R, Aramburu-Bodas O, Formiga F, Manzano L, and Trullàs JC
- Subjects
- Humans, Male, Female, Double-Blind Method, Aged, Middle Aged, Drug Therapy, Combination, Ventricular Function, Left drug effects, Ventricular Function, Left physiology, Treatment Outcome, Diuretics administration & dosage, Diuretics therapeutic use, Heart Failure drug therapy, Heart Failure physiopathology, Stroke Volume physiology, Furosemide administration & dosage, Furosemide therapeutic use, Hydrochlorothiazide administration & dosage, Hydrochlorothiazide therapeutic use, Sodium Potassium Chloride Symporter Inhibitors administration & dosage, Sodium Potassium Chloride Symporter Inhibitors therapeutic use, Sodium Chloride Symporter Inhibitors therapeutic use, Sodium Chloride Symporter Inhibitors administration & dosage
- Abstract
Background: The addition of hydrochlorothiazide (HCTZ) to furosemide in the CLOROTIC (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure) trial improved the diuretic response in patients with acute heart failure (AHF)., Objectives: This work aimed to evaluate if these results differ across the spectrum of left ventricular ejection fraction (LVEF)., Methods: This post hoc analysis of the randomized, double-blind, placebo-controlled CLOROTIC trial enrolled 230 patients with AHF to receive either HCTZ or a placebo in addition to an intravenous furosemide regimen. The influence of LVEF on primary and secondary outcomes was evaluated., Results: The median LVEF was 55%: 166 (72%) patients had LVEF >40%, and 64 (28%) had LVEF ≤40%. Patients with a lower LVEF were younger, more likely to be male, had a higher prevalence of ischemic heart disease, and had higher natriuretic peptide levels. The addition of HCTZ to furosemide was associated with the greatest weight loss at 72 of 96 hours, better metrics of diuretic response, and greater 24-hour diuresis compared with placebo, with no significant differences according to the LVEF category (using 2 LVEF cutoff points: 40% and 50%) or LVEF as a continuous variable (all P values were insignificant). There were no significant differences observed with the addition of HCTZ in terms of mortality, rehospitalizations, or safety endpoints (impaired renal function, hyponatremia, and hypokalemia) among the 2 LVEF groups (all P values were insignificant)., Conclusions: Adding HCTZ to intravenous furosemide seems to be effective strategy for improving diuretic response in AHF without treatment effect modification according to baseline LVEF. (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure [CLOROTIC], NCT01647932; Randomized, double blinded, multicenter study, to asses Safety and Efficacy of the Combination of Loop With Thiazide-type Diuretics vs Loop diuretics with placebo in Patients With Decompensated, EudraCT Number 2013-001852-36)., Competing Interests: Funding Support and Author Disclosures This work was supported by the Heart Failure Working Group of the Spanish Society of Internal Medicine. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
33. The RICA-2 registry: design and baseline characteristics of the first 1,000 patients.
- Author
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Trullàs JC, Moreno-García MC, Mittelbrunn-Alquézar V, Conde-Martel A, Soler-Rangel L, Montero-Pérez-Barquero M, Casado J, Sánchez-Marteles M, Arévalo-Lorido JC, and Pérez-Silvestre J
- Subjects
- Humans, Female, Male, Prospective Studies, Aged, Aged, 80 and over, Spain epidemiology, Middle Aged, Registries, Heart Failure epidemiology
- Abstract
Background and Objective: Heart failure (HF) is a syndrome of epidemic proportions and one of the main reasons for hospital admission. Patient registries provide real-world clinical practice information which is complementary to clinical trials. RICA-2 is a registry of the Spanish Society of Internal Medicine. Its main goal is to know the clinical and epidemiological characteristics and prognostic factors of patients with HF treated in Internal Medicine Departments. The objective of this study is to present the design of the RICA-2, the baseline characteristics of the first 1000 patients included and their comparison with those of the historical cohort of the RICA registry., Methods: Observational, multicentre and prospective study of patients with HF with the following inclusion criteria: age equal to or greater than 18 years old, diagnosis of HF according to the European Guidelines, indistinct inclusion in decompensation or stable phase, of patients with de novo HF or chronic HF, regardless of left ventricular ejection fraction, aetiology and comorbidities., Results: RICA-2 patients have advanced age (83 years old) and 51% are women. The comorbidity burden is higher than in the RICA registry (5 points in the Charlson comorbidity index), with predominating chronic decompensated HF (74%), hypertensive aetiology (39%) and preserved ejection fraction (52%). Most patients are pre-frail or vulnerable and are at risk of malnutrition., Conclusion: The RICA-2 represents a contemporary cohort of patients that will provide us with clinical, epidemiological and prognostic information on patients with acute and chronic HF treated in Internal Medicine., (Copyright © 2024 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
34. Prognostic Impact of Induced Natriuresis in Acute Decompensated Heart Failure and Its Association with Intraabdominal Pressure and Other Congestion Markers: A Multimodal Approach to Congestion Assessment.
- Author
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Crespo-Aznarez S, Campos-Saenz de Santamaría A, Sánchez-Marteles M, Josa-Laorden C, Ruiz-Laiglesia F, Amores-Arriaga B, Garcés-Horna V, Tejel-Puisac R, Julián-Ansón MA, Giménez-López I, Pérez-Calvo JI, and Rubio-Gracia J
- Abstract
Background: Congestion is an essential issue in patients with heart failure (HF). Standard treatments do not usually achieve decongestion, and various strategies have been proposed to guide treatment, such as determination of natriuresis. After starting treatment with loop diuretics, we postulate that initial natriuresis might help treatment titration, decongestion, and improve prognosis., Methods: It was a prospective and observational study. Patients admitted with the diagnosis of HF decompensation were eligible. An assessment of congestion was performed during the first 48 h., Results: A total of 113 patients were included. A poor diuretic response was observed in 39.8%. After the first 48 h, patients with a greater diuretic response on admission (NaU > 80 mmol/L) showed fewer pulmonary b lines (12 vs. 15; p = 0.084), a lower IVC diameter (18 mm vs. 22 mm; p = 0.009), and lower IAP figures (11 mmHg vs. 13 mmHg; p = 0.041). Survival analysis tests demonstrated significant differences showing a higher proportion of all-cause mortality (ACM) and HF rehospitalization in the poor-diuretic-response group (log-rank test = 0.020)., Conclusions: Up to 40% of the patients presented a poorer diuretic response at baseline, translating into worse outcomes. Patients with an optimal diuretic response showed significantly higher abdominal decongestion at 48 h and a better prognosis regarding ACM and/or HF rehospitalizations., Competing Interests: The authors declare no conflicts of interest.
- Published
- 2024
- Full Text
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35. Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial.
- Author
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Conde-Martel A, Trullàs JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Sánchez-Marteles M, Llácer P, Salamanca-Bautista P, Manzano L, and Formiga F
- Subjects
- Female, Humans, Male, Sodium Chloride Symporter Inhibitors therapeutic use, Stroke Volume, Sex Characteristics, Ventricular Function, Left, Diuretics therapeutic use, Hydrochlorothiazide therapeutic use, Furosemide therapeutic use, Heart Failure drug therapy
- Abstract
Aims: The addition of hydrochlorothiazide (HCTZ) to furosemide improved the diuretic response in patients with acute heart failure (AHF) in the CLOROTIC trial. Our aim was to evaluate if there were differences in clinical characteristics and outcomes according to sex., Methods: This is a post-hoc analysis of the CLOROTIC trial, including 230 patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The primary and secondary outcomes included changes in weight and patient-reported dyspnoea 72 and 96 h after randomization, metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. The influence of sex on primary, secondary and safety outcomes was evaluated., Results: One hundred and eleven (48%) women were included in the study. Women were older and had higher values of left ventricular ejection fraction. Men had more ischemic cardiomyopathy and chronic obstructive pulmonary disease and higher values of natriuretic peptides. The addition of HCTZ to furosemide was associated to a greatest weight loss at 72/96 h, better metrics of diuretic response and higher 24-h diuresis compared to placebo without significant differences according to sex (all p-values for interaction were not significant). Worsening renal function occurred more frequently in women (OR [95%CI]: 8.68 [3.41-24.63]) than men (OR [95%CI]: 2.5 [0.99-4.87]), p = 0.027. There were no differences in mortality or rehospitalizations at 30/90 days., Conclusion: Adding HCTZ to intravenous furosemide is an effective strategy to improve diuretic response in AHF with no difference according to sex, but worsening renal function was more frequent in women., Clinical Trial Registration: Clinicaltrials.gov: NCT01647932; EudraCT Number: 2013-001852-36., (Copyright © 2024 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
36. Combining loop and thiazide diuretics for acute heart failure across the estimated glomerular filtration rate spectrum: A post-hoc analysis of the CLOROTIC trial.
- Author
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Trullàs JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Sánchez-Marteles M, Conde-Martel A, Dávila-Ramos MF, Llácer P, Salamanca-Bautista P, Chivite D, Jordana-Comajuncosa R, Villalonga M, Páez-Rubio MI, Manzano L, and Formiga F
- Subjects
- Humans, Diuretics therapeutic use, Furosemide therapeutic use, Glomerular Filtration Rate, Hydrochlorothiazide therapeutic use, Sodium Chloride Symporter Inhibitors therapeutic use, Heart Failure
- Abstract
Aims: In patients with acute heart failure (AHF), the addition of hydrochlorothiazide (HCTZ) to furosemide improved diuretic response in the CLOROTIC trial. This work aimed to evaluate if these effects differ across the estimated glomerular filtration rate (eGFR) spectrum., Methods and Results: This post-hoc analysis of the CLOROTIC trial analysed 230 patients with AHF and explored the influence of eGFR on primary and secondary endpoints. The median eGFR was 43 ml/min/1.73 m
2 (range 14-109) and 23% had eGFR ≥60 ml/min/1.73 m2 (group 1), 24% from 45 to 59 ml/min/1.73 m2 (group 2), and 53% <45 ml/min/1.73 m2 (group 3). Patients treated with HCTZ had greatest weight loss at 72 h in all three groups, but patients in group 1 had a significantly greater response (-2.1 kg [-3.0 to 0.5]), compared to patients in groups 2 (-1.3 kg [-2.3 to 0.2]) and 3 (-0.1 kg [-1.3 to 0.4]) (p-value for interaction = 0.246). At 96 h, the differences in weight were -1.8 kg (-3.0 to -0.3), -1.4 kg (-2.6 to 0.3), and -0.5 kg (-1.3 to -0.1) in groups 1, 2, and 3, respectively (p-value for interaction = 0.256). There were no significant differences observed with the addition of HCTZ in terms of diuretic response, mortality or rehospitalizations, or safety endpoints (impaired renal function, hyponatraemia, and hypokalaemia) among the three eGFR groups (all p-values for interaction were no significant)., Conclusion: The addition of eGFR-adjusted doses of oral HCTZ to loop diuretics in patients with AHF improved diuretic response across the eGFR spectrum., Clinical Trial Registration: ClinicalTrials.gov: NCT01647932; EudraCT number: 2013-001852-36., (© 2023 European Society of Cardiology.)- Published
- 2023
- Full Text
- View/download PDF
37. The Association Between Intra-abdominal Pressure and Diuretic Response in Heart Failure.
- Author
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Crespo-Aznarez S, Campos-Sáenz de Santamaría A, Sánchez-Marteles M, Garcés-Horna V, Josa-Laorden C, Giménez-López I, Pérez-Calvo JI, and Rubio-Gracia J
- Abstract
Purpose of the Review: An efficient diuretic response is vital during cardiac decompensation in heart failure (HF) patients. The increase in intra-abdominal pressure (IAP) could be one of the keys for understanding cardiorenal syndrome and guiding diuretic treatment during hospitalization. In this review, we analyze the relationship between IAP and diuretic response in HF patients., Recent Findings: Increased IAP is associated with worsening renal function (WRF) in patients with advanced HF. Furthermore, the persistence of a rise in IAP after the first 72 h of intravenous diuretic treatment has been correlated with a worse diuretic response, a higher degree of congestion, and an impaired prognosis. The rise in IAP in HF patients has been associated with impaired renal function and a lower diuretic response. Nonetheless, more studies are needed to elucidate the actual role of IAP in congestive nephropathy and whether it may help guide diuretic therapy during acute decompensations., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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38. Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry.
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Bravo Candela I, Moya González N, Salamanca Bautista P, Pérez Silvestre J, Conde Martel A, Carrascosa García S, Sánchez Marteles M, Cerqueiro González JM, Casado Cerrada J, and Montero-Pérez-Barquero M
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- Humans, Female, Aged, Aged, 80 and over, Male, Blood Pressure physiology, Stroke Volume physiology, Prognosis, Registries, Ventricular Function, Left physiology, Heart Failure
- Abstract
Background and Aims: The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF., Material and Methods: This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission., Results: A total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21-2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels., Conclusions: Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients., (Copyright © 2023. Published by Elsevier España, S.L.U.)
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- 2023
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39. Clinical characteristics of heart failure patients with mid-range ejection fraction.
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Gracia Gutiérrez A, Grados Saso D, Esteban Cabello EI, Salas Trigo EM, Sánchez Marteles M, Garcés Horna V, Ioakeim-Skoufa I, Gimeno-Miguel A, Prados-Torres A, and Ruiz Laiglesia FJ
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- Male, Humans, Female, Stroke Volume, Ventricular Function, Left, Prognosis, Comorbidity, Heart Failure diagnosis, Heart Failure epidemiology
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Background: We aimed to characterise and compare the clinical profile of heart failure (HF) with mid-range (HFmrEF), reduced (HFrEF) and preserved (HFpEF) left-ventricular ejection fraction., Methods: We conducted a descriptive, observational study in 267 HF patients admitted to the Internal Medicine department of a tertiary hospital during 2010-2016. The study population was divided into three groups according to the ejection fraction rate: HFrEF (<40%), HFmrEF (40-49%), and HFpEF (≥50%). We analysed and compared their demographic, clinical, and analytical characteristics., Results: The mean age of the study population was 79.5 (standard deviation, 8.14) years; 56.6% were males. The most common phenotype was HFpEF (58.1%), followed by HFrEF (21.7%) and HFmrEF (20.2%). Ischaemic cardiopathy was the primary aetiology in the HFmrEF and HFrEF groups, and arterial hypertension in the HFpEF group. The most common comorbidities among HFmrEF patients were diabetes (43.4%), chronic obstructive pulmonary disease (35.8%), and anaemia (35.8%); 49.1% had impairment of segmental myocardial contractility, and 35.8% ventricular dilatation. No differences in HF outcomes were observed among the three phenotypes., Conclusion: HFmrEF shows characteristics similar to both HFpEF and HFrEF. Further large-scale studies with longer follow-up are needed to ascertain if it is worth distinguishing this phenotype in clinical practice in terms of management and prognosis.
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- 2023
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40. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial.
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Trullàs JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Sánchez-Marteles M, Conde-Martel A, Dávila-Ramos MF, Llácer P, Salamanca-Bautista P, Pérez-Silvestre J, Plasín MÁ, Cerqueiro JM, Gil P, Formiga F, and Manzano L
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- Humans, Female, Furosemide therapeutic use, Sodium Chloride Symporter Inhibitors therapeutic use, Prospective Studies, Diuretics therapeutic use, Diuretics adverse effects, Hydrochlorothiazide therapeutic use, Dyspnea, Hypokalemia chemically induced, Hypokalemia complications, Heart Failure
- Abstract
Aims: To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF)., Methods and Results: A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48 women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [2.3 vs. 1.5 kg; adjusted estimated difference (notionally 95 confidence interval) 1.14 (1.84 to 0.42); P 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine 26.5 moL/L or decrease in eGFR 50; 46.5 vs. 17.2; P 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations., Conclusion: The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF., Competing Interests: Conflict of interest: All authors declare no conflict of interest for this contribution., (The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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41. Comparative analysis of chest radiography and lung ultrasound to predict intra-hospital prognosis of patients admitted for acute SARS-CoV-2 pneumonia (COVID-19).
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Rubio-Gracia J, Ibáñez-Muñoz D, Giménez-López I, Garcés-Horna V, López-Delgado D, Sierra-Monzón JL, Crespo-Aznarez S, Peña-Fresneda N, Pérez-Calvo JI, and Sánchez-Marteles M
- Abstract
Background: Point of care lung ultrasound (POCUS) has been recently used to assess prognosis in COVID-19 patients. However, there are no data comparing POCUS and chest-X ray, a technique widely used., Patients and Methods: Retrospective analysis in stable COVID-19 patients. Schalekamp radiological lung scale and LUZ-Score ultrasound scale were compared. Primary end-point was in-hospital death and/or need for Intensive Care Unit admission., Results: A total of 138 patients were included. Median Schalekamp scale was 2 (2) and median LUZ-Score scale was 21 (10). No significant correlation was observed between both techniques. Patients with a LUZ-Score ≥ 21 points at admission had worse lung function and higher concentrations of LDH, CRP and Interleuquine-6. Schalekamp scale failed to identify patients at a higher risk at admission for the primary end-point. Addition of POCUS to a previous clinical model, improved risk prediction (AUC 0.805 [95% CI: 0.662-0.948]; P = <0.001)., Conclusions: Chest X-ray and POCUS showed no correlation at admission in this analysis. Only POCUS identified a group of patients with greater clinical and analytical involvement. POCUS improved, previous clinical model, while chest X-ray did not add relevant predictive information for the primary endpoint., (© 2022 Elsevier España, S.L.U. All rights reserved.)
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- 2022
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42. Effectiveness of sacubitril-varsartan versus angiotensin converting enzyme inhibitors in patients hospitalized for acute heart failure: a retrospective cohort study of the RICA registry.
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Soler-Rangel L, Méndez-Bailón M, Pérez-Silvestre J, Fernández-Rodríguez JM, García BC, Argüelles-Curto A, González-Franco Á, Conde-Martel A, Carrascosa-García S, Sánchez-Marteles M, Cerqueiro-González JM, Lorenzo-Villalba N, and Montero-Pérez-Barquero M
- Abstract
Background: Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure (HF) and reduced ejection fraction. The PIONEER-HF trial demonstrated that initiation of the drug during acute HF hospitalization reduced NT-proBNP levels and a post-hoc analysis of the trial found a reduction in HF hospitalizations and deaths. Real-life studies in the elderly population are scarce. The aim of our study was to assess the effectiveness of sacubitril-valsartan versus angiotensin converting enzyme inhibitors (ACEI) in elderly patients who initiate this treatment during hospitalization for acute HF., Methods: We conducted a retrospective cohort study using the Spanish acute heart failure registry (RICA) comparing rehospitalizations and deaths at 3 months and 1 year among patients aged 70 years or older who had initiated treatment with sacubitril-valsartan during hospitalization for acute HF versus those treated with ACEI., Results: One hundred and ninety-nine patients hospitalized between October 2016 and November 2020 were included, with a median age of 82 years and high rate of comorbidity. Of these, 107 were treated with sacubitril-valsartan and 92 with ACEI. The adjusted OR for readmission for HF at 3 months was 0.906 (95% CI: 0.241-3.404) and for the combined variable readmission for HF or death at 3 months was 0.696 (95% CI: 0.224-2.167). The adjusted OR for HF readmission at one year was 0.696 (95% CI: 0.224 -2.167). and for the combined variable HF readmission or death at one year 0.724 (95% CI: 0.325-1.612)., Conclusion: Treatment with sacubitril-valsartan initiated early in hospitalization for HF in elderly patients with high comorbidity was associated with a trend towards a reduction in readmissions and death due to HF compared to treatment with ACEI, which did not reach statistical significance either at 3 months or 1 year of follow-up., (© 2022 JGC All rights reserved; www.jgc301.com.)
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- 2022
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43. Elevated urinary kidney injury molecule 1 at discharge strongly predicts early mortality following an episode of acute decompensated heart failure.
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Josa-Laorden C, Rubio-Gracia J, Sánchez-Marteles M, Torcal P, Garcés-Horna V, Sola-Martínez A, Íñigo P, Giménez-López I, and Pérez-Calvo JI
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- Biomarkers, Creatinine, Cystatin C, Gelatinases, Humans, Interleukin-18, Kidney, Lipocalin-2 urine, Patient Discharge, Prospective Studies, Urea, Acute Kidney Injury, Heart Failure
- Abstract
Introduction: Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long‑term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization., Objectives: The study aimed to determine whether kidney damage biomarkers neutrophil gelatinase‑associatedlipocalin (NGAL), kidney injury molecule 1 (KIM‑1), and interleukin18 (IL‑18) might predict AKI and have prognostic value in ADHF., Patients and Methods: Serum NGAL on admission and urine NGAL, KIM‑1, and IL‑18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. Patients were followedfor 12 months to record all‑cause mortality., Results: A total of 22% patients died during the follow‑up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM‑1 (P = 0.014) levels were significantly higher in the deceased patients at discharge. After adjustment for estimated glomerular filtration rate (eGFR), only urinary KIM‑1 independently predicted mortality at month 4 (hazard ratio [HR], 3.166; 95% CI, 1.203-8.334; P = 0.020) and month 12 (HR, 1.969; 95% CI, 1.123-3.454; P = 0.018) in Cox regression models. In receiver operating characteristic (ROC) analysis urinary KIM‑1 (area under the ROC curve [AUC] = 0.830) outperformed other markers of renal function. The Kaplan-Meier survival analysis showed KIM‑1 predictive value as additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P ≤0.001) with a modest diagnostic performance (AUC = 0.667), below that of urea (AUC = 0.732), creatinine (AUC = 0.696), or cystatin C (AUC = 0.676)., Conclusions: Discharge urinary KIM‑1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF.
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- 2022
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44. Utility of plasma CA125 as a proxy of intra-abdominal pressure in patients with acute heart failure.
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Rubio-Gracia J, Crespo-Aznarez S, De la Espriella R, Nuñez G, Sánchez-Marteles M, Garcés-Horna V, Yanguas-Barea N, Josa-Laorden C, Cobo-Marcos M, Giménez-López I, Pérez-Calvo JI, and Nuñez J
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- Aged, Aged, 80 and over, Carbohydrates, Female, Humans, Male, Stroke Volume, Ventricular Function, Left, Heart Failure, Intra-Abdominal Hypertension diagnosis
- Abstract
Aims: Increased intra-abdominal pressure (IAP) is now considered a potential contributor to organ damage and disease progression in acute heart failure (AHF). In this work, we aimed to determine if antigen carbohydrate 125 (CA125) is associated with IAP and to identify a cutpoint of CA125 useful for ruling out intra-abdominal hypertension (defined as IAP ≥ 12 mmHg)., Methods and Results: We prospectively evaluated a cohort of 53 patients admitted with AHF in which IAP was measured within the first 24-h of admission. The mean age was 80 ± 8 years, 31 (58.5%) were female, and 31 (58.5%) had left ventricular ejection fraction ≥50%. The median plasma levels of NT-proBNP and CA125 were 3830 pg/mL (2417-8929) and 45.8 U/mL (29.8-114.0), respectively. The median of IAP was 15 mmHg (11-17), and 39 (73%) patients had an IAP ≥ 12 mmHg. The diagnostic performance of CA125 for identifying an IAP ≥ 12 mmHg was tested using the receiving operating characteristic (ROC) curve. The cut-off for CA125 of 17.1 U/mL showed a sensitivity of 92%, a specificity of 50%, and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with higher IAP (P-value = 0.003), explaining almost 28% of the model's variability (R2: 27.6%)., Conclusions: Patients with AHF and intra-abdominal hypertension had higher CA125 plasma levels. A baseline concentration of CA125 below 17.1 U/mL will increase the odds of identifying a subset of patients with normal IAP., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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45. Multiple Approaches at Admission Based on Lung Ultrasound and Biomarkers Improves Risk Identification in COVID-19 Patients.
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Rubio-Gracia J, Sánchez-Marteles M, Garcés-Horna V, Martínez-Lostao L, Ruiz-Laiglesia F, Crespo-Aznarez S, Peña-Fresneda N, Gracia-Tello B, Cebollada A, Carrera-Lasfuentes P, Pérez-Calvo JI, and Giménez-López I
- Abstract
Background: Risk stratification of COVID-19 patients is fundamental to improving prognosis and selecting the right treatment. We hypothesized that a combination of lung ultrasound (LUZ-score), biomarkers (sST2), and clinical models (PANDEMYC score) could be useful to improve risk stratification., Methods: This was a prospective cohort study designed to analyze the prognostic value of lung ultrasound, sST2, and PANDEMYC score in COVID-19 patients. The primary endpoint was in-hospital death and/or admission to the intensive care unit. The total length of hospital stay, increase of oxygen flow, or escalated medical treatment during the first 72 h were secondary endpoints., Results: a total of 144 patients were included; the mean age was 57.5 ± 12.78 years. The median PANDEMYC score was 243 (52), the median LUZ-score was 21 (10), and the median sST2 was 53.1 ng/mL (30.9). Soluble ST2 showed the best predictive capacity for the primary endpoint (AUC = 0.764 (0.658-0.871); p = 0.001), towards the PANDEMYC score (AUC = 0.762 (0.655-0.870); p = 0.001) and LUZ-score (AUC = 0.749 (0.596-0.901); p = 0.002). Taken together, these three tools significantly improved the risk capacity (AUC = 0.840 (0.727-0.953); p ≤ 0.001)., Conclusions: The PANDEMYC score, lung ultrasound, and sST2 concentrations upon admission for COVID-19 are independent predictors of intra-hospital death and/or the need for admission to the ICU for mechanical ventilation. The combination of these predictive tools improves the predictive power compared to each one separately. The use of decision trees, based on multivariate models, could be useful in clinical practice.
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- 2021
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46. Prognostic value of malnutrition in patients with acute heart failure and its influence on the interpretation of markers of systemic venous congestion.
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Rubio-Gracia J, Josa-Laorden C, Sánchez-Marteles M, Giménez-López I, Garcés Horna V, Morales Rull JL, and Pérez-Calvo JI
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- Humans, Nutrition Assessment, Nutritional Status, Prognosis, Retrospective Studies, Heart Failure complications, Hyperemia, Malnutrition diagnosis
- Abstract
Background: Malnutrition is frequent in patients with heart failure (HF) and contributes to increased systemic congestion, but also hinders its correct assessment, especially during decompensations. Estimating the degree of malnutrition and its relationship with systemic congestion is important to optimize treatment during decompensations., Material and Methods: Retrospective cohort study in patients with acute HF. The population was stratified according to CONUT (Controlling Nutritional Status) and PNI (Prognostic Nutritional Index) nutrition indices in order to analyse their relationship with objective parameters of congestion and the prognostic value of malnutrition., Results: 309 patients were included. More than half presented some degree of malnutrition upon admission. The degree of congestion was significantly higher in malnourished patients, with a higher proportion of «comet tail artifacts» and a higher relative plasma volume. NT-proBNP concentrations, both on admission and at discharge, were also significantly higher in malnourished patients, regardless of the scale used. The univariate analysis identified the CONUT and PNI index as factors associated with one-year mortality from any cause (HR 1.62 [1.22-2.14]; p = 0.001) and PNI (HR 65 [0.53-0.80]; p = < 0.001), respectively., Conclusions: A higher degree of malnutrition (determined by means of the CONUT and PNI indices) in patients with acute HF was associated with a higher presence of objective parameters of congestion and a higher one-year all-cause mortality., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)
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- 2021
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47. COVID was not to blame.
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Agudo-Tabuenca A, Morales Campoverde KG, García García MB, Peteiro Miranda CM, and Sánchez Marteles M
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- 2021
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48. Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: a prospective noninterventional study.
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Rubio-Gracia J, Giménez-López I, Garcés-Horna V, López-Delgado D, Sierra-Monzón JL, Martínez-Lostao L, Josa-Laorden C, Ruiz-Laiglesia F, Pérez-Calvo JI, Crespo-Aznarez S, García-Lafuente J, Peña Fresneda N, Amores Arriaga B, Gracia-Tello B, and Sánchez-Marteles M
- Subjects
- Adult, Aged, Hospital Mortality, Humans, Lung diagnostic imaging, Middle Aged, Prospective Studies, Risk Assessment, SARS-CoV-2, COVID-19, Point-of-Care Systems
- Abstract
Background: Lung ultrasound is feasible for assessing lung injury caused by coronavirus disease 2019 (COVID-19). However, the prognostic meaning and time-line changes of lung injury assessed by lung ultrasound in COVID-19 hospitalised patients are unknown., Methods: Prospective cohort study designed to analyse prognostic value of lung ultrasound in COVID-19 patients by using a quantitative scale (lung ultrasound Zaragoza (LUZ)-score) during the first 72 h after admission. The primary end-point was in-hospital death and/or admission to the intensive care unit. Total length of hospital stay, increase of oxygen flow and escalation of medical treatment during the first 72 h were secondary end-points., Results: 130 patients were included in the final analysis; mean±sd age was 56.7±13.5 years. Median (interquartile range) time from the beginning of symptoms to admission was 6 (4-9) days. Lung injury assessed by LUZ-score did not differ during the first 72 h (21 (16-26) points at admission versus 20 (16-27) points at 72 h; p=0.183). In univariable logistic regression analysis, estimated arterial oxygen tension/inspiratory oxygen fraction ratio (PAFI) (hazard ratio 0.99, 95% CI 0.98-0.99; p=0.027) and LUZ-score >22 points (5.45, 1.42-20.90; p=0.013) were predictors for the primary end-point., Conclusions: LUZ-score is an easy, simple and fast point-of-care ultrasound tool to identify patients with severe lung injury due to COVID-19, upon admission. Baseline score is predictive of severity along the whole period of hospitalisation. The score facilitates early implementation or intensification of treatment for COVID-19 infection. LUZ-score may be combined with clinical variables (as estimated by PAFI) to further refine risk stratification., Competing Interests: Conflict of interest: J. Rubio-Gracia has nothing to disclose. Conflict of interest: I. Giménez-López has nothing to disclose. Conflict of interest: V. Garcés-Horna has nothing to disclose. Conflict of interest: D. López-Delgado has nothing to disclose. Conflict of interest: J.L. Sierra-Monzón has nothing to disclose. Conflict of interest: L. Martínez-Lostao has nothing to disclose. Conflict of interest: C. Josa-Laorden has nothing to disclose. Conflict of interest: F. Ruiz-Laiglesia has nothing to disclose. Conflict of interest: J.I. Pérez-Calvo has nothing to disclose. Conflict of interest: S. Crespo-Aznarez has nothing to disclose. Conflict of interest: J. García-Lafuente has nothing to disclose. Conflict of interest: N. Peña-Fresneda has nothing to disclose. Conflict of interest: B. Amores Arriaga has nothing to disclose. Conflict of interest: B. Gracia-Tello has nothing to disclose. Conflict of interest: M. Sánchez-Marteles has nothing to disclose., (Copyright ©The authors 2021.)
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- 2021
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49. Early Measurement of Blood sST2 Is a Good Predictor of Death and Poor Outcomes in Patients Admitted for COVID-19 Infection.
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Sánchez-Marteles M, Rubio-Gracia J, Peña-Fresneda N, Garcés-Horna V, Gracia-Tello B, Martínez-Lostao L, Crespo-Aznárez S, Pérez-Calvo JI, and Giménez-López I
- Abstract
Although several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility or poor dynamic behavior. We hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome in COVID-19. In total, 152 patients admitted for confirmed COVID-19 were included in a prospective non-interventional, observational study. Blood samples were drawn at admission, 48-72 h later and at discharge. sST2 concentrations and routine blood laboratory were analyzed. Primary endpoints were admission at intensive care unit (ICU) and mortality. Median age was 57.5 years [Standard Deviation (SD: 12.8)], 60.4% males. 10% of patients ( n = 15) were derived to ICU and/or died during admission. Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1 (30.9) at admission, peaked at 48-72 h (79.5(64)) and returned to admission levels at discharge (44.9[36.7]). A concentration of sST2 above 58.9 ng/mL was identified patients progressing to ICU admission or death. Results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for endpoints was 0.776 ( p = 0.001). In patients admitted for COVID-19 infection, early measurement of sST2 was able to identify patients at risk of severe complications or death.
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- 2021
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50. Variation in intraabdominal pressure in patients with acute heart failure according to left ventricular ejection fraction. Results of an intraabdominal pressure study.
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Rubio Gracia J, Giménez López I, Josa Laorden C, Sánchez Marteles M, Garcés Horna V, de la Rica Escuín ML, and Pérez Calvo JI
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- Humans, Prognosis, Prospective Studies, Stroke Volume, Ventricular Function, Left, Heart Failure
- Abstract
Background: The increase in intraabdominal pressure (IAP) has been correlated with increased creatinine levels in patients with heart failure with severely reduced left ventricular ejection fraction (HFrEF). However, IAP has not been examined in more stable patients or those with heart failure with preserved ejection fraction (HFpEF)., Patients and Method: We conducted an observational, prospective descriptive study that measured the IAP of patients hospitalised for decompensated heart failure (HF). The sample was stratified according to left ventricular ejection fraction (LVEF), with a cut-off of 50%. The objective was to analyse the IAP, the baseline characteristics and degree of congestion using clinical ultrasonography and impedance audiometry., Results: The study included 56 patients, 22 with HFrEF and 34 with HFpEF. The patients with HFrEF presented a higher prevalence of ischaemic heart disease (11% vs. 6%; p = 0.010) and chronic obstructive pulmonary disease/asthma (6% vs. 2%; p = 0.025). The IAP was higher in the patients with HFrEF (17.2 vs. 13.3 mmHg; p = 0.004), with no differences in renal function at admission according to the LVEF (CKD-EPI creatinine) (HFrEF 55.0 mL/min/1.73 m
2 [32.6-83.6] vs. HFpEF 55.0 mL/min/1.73 m2 [44.0-74.9]; p = 0.485). The patients with HFrEF presented a more congestive profile determined through ultrasonography (inferior vena cava collapse [26% vs. 50%; p = 0.001]), impedance audiometry (total body water at admission, 46 L vs. 41 L; p = 0.052; and at 72 h, 50.2 L vs. 39.1 L; p = 0.038) and CA125 concentration (68 U/mL vs. 39 U/mL; p = 0.037)., Conclusions: During the decompensation episodes, the patients with HFrEF had a greater increase in IAP and a higher degree of systemic congestion., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)- Published
- 2021
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