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1. Compatibility of a novel temperature‐controlled, irrigated radiofrequency catheter with ultra‐high‐density mapping

Author

Daniel Rodriguez Muñoz, Álvaro Marco del Castillo, Javier Ramos Jimenez, Luis Borrego Bernabe, Alba Madrid Montoya, Adrián Lorenzo Balboa, Fernando Arribas Ynsaurriaga, and Rafael Salguero‐Bodes

Subjects
cardiac mapping, DiamondTemp, Rhythmia, temperature‐controlled ablation, ultra‐high‐density, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Compatibility of DiamondTemp (DT) radiofrequency (RF) catheter with the Rhythmia mapping system has not been manufacturer‐reported nor its tracking accuracy reported. Methods Consecutive patients undergoing macroreentrant atrial tachycardia ablation guided by Rhythmia and ablated using DT were prospectively enrolled. Following catheter configuration, ablation lines were performed and remapped to measure the RF tag to effective‐ablation‐line‐center (RFT‐ALC) distance. Results Among 20 consecutive patients (54 maps), 40 ablation lines were evaluated. Overall, the RFT‐ALC distance was 3.88 ± 2.95 mm, and the operator assessment of accuracy was high. No complications occurred. Conclusion The use of DT catheter guided by the Rhythmia mapping system is feasible and accurate.

Published
2023
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2. Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis

Author

Lourdes Vicent, Nicolás Rosillo, Guillermo Moreno, Rafael Salguero-Bodes, Clara Goñi, José Luis Bernal, Germán Seara, and Héctor Bueno

Subjects
cardiovascular disease, gender inequity, cardiology consultations, primary care, symptoms, mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

AimsWomen may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations.Methods and resultsRetrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017–2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P

Published
2023
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3. The anti-aging factor Klotho protects against acquired long QT syndrome induced by uremia and promoted by fibroblast growth factor 23

Author

José Alberto Navarro-García, Rafael Salguero-Bodes, Laura González-Lafuente, Laura Martín-Nunes, Elena Rodríguez-Sánchez, Teresa Bada-Bosch, Eduardo Hernández, Evangelina Mérida-Herrero, Manuel Praga, Jorge Solís, Fernando Arribas, Héctor Bueno, Makoto Kuro-O, María Fernández-Velasco, Luis Miguel Ruilope, Carmen Delgado, and Gema Ruiz-Hurtado

Subjects
CKD, Dialysis, FGF23, Klotho, Long QT, Potassium channels, Medicine
Abstract

Abstract Background Chronic kidney disease (CKD) is associated with increased propensity for arrhythmias. In this context, ventricular repolarization alterations have been shown to predispose to fatal arrhythmias and sudden cardiac death. Between mineral bone disturbances in CKD patients, increased fibroblast growth factor (FGF) 23 and decreased Klotho are emerging as important effectors of cardiovascular disease. However, the relationship between imbalanced FGF23-Klotho axis and the development of cardiac arrhythmias in CKD remains unknown. Methods We carried out a translational approach to study the relationship between the FGF23–Klotho signaling axis and acquired long QT syndrome in CKD-associated uremia. FGF23 levels and cardiac repolarization dynamics were analyzed in patients with dialysis-dependent CKD and in uremic mouse models of 5/6 nephrectomy (Nfx) and Klotho deficiency (hypomorphism), which show very high systemic FGF23 levels. Results Patients in the top quartile of FGF23 levels had a higher occurrence of very long QT intervals (> 490 ms) than peers in the lowest quartile. Experimentally, FGF23 induced QT prolongation in healthy mice. Similarly, alterations in cardiac repolarization and QT prolongation were observed in Nfx mice and in Klotho hypomorphic mice. QT prolongation in Nfx mice was explained by a significant decrease in the fast transient outward potassium (K+) current (I tof ), caused by the downregulation of K+ channel 4.2 subunit (Kv4.2) expression. Kv4.2 expression was also significantly reduced in ventricular cardiomyocytes exposed to FGF23. Enhancing Klotho availability prevented both long QT prolongation and reduced I tof current. Likewise, administration of recombinant Klotho blocked the downregulation of Kv4.2 expression in Nfx mice and in FGF23-exposed cardiomyocytes. Conclusion The FGF23–Klotho axis emerges as a new therapeutic target to prevent acquired long QT syndrome in uremia by minimizing the predisposition to potentially fatal ventricular arrhythmias and sudden cardiac death in patients with CKD. Graphical abstract

Published
2022
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4. The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

Author

Williams Hinojosa, María José Cristo‐Ropero, Alejandro Cruz‐Utrilla, Teresa Segura de la Cal, Francisco López‐Medrano, Rafael Salguero‐Bodes, Carmen Pérez‐Olivares, Begoña Navarro, Nuria Ochoa, Fernando Arribas Ynsurriaga, and Pilar Escribano‐Subias

Subjects
chronic thromboembolic pulmonary hypertension, COVID‐19 infection, pulmonary arterial hypertension, telemedicine, Diseases of the circulatory (Cardiovascular) system, RC666-701, Diseases of the respiratory system, RC705-779
Abstract

Abstract The coronavirus 2019 disease (COVID‐19) pandemic threatened the Spanish health‐care system. Patients with demanding conditions such as precapillary pulmonary hypertension (PH) faced a potentially severe infection, while their usual access to medical care was restricted. This prospective, unicentric study assessed the impact of COVID‐19 on PH patients' outcomes and the operational changes in the PH network. Sixty‐three PH patients (41 pulmonary arterial hypertension [PAH]; 22 chronic thromboembolic pulmonary hypertension [CTEPH]) experienced COVID‐19. Overall mortality was 9.5% without differences when stratifying by hemodynamics or PAH‐risk score. Patients who died were older (73.6 ± 5 vs. 52.2 ± 15.4; p = 0.001), with more comorbidities (higher Charlson index: 4.17 ± 2.48 vs. 1.14 ± 1.67; p = 0.0002). Referrals to the PH expert center decreased compared to the previous 3 years (123 vs. 160; p = 0.002). The outpatient activity shifted toward greater use of telemedicine. Balloon pulmonary angioplasty activity could be maintained after the first pandemic wave and lockdown while pulmonary thromboendarterectomy procedures decreased (19 vs. 36; p = 0.017). Pulmonary transplantation activity remained similar. The COVID‐19 mortality in PAH/CTEPH patients was not related to hemodynamic severity or risk stratification, but to comorbidities. The pandemic imposed structural changes but a planned organization and resource reallocation made it possible to maintain PH patients' care.

Published
2022
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5. Situación del Código Infarto tras la fase inicial de la pandemia de la COVID-19. Experiencia en un centro de alto volumen

Author

Iván Gómez-Blázquez, Sergio Huertas-Nieto, Roberto Martín-Asenjo, Héctor Bueno, Rafael Salguero-Bodes, and Fernando Sarnago-Cebada

Subjects
Internal medicine, RC31-1245
Abstract

Sr. Editor: El inicio de la pandemia de la COVID-19 tuvo una enorme repercusión en la atención del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en todo el mundo1,2. En España se produjo una disminución generalizada en el número de pacientes tratados con angioplastia primaria y un incremento en el tiempo de isquemia desde el inicio de los síntomas hasta la reperfusión3. La fase inicial de la pandemia dio paso a un periodo con rebrotes sucesivos en el que la atención al IAMCEST parece haber mejorado gracias a una menor saturación del sistema sanitario y a los protocolos de actuación implementados4. No obstante, hay pocos datos sobre las posibles secuelas en el funcionamiento de los sistemas de asistencia en red del IAMCEST una vez pasada la primera fase de la pandemia. En el área de Madrid, nuestro hospital es uno de los centros con mayor volumen de angioplastias primarias, abarcando aproximadamente el 20% de todas las activaciones de la región5. Presentamos nuestra experiencia con el Código Infarto en los meses posteriores al final de la desescalada en junio de 2020, cuando terminó la fase inicial de la pandemia en España. Se analizaron los tiempos de las activaciones del Código...

Published
2022
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6. State of the STEMI Care Network after the early phase of the COVID-19 pandemic. The experience of a high-volume centre

Author

Iván Gómez-Blázquez, Sergio Huertas-Nieto, Roberto Martín-Asenjo, Héctor Bueno, Rafael Salguero-Bodes, and Fernando Sarnago-Cebada

Subjects
Medicine
Abstract

To the Editor, The outbreak of the COVID-19 pandemic had enormous repercussions for the management of ST-segment elevation myocardial infarction (STEMI) worldwide.1,2 Overall, the number of patients treated with primary angioplasty in Spain dropped while ischemia time increased from symptom onset until reperfusion.3 The early phase of the pandemic gave rise to a period of consecutive outbreaks during which the management of STEMI seems to have improved thanks to a less saturated healthcare system and the implementation of proper healthcare protocols.4 However, data on the possible side effects associated with the functioning of the healthcare systems in the STEMI Care Network after the first phase of the pandemic are scarce. In the Madrid area, our hospital is one of the highest-volume centers regarding primary angioplasty as it takes over nearly 20% of all activations in the region.5 We present our experience with the STEMI Care Network in the months that followed the de-escalation of June 2020 when the early phase of the COVID-19 pandemic ended in Spain. Our center STEMI Care Network activation times were analyzed during the first phase of the pandemic (March 14 through June 21, 2020), as well as in the previous and following 12 months. Also, consistent with...

Published
2022
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7. Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost

Author

Héctor Bueno, Clara Goñi, Rafael Salguero-Bodes, Beatriz Palacios, Lourdes Vicent, Guillermo Moreno, Nicolás Rosillo, Luis Varela, Margarita Capel, Juan Delgado, Fernando Arribas, Manuel del Oro, Carmen Ortega, and Jose L. Bernal

Subjects
heart failiure, secondary diagnosis, outcome, mortality, resource utilization, cost, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundThere is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF).MethodsRetrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF.ResultsOut of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient.ConclusionHospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.

Published
2022
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8. Homozygous Pro1066Arg MYBPC3 Pathogenic Variant in a 26Mb Region of Homozygosity Associated with Severe Hypertrophic Cardiomyopathy in a Patient of an Apparent Non-Consanguineous Family

Author

Raquel Rodríguez-López, Javier García-Planells, Marina Martínez-Matilla, Cristian Pérez-García, Amor García Banacloy, Carola Guzmán Luján, Otilia Zomeño Alcalá, Joaquina Belchi Navarro, Juan Martínez-León, and Rafael Salguero-Bodes

Subjects
MYBPC3, region of homozygosity, MYH7, cardiac phenotype, HPO terms, Science
Abstract

MYPBC3 and MYH7 are the most frequently mutated genes in patients with hereditary HCM. Homozygous and compound heterozygous genotypes generate the most severe phenotypes. A 35-year-old woman who was a homozygous carrier of the p.(Pro1066Arg) variant in the MYBPC3 gene, developed HCM phenocopy associated with left ventricular noncompaction and various degrees of conduction disease. Her father, a double heterozygote for this variant in MYBPC3 combined with the variant p.(Gly1931Cys) in the MYH7 gene, was affected by HCM. The variant in MYBPC3 in the heterozygosis-produced phenotype was neither in the mother nor in her only sister. Familial segregation analysis showed that the homozygous genotype p.(Pro1066Arg) was located in a region of 26 Mb loss of heterozygosity due to some consanguinity in the parents. These findings describe the pathogenicity of this variant, supporting the hypothesis of cumulative variants in cardiomyopathies, as well as the modulatory effect of the phenotype by other genes such as MYH7. Advancing HPO phenotyping promoted by the Human Phenotype Ontology, the gene–disease correlation, and vice versa, is evidence for the phenotypic heterogeneity of familial heart disease. The progressive establishment of phenotypic characteristics over time also complicates the clinical description.

Published
2022
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9. Clinical Utility of HeartLogic, a Multiparametric Telemonitoring System, in Heart Failure

Author

Juan Carlos López-Azor, Noelia de la Torre, María Dolores García-Cosío Carmena, Pedro Caravaca Pérez, Catalina Munera, Irene Marco Clement, Rocío Cózar León, Jesús Álvarez-García, Marta Pachón, Fernando Arribas Ynsaurriaga, Rafael Salguero Bodes, Juan Francisco Delgado Jiménez, and Javier de Juan Bagudá

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

Telemonitoring through multiple variables measured on cardiac devices has the potential to improve the follow-up of patients with heart failure. The HeartLogic algorithm (Boston Scientific), implemented in some implantable cardiac defibrillators and cardiac resynchronisation therapy, allows monitoring of the nocturnal heart rate, respiratory movements, thoracic impedance, physical activity and the intensity of heart tones, with the aim of predicting major clinical events. Although HeartLogic has demonstrated high sensitivity for the detection of heart failure decompensations, its effects on hospitalisation and mortality in randomised clinical trials has not yet been corroborated. This review details how the HeartLogic algorithm works, compiles available evidence from clinical studies, and discusses its application in daily clinical practice.

Published
2022
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10. Successful pregnancy in a high-risk catecholaminergic polymorphic ventricular tachycardia patient

Author

Inmaculada Mejía Jiménez, Olga Villar Ruiz, Ana Sabín-Collado, María Valverde Gómez, Elena Montañés Delmás, and Rafael Salguero Bodes

Subjects
General Medicine
Abstract

Objective: To report the case of a successful pregnancy outcome in a severely symptomatic woman affected by catecholaminergic polymorphic ventricular tachycardia (CPVT) carrier of a novel variant in ryanodine receptor 2 (RYR2) followed by a review of the current literature. Case(s): A 27-year-old primigravida affected by CPVT was referred to our tertiary care hospital after an implantable cardioverter defibrillator (ICD) shock. The patient also received medical treatment with metoprolol and flecainide. A healthy baby was born by Cesarean section at 31 weeks after the onset of preterm labor and premature rupture of membranes. CPVT is a rare inherited cardiac condition characterized by episodic polymorphic ventricular arrhythmias with a structurally normal heart. These are usually triggered by exercise or emotional stress and can lead to syncope or even sudden cardiac death. Treatment of this condition comprises betablockers in isolation or in addition to other antiarrhythmics, left cardiac sympathetic denervation and/or ICD. Conclusion: This case illustrates the importance of a multidisciplinary approach in this clinical scenario and the benefits of an optimization of the medical treatment, and demonstrates that, even in severely affected patients, a successful pregnancy is possible under close control. However, the risk of arrhythmic events and the course of pregnancy remain largely unknown in patients with CPVT, and further investigation is needed.

Published
2022
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11. Tratamiento a distancia de la insuficiencia cardiaca mediante el algoritmo HeartLogic. Registro RE-HEART

Author

Juan Gabriel Martínez, Rocío Cózar León, Nuria Rivas Gándara, Paula Sánchez-Aguilera, Nicasio Pérez Castellano, Ana B. Méndez Fernández, Olga Medina Moreno, Luis González Torres, Javier de Juan Bagudá, Óscar González Fernández, Pablo Ramos Ruiz, Carlos de Diego Rus, Virgilio Martínez Mateo, como representantes del grupo del registro Re-Heart, Juan F. Jimenez, Natalia Marrero Negrín, Josebe Goirigolzarri Artaza, Alfonso Macías Gallego, María F. Arcocha Torres, Gonzalo Luis Alonso Salinas, Juan José Gavira Gómez, Marta Pachón Iglesias, David Cordero Pereda, Manuel J. Fernández-Anguita, Inés Madrazo Delgado, Fernando Arribas Ynsaurriaga, Ignacio García Bolao, Rafael Salguero Bodes, Laura Peña Conde, Ernesto Díaz Infante, José Manuel López, Beatriz Díaz Molina, and Vanessa Escolar Pérez

Subjects
business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos HeartLogic es un algoritmo multiparametrico incorporado a desfibriladores automaticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociacion entre alertas y eventos clinicos bajo un protocolo de seguimiento comun en un registro multicentrico. Metodos Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activacion de HeartLogic, segun practica local y un protocolo comun respectivamente). Resultados Se incluyo a 288 pacientes en 15 centros. En fase 1, tras una media de observacion de 10 meses, hubo 73 alertas (0,72 alertas/paciente-ano), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/ano-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/ano-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/ano-paciente. Fuera del estado de alerta solo hubo una hospitalizacion y una descompensacion menor. La mayoria de las alertas (el 82% en fase 2 y el 81% en fase 3; p = 0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de el (7.378 frente a 1.210 pg/ml; p Conclusiones El indice HeartLogic se asocio con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitio detectar y actuar a distancia con seguridad sobre las alertas.

Published
2022
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13. Impacto de la fracción de eyección del ventrículo izquierdo en el consumo de recursos, los costes y el pronóstico en pacientes con insuficiencia cardiaca

Author

Juan Carlos López-Azor, Juan Francisco Delgado, Jorge Vélez, Rocío Rodríguez, Jorge Solís, Manuel del Oro, Carmen Ortega, Rafael Salguero-Bodes, Beatriz Palacios, Lourdes Vicent, Guillermo Moreno, Nicolás Rosillo, Luis Varela, Margarita Capel, Fernando Arribas, José L. Bernal, and Héctor Bueno

Subjects
Cardiology and Cardiovascular Medicine
Published
2023
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15. Impact of Coronavirus Disease 2019 on Cardiac Arrhythmia Care: Experience of a Spanish Tertiary Hospital During the Health Crisis Triggered by the First Wave of the Pandemic

Author

Daniel Rodríguez-Muñoz, Ana Isabel Fernández-Arranz, Javier Ramos, Luis Borrego-Bernabé, Rafael Salguero-Bodes, María López-Gil, Isabel Montilla-Padilla, Fernando Arribas, Adolfo Fontenla, and Álvaro Marco Del Castillo

Subjects
medicine.medical_specialty, Health management system, business.industry, media_common.quotation_subject, coronavirus, Psychological intervention, COVID-19, Cardiac arrhythmia, Outbreak, Retrospective cohort study, Promotion (rank), Arrhythmia unit, Physiology (medical), Emergency medicine, Health care, Pandemic, health management, medicine, Cardiology and Cardiovascular Medicine, business, cardiac electrophysiology, Original Research, media_common
Abstract

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a deep restructuring of cardiovascular care, especially in the setting of cardiac arrhythmia units, which are characterized by a wide variety of clinical and interventional activities. We describe the experience of a large university hospital deeply hit during the COVID-19 health crisis (first outbreak of the pandemic), focusing on the exceptional measures implemented and their impact in terms of outcomes. We performed a retrospective study comparing the human and structural resources and the activity of a cardiac arrhythmia unit in a Spanish tertiary hospital for two consecutive periods: from January 12, 2020, to March 8, 2020 (“pre-COVID stage”), and from March 9, 2020, to May 2, 2020 (“COVID stage”). Data were contextualized within the number of confirmed COVID-19 cases in the region of Madrid. The measures implemented were promotion of non–face-to-face consultations, selection of urgent procedures, design of a “COVID-free” circuit for outpatient interventions, and protocolization for patients with COVID-19. A total of 3,526 consultations and 362 procedures were performed. During the COVID stage, the number of consultations remained stable, and the electrophysiology rooms’ activity decreased by 55.2% with a relative increase in the number of urgent-hospitalized cases attended (11.8% COVID-19-positive patients). The electrophysiology rooms’ activity returned to “normal” in the last week of the COVID stage, with no contagion being detected among patients or professionals. In conclusion, the measures implemented allowed us to respond safely and efficiently to the health care needs of patients with arrhythmias during the COVID-19 crisis and may be useful for other institutions facing similar situations.

Published
2021
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16. Thromboembolic and bleeding events with rivaroxaban in clinical practice in Spain: impact of inappropriate doses (the EMIR study)

Author

Marcelo Sanmartín Fernández, Francisco Marín, Carles Rafols, Fernando Arribas, Vivencio Barrios, Juan Cosín-Sales, Manuel Anguita Sánchez, Alejandro Pérez Cabeza, Luis Tercedor, Antonio Luis Gamez Lopez, Martín Ruiz, Gustavo Cortez Quiroga, Antonio Luis Arrebola Moreno, Eduardo Sebastian Lopez Sanchez, Javier Torres Llergo, Juan Motero Carrasco, Ignacio Sáinz Hidalgo, Carlos Pérez Muñoz, Adolfo Bolea Lafont, Gonzalo Barón Esquivas, Jose Francisco Monzón, Alfredo Renilla González, Irene Valverde Andre, Tomás Ripoll Vera, Salvador Diez-Aja López, Antonio Melero Pita, Alfonso Macias Gallego, Olga Duran Bobin, Diego Martin Raimondi, Jesus Ignacio Dominguez Calvo, Jose Angel Perez Rivera, Juan R. Costa Vazquez, María Jesús Rollán Gómez, Romà Freixa, Ivo Roca, Lluis Mont Girbau, Ermengol Valles Gros, Nicolás Manito Lorite, David Vilades, Jordi Punti, Axel Sarrias, Marco Paz, Zamira Gomez, Sara Darnes, Juan Manuel Roca Catalán, Javier Pindado Rodriguez, Javier Andrés Novales, Juana Umaran, Ruben Natividad Andres, Esther Recalde Del Vigo, Juan Ramon Beramendi Calero, Laura Quintas, Yolanda Porras Ramos, Ricardo Fernandez Mouzo, Alejandro Rodriguez Vilela, Oscar Díaz Castro, Carlos Gonzalez Juanatey, Julio Martinez Florez, Luis Miguel Rincón Díaz, Juan Manuel Escudier Villa, Esther Merino Lanza, Isabel Antorrena, Rafael Salguero Bodes, Eduardo Alegria, Cristina Llanos Guerrero, Viviana Serra Tomás, Javier Fuertes Beneitez, Jorge Palazuelos Molinero, Roberto Del Castillo, Antonio Alvarez-Vieitez Blanco, Francisco Marin Ortuño, Isabel Ureña, Fernando Olaz Preciado, Ana Peset Cubero, Juan Quiles, Thomas Brouzet, Carlos Israel Chamorro Fernandez, Juan Cosin Sales, Francisco Ridocci Soriano, Enrique Peris Domingo, Belen Puigdueta Vindel, Francisco Javier Parra Jimenez, Gerardo Estruch Catalá, Eduardo Martinez Litago, Virgilio Martinez Mateo, Manuel Royo Gutierrez, Mohaned Monzer Khanjikhatib, Eugenia Vazquez Rey, Javier Elduayen Gragera, Marcos Garcia Aguado, David Cordero Pereda, Patricia Clares Montón, Jose Manuel Vazquez, and Iñaki Lekuona

Subjects
medicine.medical_specialty, Rivaroxaban 15 MG, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Rivaroxaban, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Stroke, Aged, business.industry, Health Policy, Hazard ratio, Anticoagulants, Atrial fibrillation, medicine.disease, Clinical Practice, Multicenter study, Spain, Observational study, business, Factor Xa Inhibitors, medicine.drug
Abstract

Aim: To analyze the frequency and variables related to inappropriate rivaroxaban dosage in clinical practice and its impact on outcomes after 2 years. Materials & methods: Postauthorization, observational, multicenter study, in which atrial fibrillation patients, treated with rivaroxaban ≥6 months were included. Results: A total of 1421 patients (74.2 ± 9.7 years, CHA 2 DS 2 -VASc 3.5 ± 1.6) were included. Overall, 22.9% received rivaroxaban 15 mg. The proper dose of rivaroxaban was taken by 83.3% (9.7% underdosed, 7.0% overdosed). Older age and renal insufficiency were associated with inadequate rivaroxaban dosage. There was a trend toward higher all-cause mortality among underdosed patients (adjusted hazard ratio 1.39; 95% CI 0.75–2.58), and more bleedings in overdosed patients (2.29 vs 0.80 events/100 patient-years; p = 0.14). Conclusion: In clinical practice, rivaroxaban is properly dosed in most patients.

Published
2021
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17. Percutaneous left atrial appendage closure in the presence of thrombus: a single-center experience

Author

Iván Gómez-Blázquez, Rafael Arboleda-Salazar, Cecilia Corros-Vicente, Adolfo Fontenla, Rafael Salguero-Bodes, and Fernando Arribas

Subjects
Appendage, medicine.medical_specialty, Percutaneous, Stroke etiology, business.industry, Treatment outcome, General Medicine, Single Center, medicine.disease, Surgery, Left atrial, medicine, Thrombus, business
Published
2021
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19. Truncating titin variants in dilated cardiomyopathy: not only LVEF recovery, but also maintenance

Author

Rafael Salguero-Bodes, Cristina Martín-Arriscado, Fernando Arribas-Ynsaurriaga, Julián Palomino-Doza, María Valverde-Gómez, and Juan Delgado-Jiménez

Subjects
medicine.medical_specialty, Ejection fraction, biology, business.industry, Cardiomyopathy, Dilated cardiomyopathy, General Medicine, medicine.disease, Internal medicine, biology.protein, Cardiology, Medicine, Titin, business
Published
2020
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22. A new mutation affecting the converter region of the beta-myosin heavy chain related to hypertrophic cardiomyopathy with poor prognosis

Author

Fernando Arribas-Ynsaurriaga, Jorge Nuche, Rafael Salguero-Bodes, Juan F. Delgado, María Valverde-Gómez, and Julián Palomino-Doza

Subjects
Poor prognosis, Beta-Myosin, Heavy chain, business.industry, New mutation, Mutation (genetic algorithm), Cancer research, Hypertrophic cardiomyopathy, medicine, Cardiomyopathy, General Medicine, medicine.disease, business
Published
2020
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24. Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study

Author

Jonathan P Piccini, Valeria Caso, Stuart J Connolly, Keith A A Fox, Jonas Oldgren, W Schuyler Jones, Diana A Gorog, Václav Durdil, Thomas Viethen, Christoph Neumann, Hardi Mundl, Manesh R Patel, Johann Auer, Martin Hubauer, Sead Pandzic, Eva Preishuber, Carina Primus-Grabscheit, Dietmar Reitgruber, Florian Schmalzer, Christopher Adlbrecht, Andreas Schober, Johannes Hajos, Christoph Keil, Alexandra Schratter, Matthias Frick, Magdalena Anna Benda, Maximilian Mächler, Beatrix Mutschlechner, Christoph Saely, Lukas Sprenger, Michael Lichtenauer, Miriam Eber, Uta Hoppe, Tobias Kolbitsch, Peter Michael Jirak, Moritz Mirna, Robert Schönbauer, Jutta Bergler-Klein, Christian Hengstenberg, Stefan Stojkovic, Daniel Scherr, Martin Manninger-Wünscher, Ursula Rohrer, Markus Stühlinger, Wilfried Schgoer, Jana Schwarzl, Helmut Pürerfellner, Michael Derndorfer, Christian Ebner, Veronika Eder, Georgios Kollias, Thomas Sturmberger, Stefan Sieghartsleitner, Johan Vijgen, Peter Koopman, Karl Dujardin, Wim Anné, Michel De Ceuninck, Rene Tavernier, Mattias Duytschaever, Sébastien Knecht, Luc Missault, Yves Vandekerckhove, Tom Rossenbacker, Bavo Ector, Filip Charlier, Philippe Debruyne, Willem Dewilde, Luc Janssens, John Roosen, Bart Vankelecom, Hein Heidbuchel, Michiel Delesie, Gert Vervoort, Hans Rombouts, Thomas Vanassche, Matthias Engelen, Peter Verhamme, Rik Willems, Christian Constance, Nicolas Pranno, Jafna Cox, Iqbal Bata, Laurent Macle, Martin Aguilar, Julia Cadrin Tourigny, Marc Dubuc, Katia Dyrda, Peter Guerra, Paul Khairy, Blandine Mondésert, Léna Rivard, Denis Roy, Rafik Tadros, Mario Talajic, Bernard Thibault, Isabelle Nault, Louis Blier, Jean Champagne, Franck Molin, Gilles O'Hara, François Philippon, Benoit Plourde, Jean-François Sarrazin, Christian Steinberg, Zdenek Coufal, David Balazsik, Michal Mikulica, Jakub Zapeca, Ondrej Cermak, Tomas Drasnar, Matej Falc, Josef Hornof, Blazej Racz, Danica Weissova, Hana Linkova, Eva Paskova, Robert Petr, Andrea Sirakova, Jiri Kettner, Ales Benak, Martin Holek, Ivo Podpera, Monika Podperova, Vlastimil Vancura, Tomas Jandik, Jiri Smid, Vratislav Dedek, Jan Banik, Vaclav Durdil, Tomas Hnat, Nicolas Lellouche, Ségolène Rouffiac, Guillaume Taldir, Valentin Bridonneau, Philippe Couffon, Magalie Daudin, Cécile Hamon, Jonathan Lacaze, Anne Quentin, Christophe Thebault, Emmanuel Boiffard, Olivier Billon, Fabien Miette, Hervé Pouliquen, Guillaume Turlotte, Hervé Gorka, Franck Albert, Sandrine Bayle, Reda Bensaid, Madalina Dasoveanu, Thibaud Demichili, Teodora Dutoiu, Cliff Khalil, Caterina Loghin, Grégoire Range, Laurent Roussel, Pierre Socié, Christophe Thuaire, Fabrice Extramiana, Vincent Algalarrondo, Haten Boughanmi, Noreddine El Mansour, Usman Mohammad, Romain Sellier, Meyer Elbaz, Clémence Laperche, Philippe Maury, Robert Kiss, Tunde Borsanyi, Zoltan Gingl, Balaza Polgar, Bela Benczur, Alexandra Bodor, Tamas Hepp, Eva Malati, Laszlo Nagy, Norbert Erdei, Jozsef Kapus, Katalin Kapus, Brigitta Toth, Andras Matoltsy, Tunde Kiss, Bela Merkely, Szilvia Herczeg, Orsolya Kiss, Zoltan Sallo, Kalman Toth, Tamas Habon, Miklos Rabai, Kinga Totsimon, Zsolt Zilahi, Gabriella Bencze, Janos Santa, Daniel Aradi, Barbara Kelemen, Leonardo Bolognese, Martina Nesti, Pasquale Giovanni Notarstefano, Simona D'Orazio, Franco Cosmi, Cecilia Becattini, Giancarlo Agnelli, Belinda Broccatelli, Maria Giulia Mosconi, Maurizio Paciaroni, Chiara Urbini, Vito Maurizio Parato, Camilla Notaristefani, Michele Scarano, Pietro Ameri, Giorgio Ghigliotti, Giulia Guglielmi, Roberta Lotti, Andrea Carlo Merlo, Maria Lorenza Muiesan, Andrea Abondio, Caterina Berasi, Elena Mattiuzzo, Claudio Mutti, Massimo Salvetti, Pasquale Pignatelli, Danilo Menichelli, Daniele Pastori, Eiji Tamiya, Takahiro Matsumoto, Tomosato Takabe, Shoichi Yamamoto, Haruyo Yamashita, Shinichi Higashiue, Onichi Furuya, Norihiko Hiramatsu, Kensuke Kasuga, Saburo Kojima, Masatoshi Komooka, Satoshi Kuroyanagi, Makoto Matsuura, Tetsushi Takemoto, Shuji Yamamoto, Katusmi Saito, Takuro Abe, Issei Ishida, Yuji Iwanami, Shohei Kataoka, Tetsu Moriyama, Akira Murohashi, Akihito Sasaki, Yuichiro Nakamura, Tetsuya Ueno, Akira Shimane, Tomoyo Hamana, Hirotoshi Ichibori, Tomohiro Inoue, Mitsuaki Itoh, Seigo Iwane, Hiroya Kawai, Tatsuya Kokawa, Akiko Masumoto, Koki Matsuo, Taishi Miyata, Shinsuke Nakano, Shogo Oishi, Tetsuari Onishi, Takahiro Sawada, Takayuki Saito, Mitsuhiko Shoda, Nobuyuki Takahashi, Tomofumi Takaya, Yasuyo Taniguchi, Shota Tsukamoto, Yasue Tsukishiro, Yoshiro Tsukiyama, Hiroshi Tsunamoto, Kenzo Uzu, Hiroyuki Yamamoto, Tetsuya Yamamoto, Kiminobu Yokoi, Chiaki Yoshida, Nobuhiro Watanabe, Tetsuo Betsuyaku, Kumiko Adachi, Kouichi Awane, Daisuke Goto, Mamoru Sakakibara, Masashi Watanabe, Hideki Ueno, Yoshitaka Hiroe, Koshi Matsuo, Kenji Ayata, Ko Fukuda, Yoshiki Hata, Katsushi Hashimoto, Hiroaki Matsumi, Akira Nikaido, Shuichi Okamoto, Iveta Sime, Valters Stirna, Ilze Reinholde, Silvija Hansone, Anita Kozlovska, Janina Romanova, Dace Klincare, Natalja Pontaga, Igors Dirmans, Artis Kalnins, Dana Upite, Arcils Gersamija, Arturs Teleznikovs, Nadezda Rozkova, Jelena Safro, Ignasi Anguera Camós, Paolo Domenico Dallaglio, Rafael Salguero Bodes, Fernando Arnbas, Luis Borrego, Alvaro Marco, Javier Ramos Jimenez, Juan José Gómez-Doblas, Alejandro Pérez Cabeza, Ignacio Ferreira Gonzålez, Javier Limeres Freire, Merce Lopez Grau, Xavier Viñolas Prat, Zoraida Moreno Weidmann, Jose Maria Guerra Ramos, Maria Concepcion Alonso Martin, Bieito Campos Garcia, Javier Mauricio Mogro Carranza, Francisco Javier Mendez Zurita, Enrique Rodriguez Font, Carlos Eduardo Gonzales Matos, Víctor García Hernando, Carl-Johan Lindholm, Jörgen Thulin, Håkan Wallén, Kristina Hagwall, Ken Eliasson, Martin Lundvall, Jens Olsson, Björn Kjellman, Markus Lind, Lars Johansson, Niclas Svedberg, Stefan Berglund, Julia Söderberg, Christer Zedigh, Thomas Mooe, Mattias Axelsson, Emil Binsell, Daniel Huber, Christian Müller, Isabelle Danier, Michael Kühne, Bernhard Okamura, Hadrien Schoepfer, Cornelia Simmen, Tobias Reichlin, Laurève Chollet, Anna Lam, Severin Wittmer, Hans Rickli, Christian Gall, Greta Hametner, Stephanie Intorp, Daniel Luescher, Laurent Haegeli, Jan Christopher Berg, Ramin Ebrahimi, Angelo Auricchio, Carmela Crljenica, Tizziano Moccetti, Cristina Monti, Elena Pasotti, Iveta Petrova, Mariagrazia Rossi, François Mach, Mehdi Namdar, Joris de Groot, Virginnio Proost, Joline Neefs, Dominik Linz, Twan van Stipdonk, Dennis den Uijl, Marco Alings, Jeroen Schaap, Dolf Segers, Noemi Wouters, Louis Bartels, Robert Tieleman, Ron Pisters, Tim de Vries, Jaap Selig, Aaf Kuijper, Pieter Bot, Mitran Keijzers, Gerardus Verdel, Raymond Tukkie, Ewout van den Bos, Floris Kauer, Rohit Oemrawsingh, Jeroen Stevenhagen, Jan van Es, Gregory Lip, Dhiraj Gupta, Agnieszka Kotalczyk, Anthony Gunstone, Richard David Brixey, Diana Gorog, Danial Dinarvand, Ying Gue, Rahim Kanji, Vassilios Memtsas, Roxy Senior, Gabriel Bioh, Yuk-Ki Wong, Nick Child, Cardiology, and ACS - Heart failure & arrhythmias

Subjects
anticoagulants, factor xa inhibitors, General Medicine, aged, double-blind method, female, hemorrhage, humans, male, pyrazoles, pyridones, treatment outcome, atrial fibrillation, 610 Medicine & health
Abstract

BACKGROUND Direct-acting oral anticoagulant use for stroke prevention in atrial fibrillation is limited by bleeding concerns. Asundexian, a novel, oral small molecule activated coagulation factor XIa (FXIa) inhibitor, might reduce thrombosis with minimal effect on haemostasis. We aimed to determine the optimal dose of asundexian and to compare the incidence of bleeding with that of apixaban in patients with atrial fibrillation. METHODS In this randomised, double-blind, phase 2 dose-finding study, we compared asundexian 20 mg or 50 mg once daily with apixaban 5 mg twice daily in patients aged 45 years or older with atrial fibrillation, a CHA2DS2-VASc score of at least 2 if male or at least 3 if female, and increased bleeding risk. The study was conducted at 93 sites in 14 countries, including 12 European countries, Canada, and Japan. Participants were randomly assigned (1:1:1) to a treatment group using an interactive web response system, with randomisation stratified by whether patients were receiving a direct-acting oral anticoagulant before the study start. Masking was achieved using a double-dummy design, with participants receiving both the assigned treatment and a placebo that resembled the non-assigned treatment. The primary endpoint was the composite of major or clinically relevant non-major bleeding according to International Society on Thrombosis and Haemostasis criteria, assessed in all patients who took at least one dose of study medication. This trial is registered with ClinicalTrials.gov, NCT04218266, and EudraCT, 2019-002365-35. FINDINGS Between Jan 30, 2020, and June 21, 2021, 862 patients were enrolled. 755 patients were randomly assigned to treatment. Two patients (assigned to asundexian 20 mg) never took any study medication, resulting in 753 patients being included in the analysis (249 received asundexian 20 mg, 254 received asundexian 50 g, and 250 received apixaban). The mean age of participants was 73·7 years (SD 8·3), 309 (41%) were women, 216 (29%) had chronic kidney disease, and mean CHA2DS2-VASc score was 3·9 (1·3). Asundexian 20 mg resulted in 81% inhibition of FXIa activity at trough concentrations and 90% inhibition at peak concentrations; asundexian 50 mg resulted in 92% inhibition at trough concentrations and 94% inhibition at peak concentrations. Ratios of incidence proportions for the primary endpoint were 0·50 (90% CI 0·14-1·68) for asundexian 20 mg (three events), 0·16 (0·01-0·99) for asundexian 50 mg (one event), and 0·33 (0·09-0·97) for pooled asundexian (four events) versus apixaban (six events). The rate of any adverse event occurring was similar in the three treatment groups: 118 (47%) with asundexian 20 mg, 120 (47%) with asundexian 50 mg, and 122 (49%) with apixaban. INTERPRETATION The FXIa inhibitor asundexian at doses of 20 mg and 50 mg once daily resulted in lower rates of bleeding compared with standard dosing of apixaban, with near-complete in-vivo FXIa inhibition, in patients with atrial fibrillation. FUNDING Bayer.

Published
2022

25. Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost

Author

Héctor Bueno, Clara Goñi, Rafael Salguero-Bodes, Beatriz Palacios, Lourdes Vicent, Guillermo Moreno, Nicolás Rosillo, Luis Varela, Margarita Capel, Juan Delgado, Fernando Arribas, Manuel del Oro, Carmen Ortega, Jose L. Bernal, AstraZeneca, Instituto de Salud Carlos III, and Ministerio de Ciencia e Innovación (España)

Subjects
Cardiology and Cardiovascular Medicine
Abstract

BackgroundThere is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF).MethodsRetrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF.ResultsOut of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient.ConclusionHospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.

Published
2021

26. Zfhx3 Transcription Factor Represses the Expression of

Author

Marcos, Rubio-Alarcón, Anabel, Cámara-Checa, María, Dago, Teresa, Crespo-García, Paloma, Nieto-Marín, María, Marín, José Luis, Merino, Jorge, Toquero, Rafael, Salguero-Bodes, Juan, Tamargo, Jorge, Cebrián, Eva, Delpón, and Ricardo, Caballero

Subjects
Adult, Male, cardiac, Nedd4 Ubiquitin Protein Ligases, Mutation, Missense, Article, Pitx2c, Cell Line, Membrane Potentials, NAV1.5 Voltage-Gated Sodium Channel, Humans, Myocytes, Cardiac, RNA, Small Interfering, SCN5A, Brugada Syndrome, Homeodomain Proteins, Nav1.5, sodium current, patch-clamp, Tbx5, Pedigree, Gene Expression Regulation, Female, RNA Interference, T-Box Domain Proteins, Zfhx3
Abstract

The ZFHX3 and SCN5A genes encode the zinc finger homeobox 3 (Zfhx3) transcription factor (TF) and the human cardiac Na+ channel (Nav1.5), respectively. The effects of Zfhx3 on the expression of the Nav1.5 channel, and in cardiac excitability, are currently unknown. Additionally, we identified three Zfhx3 variants in probands diagnosed with familial atrial fibrillation (p.M1260T) and Brugada Syndrome (p.V949I and p.Q2564R). Here, we analyzed the effects of native (WT) and mutated Zfhx3 on Na+ current (INa) recorded in HL-1 cardiomyocytes. ZFHX3 mRNA can be detected in human atrial and ventricular samples. In HL-1 cardiomyocytes, transfection of Zfhx3 strongly reduced peak INa density, while the silencing of endogenous expression augmented it (from −65.9 ± 8.9 to −104.6 ± 10.8 pA/pF; n ≥ 8, p < 0.05). Zfhx3 significantly reduced the transcriptional activity of human SCN5A, PITX2, TBX5, and NKX25 minimal promoters. Consequently, the mRNA and/or protein expression levels of Nav1.5 and Tbx5 were diminished (n ≥ 6, p < 0.05). Zfhx3 also increased the expression of Nedd4-2 ubiquitin-protein ligase, enhancing Nav1.5 proteasomal degradation. p.V949I, p.M1260T, and p.Q2564R Zfhx3 produced similar effects on INa density and time- and voltage-dependent properties in WT. WT Zfhx3 inhibits INa as a result of a direct repressor effect on the SCN5A promoter, the modulation of Tbx5 increasing on the INa, and the increased expression of Nedd4-2. We propose that this TF participates in the control of cardiac excitability in human adult cardiac tissue.

Published
2021

27. Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure

Author

Juan F. Delgado, Fernando Arribas Ynsaurriaga, David Lora, Javier de Juan Bagudá, Laura Fernández, Pilar Escribano Subías, María Dolores García-Cosío Carmena, Rafael Salguero-Bodes, Juan Carlos López-Azor, Pedro Caravaca Pérez, Zorba Blázquez-Bermejo, and Jorge Nuche

Subjects
Male, medicine.medical_specialty, Time Factors, Natriuresis, Stress test, Furosemide, Internal medicine, medicine, Humans, Prospective Studies, Diuretics, Aged, Heart Failure, Urinary sodium, business.industry, Middle Aged, medicine.disease, Diuretic treatment, Heart failure, Cardiology, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, medicine.drug
Abstract

Background: Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization. Methods: Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0–9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST. Results: Median UNa after FST in the 65 patients included was 113 (97–122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P =0.005) and an appropriate grade of decongestion (CCSP 83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS Conclusions: Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.

Published
2021

29. First experience in Spain of cardiac contractility modulation. A new alternative for patients with heart failure

Author

Adolfo Fontenla, Fernando Arribas Ynsaurriaga, Rafael Salguero Bodes, Javier de Juan Bagudá, María Dolores García-Cosío Carmena, and Juan F. Jimenez

Subjects
medicine.medical_specialty, business.industry, Heart failure, Internal medicine, Cardiology, medicine, General Medicine, medicine.disease, business, Cardiac contractility modulation
Published
2020
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32. Remote heart failure management using the HeartLogic algorithm. RE-HEART registry

Author

Javier de Juan Bagudá, Juan J. Gavira Gómez, Marta Pachón Iglesias, Rocío Cózar León, Vanessa Escolar Pérez, Óscar González Fernández, Nuria Rivas Gándara, Josebe Goirigolzarri Artaza, Beatriz Díaz Molina, Alfonso Macías Gallego, Virgilio Martínez Mateo, Juan G. Martínez Martínez, Natalia Marrero Negrín, Gonzalo L. Alonso Salinas, Luis González Torres, Juan F. Delgado Jiménez, Paula Sánchez-Aguilera, Ernesto Díaz Infante, María F. Arcocha Torres, Laura Peña Conde, Ana B. Méndez Fernández, Nicasio Pérez Castellano, José M. Rubín López, Inés Madrazo Delgado, Manuel J. Fernández-Anguita, Pablo Ramos Ruiz, Olga Medina Moreno, David Cordero Pereda, Carlos de Diego Rus, Fernando Arribas Ynsaurriaga, Ignacio García Bolao, and Rafael Salguero Bodes

Subjects
Heart Failure, Hospitalization, Humans, General Medicine, Registries, Algorithms, Defibrillators, Implantable
Abstract

HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry.We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively).We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P.001).The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.

Published
2021

36. Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Author

George Ntaios, Menno V. Huisman, Hans-Christoph Diener, Jonathan L. Halperin, Christine Teutsch, Sabrina Marler, Venkatesh K. Gurusamy, Milla Thompson, Gregory Y.H. Lip, Brian Olshansky, Dzifa Wosornu Abban, Nasser Abdul, Atilio Marcelo Abud, Fran Adams, Srinivas Addala, Pedro Adragão, Walter Ageno, Rajesh Aggarwal, Sergio Agosti, Piergiuseppe Agostoni, Francisco Aguilar, Julio Aguilar Linares, Luis Aguinaga, Jameel Ahmed, Allessandro Aiello, Paul Ainsworth, Jorge Roberto Aiub, Raed Al-Dallow, Lisa Alderson, Jorge Antonio Aldrete Velasco, Dimitrios Alexopoulos, Fernando Alfonso Manterola, Pareed Aliyar, David Alonso, Fernando Augusto Alves da Costa, José Amado, Walid Amara, Mathieu Amelot, Nima Amjadi, Fabrizio Ammirati, Marianna Andrade, Nabil Andrawis, Giorgio Annoni, Gerardo Ansalone, M.Kevin Ariani, Juan Carlos Arias, Sébastien Armero, Chander Arora, Muhammad Shakil Aslam, M. Asselman, Philippe Audouin, Charles Augenbraun, S. Aydin, Ivaneta Ayryanova, Emad Aziz, Luciano Marcelo Backes, E. Badings, Ermentina Bagni, Seth H. Baker, Richard Bala, Antonio Baldi, Shigenobu Bando, Subhash Banerjee, Alan Bank, Gonzalo Barón Esquivias, Craig Barr, Maria Bartlett, Vanja Basic Kes, Giovanni Baula, Steffen Behrens, Alan Bell, Raffaella Benedetti, Juan Benezet Mazuecos, Bouziane Benhalima, Jutta Bergler-Klein, Jean-Baptiste Berneau, Richard A. Bernstein, Percy Berrospi, Sergio Berti, Andrea Berz, Elizabeth Best, Paulo Bettencourt, Robert Betzu, Ravi Bhagwat, Luna Bhatta, Francesco Biscione, Giovanni BISIGNANI, Toby Black, Michael J. Bloch, Stephen Bloom, Edwin Blumberg, Mario Bo, Ellen Bøhmer, Andreas Bollmann, Maria Grazia Bongiorni, Giuseppe Boriani, D.J. Boswijk, Jochen Bott, Edo Bottacchi, Marica Bracic Kalan, Drew Bradman, Donald Brautigam, Nicolas Breton, P.J.A.M. Brouwers, Kevin Browne, Jordi Bruguera Cortada, A. Bruni, Claude Brunschwig, Hervé Buathier, Aurélie Buhl, John Bullinga, Jose Walter Cabrera, Alberto Caccavo, Shanglang Cai, Sarah Caine, Leonardo Calò, Valeria Calvi, Mauricio Camarillo Sánchez, Rui Candeias, Vincenzo Capuano, Alessandro Capucci, Ronald Caputo, Tatiana Cárdenas Rizo, Francisco Cardona, Francisco Carlos da Costa Darrieux, Yan Carlos Duarte Vera, Antonio Carolei, Susana Carreño, Paula Carvalho, Susanna Cary, Gavino Casu, Claudio Cavallini, Guillaume Cayla, Aldo Celentano, Tae-Joon Cha, Kwang Soo Cha, Jei Keon Chae, Kathrine Chalamidas, Krishnan Challappa, Sunil Prakash Chand, Harinath Chandrashekar, Ludovic Chartier, Kausik Chatterjee, Carlos Antero Chavez Ayala, Aamir Cheema, Amjad Cheema, Lin Chen, Shih-Ann Chen, Jyh Hong Chen, Fu-Tien Chiang, Francesco Chiarella, Lin Chih-Chan, Yong Keun Cho, Jong-Il Choi, Dong Ju Choi, Guy Chouinard, Danny Hoi-Fan Chow, Dimitrios Chrysos, Galina Chumakova, Eduardo Julián José Roberto Chuquiure Valenzuela, Nicoleta Cindea Nica, David J. Cislowski, Anthony Clay, Piers Clifford, Andrew Cohen, Michael Cohen, Serge Cohen, Furio Colivicchi, Ronan Collins, Paolo Colonna, Steve Compton, Derek Connolly, Alberto Conti, Gabriel Contreras Buenostro, Gregg Coodley, Martin Cooper, Julian Coronel, Giovanni Corso, Juan Cosín Sales, Yves Cottin, John Covalesky, Aurel Cracan, Filippo Crea, Peter Crean, James Crenshaw, Tina Cullen, Harald Darius, Patrick Dary, Olivier Dascotte, Ira Dauber, Vicente Davalos, Ruth Davies, Gershan Davis, Jean-Marc Davy, Mark Dayer, Marzia De Biasio, Silvana De Bonis, Raffaele De Caterina, Teresiano De Franceschi, J.R. de Groot, José De Horta, Axel De La Briolle, Gilberto de la Pena Topete, Angelo Amato Vicenzo de Paola, Weimar de Souza, A. de Veer, Luc De Wolf, Eric Decoulx, Sasalu Deepak, Pascal Defaye, Freddy Del-Carpio Munoz, Diana Delic Brkljacic, N. Joseph Deumite, Silvia Di Legge, Igor Diemberger, Denise Dietz, Pedro Dionísio, Qiang Dong, Fabio Rossi dos Santos, Elena Dotcheva, Rami Doukky, Anthony D'Souza, Simon Dubrey, Xavier Ducrocq, Dmitry Dupljakov, Mauricio Duque, Dipankar Dutta, Nathalie Duvilla, A. Duygun, Rainer Dziewas, Charles B. Eaton, William Eaves, L.A. Ebels-Tuinbeek, Clifford Ehrlich, Sabine Eichinger-Hasenauer, Steven J. Eisenberg, Adnan El Jabali, Mahfouz El Shahawy, Mauro Esteves Hernandes, Ana Etxeberria Izal, Rudolph Evonich, Oksana Evseeva, Andrey Ezhov, Raed Fahmy, Quan Fang, Ramin Farsad, Laurent Fauchier, Stefano Favale, Maxime Fayard, Jose Luis Fedele, Francesco Fedele, Olga Fedorishina, Steven R. Fera, Luis Gustavo Gomes Ferreira, Jorge Ferreira, Claudio Ferri, Anna Ferrier, Hugo Ferro, Alexandra Finsen, Brian First, Stuart Fischer, Catarina Fonseca, Luísa Fonseca Almeida, Steven Forman, Brad Frandsen, William French, Keith Friedman, Athena Friese, Ana Gabriela Fruntelata, Shigeru Fujii, Stefano Fumagalli, Marta Fundamenski, Yutaka Furukawa, Matthias Gabelmann, Nashwa Gabra, Niels Gadsbøll, Michel Galinier, Anders Gammelgaard, Priya Ganeshkumar, Christopher Gans, Antonio Garcia Quintana, Olivier Gartenlaub, Achille Gaspardone, Conrad Genz, Frédéric Georger, Jean-Louis Georges, Steven Georgeson, Evaldas Giedrimas, Mariusz Gierba, Ignacio Gil Ortega, Eve Gillespie, Alberto Giniger, Michael C. Giudici, Alexandros Gkotsis, Taya V. Glotzer, Joachim Gmehling, Jacek Gniot, Peter Goethals, Seth Goldbarg, Ronald Goldberg, Britta Goldmann, Sergey Golitsyn, Silvia Gómez, Juan Gomez Mesa, Vicente Bertomeu Gonzalez, Jesus Antonio Gonzalez Hermosillo, Víctor Manuel González López, Hervé Gorka, Charles Gornick, Diana Gorog, Venkat Gottipaty, Pascal Goube, Ioannis Goudevenos, Brett Graham, G. Stephen Greer, Uwe Gremmler, Paul G. Grena, Martin Grond, Edoardo Gronda, Gerian Grönefeld, Xiang Gu, Ivett Guadalupe Torres Torres, Gabriele Guardigli, Carolina Guevara, Alexandre Guignier, Michele Gulizia, Michael Gumbley, Albrecht Günther, Andrew Ha, Georgios Hahalis, Joseph Hakas, Christian Hall, Bing Han, Seongwook Han, Joe Hargrove, David Hargroves, Kenneth B. Harris, Tetsuya Haruna, Emil Hayek, Jeff Healey, Steven Hearne, Michael Heffernan, Geir Heggelund, J.A. Heijmeriks, Maarten Hemels, I. 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Nowalany-Kozielska E., Nsah E., Nunez Fragoso J.C., Nurgalieva S., Nuyens D., Nyvad O., Odin de Los Rios Ibarra M., O'Donnell P., O'Donnell M., Oh S., Oh Y.S., Oh D., O'Hara G., Oikonomou K., Olivares C., Oliver R., Ruiz R.O., Olympios C., Anna omaszuk-Kazberuk, Asensi J.O., eena Padayattil jose, Padilla Padilla F.G., Rios V.P., Pajes G., Pandey A.S., Paparella G., Paris F., Park H.W., Park J.S., Parthenakis F., Passamonti E., Patel R.J., Patel J., Patel M., Patrick J., Jimenez R.P., Paz A., Pengo V., Pentz W., Perez B., Perez Rios A.M., Perez-Cabezas A., Perlman R., Persic V., Perticone F., Peters T.K., Petkar S., Pezo L.F., Pflucke C., Pham D.N., Phillips R.T., Phlaum S., Pieters D., Pineau J., Pinter A., Pinto F., Pisters R., Pivac N., Pocanic D., Podoleanu C., Politano A., Poljakovic Z., Pollock S., Garcea J.P., Poppert H., Porcu M., Reino A.P., Prasad N., Precoma D.B., Prelle A., Prodafikas J., Protasov K., Pye M., Qiu Z., Quedillac J.-M., Raev D., Raffo Grado C.A., Rahimi S., Raisaro A., Rama B., Ramos R., Ranieri M., Raposo N., Rashba E., Rauch-Kroehnert U., Reddy R., Renda G., Reza S., Ria L., Richter D., Rickli H., Rieker W., Vera T.R., Ritt L.E., Roberts D., Briones I.R., Rodriguez Escudero A.E., Pascual C.R., Roman M., Romeo F., Ronner E., Roux J.-F., Rozkova N., Rubacek M., Rubalcava F., Russo A.M., Rutgers M.P., Rybak K., Said S., Sakamoto T., Salacata A., Salem A., Bodes R.S., Saltzman M.A., Salvioni A., Vallejo G.S., Fernandez M.S., Saporito W.F., Sarikonda K., Sasaoka T., Sati H., Savelieva I., Scala P.-J., Schellinger P., Scherr C., Schmitz L., Schmitz K.-H., Schmitz B., Schnabel T., Schnupp S., Schoeniger P., Schon N., Schwimmbeck P., Seamark C., Searles G., Seidl K.-H., Seidman B., Sek J., Sekaran L., SERRATI C., Shah N., Shah V., Shah A., Shah S., Sharma V.K., Shaw L., Sheikh K.H., Shimizu N., Shimomura H., Shin D.-G., Shin E.-S., Shite J., Sibilio G., Silver F., Sime I., Simmers T.A., Singh N., Siostrzonek P., Smadja D., Smith D.W., Snitman M., Filho D.S., Soda H., Sofley C., Sokal A., Oi Yan Y.S., Sotolongo R., Ferreira de Souza O., Sparby J.A., Spinar J., Sprigings D., Spyropoulos A.C., Stakos D., Steinwender C., Stergiou G., Stiell I., Stoddard M., Stoikov A., Streb W., Styliadis I., Su G., Su X., Sudnik W., Sukles K., Sun X., Swart H., Szavits-Nossan J., Taggeselle J., Takagi Y., Singh Takhar A.P., Tamm A., Tanaka K., Tanawuttiwat T., Tang S., Tang A., Tarsi G., Tassinari T., Tayal A., Tayebjee M., Berg J.M.T., Tesloianu D., The S.H.K., Thomas D., Timsit S., Tobaru T., Tomasik A.R., Torosoff M., Touze E., Trendafilova E., Tsai W.K., Tse H.F., Tsutsui H., Tu T.M., Tuininga Y., Turakhia M., Turk S., Tcurner W., Tveit A., Tytus R., Valadao C., van Bergen P.F.M.M., van de Borne P., van den Berg B.J., van der Zwaan C., Van Eck M., Vanacker P., Vasilev D., Vasilikos V., Vasilyev M., Veerareddy S., Mino M.V., Venkataraman A., Verdecchia P., Versaci F., Vester E.G., Vial H., Victory J., Villamil A., Vincent M., Vlastaris A., Dahl J.V., Vora K., Vranian R.B., Wakefield P., Wang N., Wang M., Wang X., Wang F., Wang T., Warner A.L., Watanabe K., Wei J., Weimar C., Weiner S., Weinrich R., Wen M.-S., Wiemer M., Wiggers P., Wilke A., Williams D., Williams M.L., Witzenbichler B., Wong B., Lawrence Wong K.S., Wozakowska-Kaplon B., Wu S., Wu R.C., Wunderlich S., Wyatt N., Wylie J.J., Xu Y., Xu X., Yamanoue H., Yamashita T., Bryan Yan P.Y., Yang T., Yao J., Yeh K.-H., Yin W.H., Yotov Y., Zahn R., Zarich S., Zenin S., Zeuthen E.L., Zhang H., Zhang D., Zhang X., Zhang P., Zhang J., Zhao S.P., Zhao Y., Zhao Z., Zheng Y., Zhou J., Zimmermann S., Zini A., Zizzo S., Zong W., and Zukerman L.S.

Subjects
Oral, medicine.medical_specialty, anticoagulants, Vitamin K, medicine.drug_class, Medizin, Administration, Oral, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, Antithrombotic treatment, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Internal medicine, Antithrombotic, medicine, non-vitamin-K antagonist oral anticoagulant, Diseases of the circulatory (Cardiovascular) system, Humans, SAMe-TT2R2, In patient, atrial fibrillation, 030212 general & internal medicine, Prospective Studies, Registries, Medical prescription, business.industry, Anticoagulant, non-vitamin-K antagonist oral, Atrial fibrillation, medicine.disease, non-vitamin-K antagonist oral anticoagulants, Clinical trial, Stroke, Treatment Outcome, SAMe-TT, RC666-701, 2, R, vitamin-K-antagonist oral anticoagulants, Administration, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, SAMe-TT R, Cardiology and Cardiovascular Medicine, business
Abstract

CA extern - Weitere Nicht-UDE-Autoren sind nicht genannt. Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007. © 2020 Hellenic Society of Cardiology

Published
2021

38. Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Author

FRANCISCO DARRIEUX, Martin James, Cristian Podoleanu, Diana Gorog, Rafael Salguero Bodes, GIUSEPPE BORIANI, Michel GALINIER, Andrea Zini, Agnieszka Kotalczyk, and Witold Streb

Subjects
Medizin, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Weitere Verfasser:innen aus Einrichtungen außerhalb der Universität Duisburg-Essen sind nicht aufgeführt. In this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected.

Published
2022
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39. Metabolic 'ace of spades' in apical hypertrophic cardiomyopathy

Author

Patricia Barrio, Rafael Salguero-Bodes, and Jorge Solis

Subjects
Electrocardiography, Text mining, business.industry, MEDLINE, Hypertrophic cardiomyopathy, medicine, Humans, General Medicine, Cardiomyopathy, Hypertrophic, Bioinformatics, business, medicine.disease
Published
2020

40. Clinical characteristics and determinants of the phenotype in TMEM43 arrhythmogenic right ventricular cardiomyopathy type 5

Author

Javier Segovia, Pilar Molina, Pablo García-Pavía, Aitana Braza-Boïls, Juan F. Delgado, Esther Gonzalez-Lopez, Robert Zwart, Belén Bornstein, Rafael Salguero-Bodes, Esther Zorio, J. Peter van Tintelen, Enrique Lara-Pezzi, Francisco Bermúdez-Jiménez, Jorge Toquero, Juan Jiménez-Jáimez, Fernando Dominguez, Instituto de Salud Carlos III, Fundación ProCNIC, Fundación Isabel Gemio, Sociedad Española de Cardiología, Unión Europea. Comisión Europea, Ministerio de Economía y Competitividad (España), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Ministerio de Ciencia, Innovación y Universidades (España), Human Genetics, and ACS - Heart failure & arrhythmias

Subjects
Adult, Male, medicine.medical_specialty, DNA Mutational Analysis, Mutation, Missense, Disease, 030204 cardiovascular system & hematology, Ventricular Function, Left, Right ventricular cardiomyopathy, Sudden cardiac death, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, Genetics, Humans, 030212 general & internal medicine, Exercise, Arrhythmogenic Right Ventricular Dysplasia, Ejection fraction, TMEM43, business.industry, Incidence (epidemiology), Haplotype, Membrane Proteins, Stroke Volume, DNA, medicine.disease, Phenotype, Pedigree, 3. Good health, Mutation (genetic algorithm), Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Arrhythmogenic right ventricular cardiomyopathy, Arrhythmia
Abstract

Arrhythmogenic right ventricular cardiomyopathy type V (ARVC-5) is the most aggressive heterozygous form of ARVC. It is predominantly caused by a fully penetrant mutation (p.S358L) in the nondesmosomal gene TMEM43-endemic to Newfoundland, Canada. To date, all familial cases reported worldwide share a common ancestral haplotype. It is unknown whether the p.S358L mutation by itself causes ARVC-5 or whether the disease is influenced by genetic or environmental factors. The purpose of this study was to examine the phenotype, clinical course, and the impact of exercise on patients with p.S358L ARVC-5 without the Newfoundland genetic background. We studied 62 affected individuals and 73 noncarriers from 3 TMEM43-p.S358L Spanish families. The impact of physical activity on the phenotype was also evaluated. Haplotype analysis revealed that the 3 Spanish families were unrelated to patients with ARVC-5 with the Newfoundland genetic background. Two families shared 10 microsatellite markers in a 4.9 cM region surrounding TMEM43; the third family had a distinct haplotype. The affected individuals showed a 38.7% incidence of sudden cardiac death, which was higher in men. Left ventricular involvement was common, with 40% of mutation carriers showing a left ventricular ejection fraction of

Published
2020

41. Zfhx3 Transcription Factor Represses the Expression of SCN5A Gene and Decreases Sodium Current Density (INa)

Author

Rafael Salguero-Bodes, María Marín, Jorge Toquero, Marcos Rubio-Alarcón, Teresa Crespo-García, Jorge Cebrián, Juan Tamargo, Ricardo Caballero, Paloma Nieto-Marín, María Dago, José L. Merino, Anabel Cámara-Checa, and Eva Delpón

Subjects
cardiac, QH301-705.5, Repressor, Nav1.5, Pitx2c, Catalysis, Inorganic Chemistry, Gene silencing, Biology (General), Physical and Theoretical Chemistry, Zfhx3, SCN5A, Tbx5, sodium current, patch-clamp, QD1-999, Molecular Biology, Transcription factor, Spectroscopy, Zinc finger, Messenger RNA, biology, Chemistry, Organic Chemistry, Promoter, General Medicine, Transfection, Molecular biology, Computer Science Applications, biology.protein
Abstract

The ZFHX3 and SCN5A genes encode the zinc finger homeobox 3 (Zfhx3) transcription factor (TF) and the human cardiac Na+ channel (Nav1.5), respectively. The effects of Zfhx3 on the expression of the Nav1.5 channel, and in cardiac excitability, are currently unknown. Additionally, we identified three Zfhx3 variants in probands diagnosed with familial atrial fibrillation (p.M1260T) and Brugada Syndrome (p.V949I and p.Q2564R). Here, we analyzed the effects of native (WT) and mutated Zfhx3 on Na+ current (INa) recorded in HL-1 cardiomyocytes. ZFHX3 mRNA can be detected in human atrial and ventricular samples. In HL-1 cardiomyocytes, transfection of Zfhx3 strongly reduced peak INa density, while the silencing of endogenous expression augmented it (from −65.9 ± 8.9 to −104.6 ± 10.8 pA/pF; n ≥ 8, p < 0.05). Zfhx3 significantly reduced the transcriptional activity of human SCN5A, PITX2, TBX5, and NKX25 minimal promoters. Consequently, the mRNA and/or protein expression levels of Nav1.5 and Tbx5 were diminished (n ≥ 6, p < 0.05). Zfhx3 also increased the expression of Nedd4-2 ubiquitin-protein ligase, enhancing Nav1.5 proteasomal degradation. p.V949I, p.M1260T, and p.Q2564R Zfhx3 produced similar effects on INa density and time- and voltage-dependent properties in WT. WT Zfhx3 inhibits INa as a result of a direct repressor effect on the SCN5A promoter, the modulation of Tbx5 increasing on the INa, and the increased expression of Nedd4-2. We propose that this TF participates in the control of cardiac excitability in human adult cardiac tissue.

Published
2021
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42. El volumen extracelular no se asocia a arritmias malignas en miocardiopatía hipertrófica de alto riesgo

Author

Esther Gonzalez-Lopez, Jesus G Mirelis, Javier Sánchez-González, Borja Ibanez, Valentin Fuster, Pablo García-Pavía, Esther Zorio, Rafael Salguero-Bodes, Tomás Ripoll-Vera, Rodrigo Fernández-Jiménez, David Filgueiras-Rama, Juana Núñez, María Jesús Soleto, Gonzalo Pizarro, María Gallego-Delgado, and Javier Sanz

Subjects
Male, Tomografía, medicine.medical_specialty, Enfermedad cardiovascular, Arritmia, Computed tomography, 030204 cardiovascular system & hematology, Interstitial fibrosis, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Fibrosis, Internal medicine, Extracellular fluid, medicine, Humans, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Retrospective Studies, Observer Variation, medicine.diagnostic_test, business.industry, Myocardium, Hypertrophic cardiomyopathy, Arrhythmias, Cardiac, Mean age, Organ Size, General Medicine, Cardiomyopathy, Hypertrophic, Middle Aged, Endomyocardial Fibrosis, medicine.disease, Defibrillators, Implantable, Miocardio, Diffuse fibrosis, Case-Control Studies, cardiovascular system, Cardiology, Female, Tomography, X-Ray Computed, business, Left ventricular wall
Abstract

Introduction and objectives: Myocardial interstitial fibrosis, a hallmark of hypertrophic cardiomyopathy (HCM), has been proposed as an arrhythmic substrate. Fibrosis is associated with increased extracellular volume (ECV), which can be quantified by computed tomography (CT). We aimed to analyze the association between CT-determined ECV and malignant ventricular arrhythmias. Methods: A retrospective case-control observational study was conducted in HCM patients with implantable cardioverter-defibrillator, undergoing a CT-protocol with continuous iodine contrast infusion to determine equilibrium ECV. Left ventricular septal and lateral CT-determined ECV was compared between prespecified cases (malignant arrhythmia any time before CT scan) and controls (no prior malignant arrhythmias) and among ECV tertiles. Results: A total of 78 implantable cardioverter-defibrillator HCM patients were included; 24 were women, with a mean age of 52.1 ± 15.6 years. Mean ECV ± standard deviation in the septal left ventricular wall and was 29.8% ± 6.3% in cases (n = 24) vs 31.9% ± 8.5% in controls (n = 54); P = .282. Mean ECV in the lateral wall was 24.5% ± 6.8% in cases vs 28.2% ± 7.4% in controls; P = .043. On comparison of the entire population according to septal ECV tertiles, no significant differences were found in the number of patients receiving appropriate shocks. Conversely, we found a trend (P = .056) for a higher number of patients receiving appropriate shocks in the lateral ECV lowest tertile. Conclusions: Extracellular volume was not increased in implantable cardioverter-defibrillator HCM patients with malignant ventricular arrhythmias vs those without arrhythmias. Our findings do not support the use of ECV (a surrogate of diffuse fibrosis) as a predictor of arrhythmias in high-risk HCM patients. Introducción y objetivos: La fibrosis intersticial en miocardiopatía hipertrófica (MCH) se ha propuesto como substrato de arritmias malignas. La fibrosis se asocia a expansión del volumen extracelular (VEC) que se puede cuantificar por tomografía computarizada (TC). El objetivo es analizar la asociación entre VEC determinado por TC y la presencia de arritmias malignas. Métodos: Estudio observacional de casos y controles en pacientes con MCH y desfibrilador automático implantable sometidos a TC con infusión continua de contraste yodado para cuantificar el VEC en equilibrio. Se comparó el VEC determinado por TC en las paredes septal y lateral de ventrículo izquierdo entre casos (presencia de arritmia maligna previa) y controles (sin arritmias malignas). Resultados: Se incluyó a 78 pacientes con MCH-desfibrilador automático implantable, 24 eran mujeres con una edad media de 52,1 ± 15,6 años. El VEC medio ± desviación estándar en pared septal fue 29,8 ± 6,3% en casos (n = 24) frente a 31,9 ± 8,5% en controles (n = 54); p = 0,282. El VEC medio en pared lateral fue 24,5 ± 6,8% en casos frente a 28,2 ± 7,4% en controles; p = 0,043. No se encontraron diferencias en el número de pacientes con choques apropiados entre los diferentes terciles de VEC. Por el contrario, se encontró una tendencia (p = 0,056) de un mayor número de pacientes dentro del menor tercil de VEC en pared lateral con descargas apropiadas. Conclusiones: El VEC en pacientes con MCH-desfibrilador automático implantable con arritmias malignas no se mostró incrementado comparado con pacientes con MCH-desfibrilador automático implantable sin arritmias. Estos hallazgos no apoyan en uso de VEC (subrogado de fibrosis difusa) como predictor de arritmias malignas en pacientes con MCH de alto riesgo. Sin financiación 5.166 JCR (2017) Q1, 26/128 Cardiac and Cardiovacular Systems UEM

Published
2017
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43. Association Between Mutations in the NKX2.5 Homeobox, Atrial Septal Defects, Ventricular Noncompaction and Sudden Cardiac Death

Author

Julián Palomino Doza, Rafael Salguero-Bodes, María de la Parte, and Fernando Arribas-Ynsaurriaga

Subjects
0301 basic medicine, medicine.medical_specialty, business.industry, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Atrial septal defects, Sudden cardiac death, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Internal medicine, Cardiology, Medicine, Homeobox, business
Published
2018
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44. Asociación entre mutaciones en el homeodominio de NKX2.5, desarrollo de defectos del tabique interauricular, falta de compactación ventricular y muerte súbita

Author

Rafael Salguero-Bodes, Julián Palomino Doza, Fernando Arribas-Ynsaurriaga, and María de la Parte

Subjects
0301 basic medicine, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Published
2018
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47. Distrofia miotónica de tipo 1: una serie de 107 pacientes

Author

C Domínguez-González, A Hernández-Voth, M Valverde-Gómez, A Ruiz-Curiel, D Sánchez-Tejerina, Julián Palomino-Doza, J Sayas-Catalán, and Rafael Salguero-Bodes

Subjects
Pediatrics, medicine.medical_specialty, Weakness, business.industry, Incidence (epidemiology), General Medicine, Myotonia, medicine.disease, Myotonic dystrophy, Sudden cardiac death, Respiratory failure, medicine, Neurology (clinical), medicine.symptom, Muscular dystrophy, business, Cause of death
Abstract

Introduction Myotonic dystrophy type 1 is the most common muscular dystrophy in adults. It is a genetic disorder of autosomal dominant inheritance and one of its most striking features is its multi-systemic involvement with a wide clinical phenotype. Patients and methods Data from 107 patients with a genetically confirmed diagnosis of the disease were retrospectively analysed from the database of a national reference division for neuromuscular diseases. Demographic and clinical data were collected over a 7-year period. Results The most frequent age of symptom onset was adulthood (66.4%). 35% showed exclusive distal weakness and a majority (63.6%) had clinical myotonia. Only 10 patients lacked neuromuscular symptoms at diagnosis and up to 9.5% were restricted to a wheelchair. The implantation of a pacemaker or cardioverter-defibrillator was conducted in 16 patients but no sudden cardiac death was detected. A venous thromboembolic disease incidence rate of 5.6 cases per 1000 patient-year was identified. More than half of the patients (54%) in the series developed respiratory failure. 13 patients died during the follow-up period, with respiratory failure being the main cause of death. Conclusions The follow-up and clinical management of patients with DM1 should be multidisciplinary. In our series, the main cause of morbidity and mortality was respiratory disorders, whereas the incidence of cardiac disorders was lower. In addition, there is a notable frequency of complications derived from falls, which can have serious consequences. Finally, a higher than expected incidence of thromboembolic events was identified, which deserves further study in other cohorts of patients.

Published
2021
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49. A simple validated method for predicting the risk of hospitalization for worsening of heart failure in ambulatory patients : the Redin-SCORE

Author

Manuel Gómez-Bueno, Andreu Ferrero-Gregori, Manuel Portoles, Juan Francisco Delgado Jiménez, Ana Fernández-Palacín, Rafael Vazquez-Garcia, Julián Pérez-Villacastín, Montserrat Batlle, Esther Sanz-Girgas, Pamela Lear, Miquel Vives-Borrás, Rafael Salguero Bodes, Pere Pericas, Pere Torán-Monserrat, Leif Hove-Madsen, Domingo A. Pascual Figal, Luis Martinez-Dolz, Felix Perez-Villa, Esther Roselló-Lletí, Violeta Sanchez, Jaume Aguero, Isabel Hernández-Martín, José Ramón González Juanatey, Jesus Alvarez-Garcia, Dulcenombre Gomez-Garre, María Eugenia Vázquez Mosquera, Alfredo Bardaji, Jorge G. Quintanilla, Ana Ortega, Fernando Arribas, María Amparo Pérez Navarro, and Estefanía Tarazón

Subjects
Male, medicine.medical_specialty, Prognostic variable, Renal function, Heart failure, Competing risks, Patient Readmission, Internal medicine, Outpatients, Heart rate, medicine, Humans, Intensive care medicine, Aged, Models, Statistical, Framingham Risk Score, business.industry, Score, Competing risk, Prognosis, medicine.disease, Death, Acute Disease, Chronic Disease, Ambulatory, Cohort, Cardiology, Female, Original Article, Cardiology and Cardiovascular Medicine, business, Readmission
Abstract

AimsPrevention of hospital readmissions is one of the main objectives in the management of patients with heart failure (HF). Most of the models predicting readmissions are based on data extracted from hospitalized patients rather than from outpatients. Our objective was to develop a validated score predicting 1-month and 1-year risk of readmission for worsening of HF in ambulatory patients. Methods and resultsA cohort of 2507 ambulatory patients with chronic HF was prospectively followed for a median of 3.3years. Clinical, echocardiographic, ECG, and biochemical variables were used in a competing risk regression analysis to construct a risk score for readmissions due to worsening of HF. Thereafter, the score was externally validated using a different cohort of 992 patients with chronic HF (MUSIC registry). Predictors of 1-month readmission were the presence of elevated natriuretic peptides, left ventricular (LV) HF signs, and estimated glomerular filtration rate (eGFR) 26mm/m(2), heart rate >70 b.p.m., LV HF signs, and eGFR 5% event rate) for 1-month HF readmission. Likewise, low-risk (7.8%), intermediate-risk (15.6%) and high-risk groups (26.1%) were identified for 1-year HF readmission risk. The C-statistics remained consistent after the external validation (

Published
2015

50. Linfoma cardíaco primario: diagnóstico mediante biopsia transyugular

Author

Ignacio Sánchez Pérez, Rafael Salguero Bodes, Felipe Hernández, Juan C. Tascón Pérez, Amparo Carbonell Porras, and Ángela Flox Camacho

Subjects
medicine.medical_specialty, Percutaneous, medicine.diagnostic_test, business.industry, medicine.medical_treatment, medicine.disease, Malignancy, Pericardial effusion, Intracardiac injection, Surgery, medicine.anatomical_structure, hemic and lymphatic diseases, Heart failure, Biopsy, cardiovascular system, medicine, Pericardium, Radiology, Cardiology and Cardiovascular Medicine, business, Pericardiectomy
Abstract

Primary cardiac lymphoma, defined as a non-Hodgkin’s lymphoma involving only the heart and pericardium, is an extremely rare malignancy. It should be suspected in patients with a heart mass and heart failure, unexplained refractory pericardial effusion or rhythm disturbances. Transvenous intracardiac tumor biopsy under fluoroscopic or transesophageal echocardiographic guidance, is a minimally invasive technique which makes definite diagnosis possible. We describe a patient in whom primary cardiac lymphoma was diagnosed by this technique. He also underwent percutaneous balloon pericardiotomy because of severe refractory pericardial effusion. Seven months after diagnosis and treatment with standard chemotherapy, the patient remained free of disease.

Published
2003
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