Publications (6)11.55 Total impact
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Article: Posterior paralimbic and frontal metabolite impairments in asymptomatic hypertension with different treatment outcomes.
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ABSTRACT: Hypertension is associated with cognitive decline in elderly persons. We studied asymptomatic hypertensive subjects using brain magnetic resonance (MR) spectroscopy to evaluate metabolite impairments before the appearance of symptoms in patients with different treatment outcomes. In all, 14 healthy controls and 37 asymptomatic hypertensive patients (17 controlled and 20 resistant) underwent brain structural MR and MR spectroscopy of the posterior paralimbic (PPL) area and left frontal white matter. Ischemic burden (IB), global cortical atrophy and microbleeds were analyzed with visual scales. Metabolite ratios involving N-acetyl-aspartate (NAA), creatine (Cr), choline (Cho) and myoinositol (mI) were computed. Ultrasound measurements, including intima-media thickness, plaques and hemodynamic ratios, were obtained. Intergroup differences in IB, atrophy and metabolite ratios, and the atrophy and IB relationship were assessed with parametric and nonparametric statistical tests. In addition, the impacts of demographic, analytic and clinical factors, ischemia and atrophy, and ultrasound measurements on metabolite ratios were assessed. The significance level was set at P<or=0.05. Higher atrophy scores presented with higher total or frontal IB (P<0.05). However, there was no intergroup difference in atrophy and IB. PPL mI/Cr was increased in resistant hypertension (P<0.021), whereas frontal NAA/Cr (P<0.007) showed opposite trends between controlled (increased ratios) and resistant (decreased ratios) hypertension. Unlike PPL mI/Cr, frontal NAA/Cr showed significant correlations with the lipid profile and ultrasound measurements. PPL mI/Cr increases in resistant hypertension, and frontal NAA/Cr diverges between controlled and resistant hypertension before physical and neuropsychological symptoms appear.Hypertension Research 10/2009; 33(1):67-75. · 2.58 Impact Factor -
Article: [Analysis of the patient safety culture in hospitals of the Spanish National Health System].
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ABSTRACT: A safety culture is essential to minimize errors and adverse events. Its measurement is needed to design activities in order to improve it. This paper describes the methods and main results of a study on safety climate in a nation-wide representative sample of public hospitals of the Spanish NHS. The Hospital Survey on Patient Safety Culture questionnaire was distributed to a random sample of health professionals in a representative sample of 24 hospitals, proportionally stratified by hospital size. Results are analyzed to provide a description of safety climate, its strengths and weaknesses. Differences by hospital size, type of health professional and service are analyzed using ANOVA. A total of 2503 responses are analyzed (response rate: 40%, (93% from professionals with direct patient contact). A total of 50% gave patient safety a score from 6 to 8 (on a 10-point scale); 95% reported < 2 events last year. Dimensions "Teamwork within hospital units" (71.8 [1.8]) and "Supervisor/Manager expectations and actions promoting safety" (61.8 [1.7]) have the highest percentage of positive answers. "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" could be identified as weaknesses. Significant differences by hospital size, type of professional and service suggest a generally more positive attitude in small hospitals and Pharmacy services, and a more negative one in physicians. Strengths and weaknesses of the safety climate in the hospitals of the Spanish NHS have been identified and they are used to design appropriate strategies for improvement.Medicina Clínica 01/2009; 131 Suppl 3:18-25. · 1.38 Impact Factor -
Article: [Prognostic value of tumor necrosis factor-alpha in patients with ST-segment elevation acute myocardial infarction].
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ABSTRACT: Tumor necrosis factor-alpha (TNFalpha in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNFalpha in this clinical setting at six-month follow-up. The levels of TNFalpha, C-reactive protein (CRP), interleukin 6 and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (i.e., angina, reinfarction, and death), heart failure (HF), or both (i.e., all cardiovascular events) were studied. Overall, TNFalpha levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNFalpha quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59 and 9.75, respectively. A TNFalpha level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNFalpha level, at admission was found to be an independent predictor of the development of a cardiovascular events. In patients with STEMI, the plasma TNFalpha level 48 h after symptom onset and the CRP level at admission were independent predictors of cardiovascular events.Revista Espa de Cardiologia 12/2007; 60(12):1233-41. · 2.53 Impact Factor -
Article: [Assessment of left atrial wall velocities by pulsed wave tissue Doppler imaging. A new approach to the study of atrial function].
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ABSTRACT: To analyze the profile of left atrial wall velocities by pulsed wave tissue Doppler imaging, and to compare the relationship between these observations and the transmitral and pulmonary vein flow velocities obtained by conventional pulsed Doppler echocardiography. We studied 90 patients (50 women and 40 men, mean age 48 [22] years). Pulsed tissue Doppler images of the left atrial wall were obtained and analyzed in all subjects. The study population was then divided in two groups: group I (age < 45 years) and group II (age > 45 years). Transmitral and pulmonary vein flow velocity tracings were obtained simultaneously by pulsed Doppler echocardiography. With pulsed tissue Doppler interrogation of the left atrial wall, a triphasic signal was recorded in all patients, consisting of a positive wave (A1) followed by two negative waves (A2 and A3). Younger subjects (group I) showed a pattern with a prominent A2 wave and an A2/A3 ratio > 1. In older patients (group II) peak velocity of the A2 wave diminished and peak velocity of the A3 wave increased, so that the A2/A3 ratio was < 1. We found no differences in peak velocity of the A1 wave between the two age groups (13.5 (3.9) cm/s in group I vs 13.1 (5.4) cm/s in group II; P = .59). Significant concordance was observed between the transmitral flow pattern and the left atrial pulsed tissue Doppler tracing (kappa = 0.584; P < .0001). Evaluation of the left atrial wall using pulsed tissue Doppler imaging is feasible and reproducible. Tissue Doppler imaging provides new quantitative insights of potential use in the assessment of left atrial function.Revista Espa de Cardiologia 11/2004; 57(11):1059-65. · 2.53 Impact Factor -
Article: [Predictors of myocardial contractile reserve in patients with nonischemic dilated cardiomyopathy. An echo-stress dobutamine study].
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ABSTRACT: Myocardial contractile reserve studies with low-dose dobutamine echocardiography have been shown to be useful to assess functional myocardial status. However, the variables associated with contractile reserve after inotropic stimulation are not well known. We studied 50 patients (35 men, mean age 56.4 +/- 9.5 years) with nonischemic dilated cardiomyopathy (NIDC), LVEF 28.7% +/- 8.5% and wall motion score index (WMSI) 2.42 +/- 0.34 with low-dose dobutamine echocardiography. Left ventricular contractile reserve was assessed by a differential parameter defined as the difference between rest and stress WMSI (DeltaWMSI). After dobutamine infusion the WMSI was 1.95 +/- 0.58; from this value we calculated a DeltaWMSI of 0.45 +/- 0.39. None of the clinical variables showed a relationship with the presence of contractile reserve. In contrast, the following echocardiographic parameters correlated with DeltaWMSI: end-diastolic (p=0.05) and end-systolic (p=0.02) diameters, end-systolic volume index (p=0.01) and LVEF (p=0.002). In the multivariate analysis, only end-diastolic diameter was an independent predictor of contractile reserve (hazard ratio=0.852; 95% CI, 0.735-0.987; p=0.03). Ventricular diameters, end-systolic volume index and LVEF are related with improvements in myocardial contractility after dobutamine infusion, although only end-diastolic diameter was an independent predictor of contractile reserve. Thus, this parameter should receive particular attention in evaluations of the functional status of the myocardium in patients with NIDC.Revista Espa de Cardiologia 11/2003; 56(10):995-1000. · 2.53 Impact Factor -
Article: Evaluación de las velocidades de pared de la aurícula izquierda mediante Doppler pulsado tisular: Una nueva aproximación al estudio de la función auricular
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ABSTRACT: Introducción y objetivos. Analizar el perfil de velocidades de la pared auricular izquierda mediante Doppler pulsado tisular y su relación con los registros de Doppler convencional obtenidos a partir del flujo transmitral y de las venas pulmonares. Pacientes y método. Estudiamos a 90 sujetos, 50 mujeres y 40 varones, con una edad de 48 ± 22 años. Se obtuvieron los patrones de Doppler pulsado tisular de la pared auricular izquierda. La población fue dividida en 2 grupos: grupo I (< 45 años) y grupo II (> 45 años). Se obtuvieron simultáneamente los registros de Doppler pulsado transmitral y de las venas pulmonares. Resultados. El análisis con Doppler pulsado tisular de la pared auricular izquierda muestra una señal espectral trifásica, con una onda positiva A1, seguida de 2 ondas negativas (A2 y A3). En el grupo más joven (grupo I) se observa un patrón con una onda A2 prominente y una relación A2/A3 > 1. Con la edad (grupo II), el pico de velocidad de A2 disminuye y el de A3 aumenta, por lo que la relación A2/A3 se hace < 1. No se observaron diferencias en las velocidades máximas de A1 entre ambos grupos (13,5 ± 3,9 cm/s en el grupo I frente a 13,1 ± 5,4 cm/s en el grupo II; p = 0,59). Los patrones de Doppler transmitral y de pared auricular mostraron una concordancia significativa (kappa = 0,584; p < 0,0001). Conclusiones. Es posible estudiar de forma reproducible las velocidades de pared de la aurícula izquierda mediante Doppler pulsado tisular. Este análisis nos permite disponer de nuevos datos cuantitativos que quizá puedan ser de utilidad para el estudio de la función auricular.Revista española de cardiología, ISSN 0300-8932, Vol. 57, Nº. 11, 2004, pags. 1059-1065.
