F Ten

Hospital Universitari i Politècnic la Fe, Valenza, Valencia, Spain

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Publications (5)6.06 Total impact

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    ABSTRACT: The present study evaluated the clinical and hemodynamic situation of patients with advanced heart failure considered for heart transplantation (HT) to examine the possible impact of prior cardiac disease. We analyzed the pretransplant clinical, echocardiographic, and hemodynamic parameters of 422 consecutive HT patients. Pediatric and heart plus lung transplants were excluded, as were retransplantations. The results were compared by dividing the patients into three groups according to the background heart disease that led to HT: ischemic heart disease (IHD), dilated myocardiopathy (DMC), or valvular disease. Differences were observed in the baseline characteristics according to the type of heart disease. Male gender, hypertension, and diabetes were more frequent among IHD, while DMC patients tended to be younger. There were no differences in the clinical parameters such as liver and kidney function, in the functional class, or in the need for inotropic treatment over the days prior to transplantation. Likewise, no differences were recorded in the hemodynamic parameters, such as pulmonary pressure, pulmonary vascular resistance, or transpulmonary pressure gradient. As regards the echocardiographic parameters, the patients with DMC showed greater ventricular diameters and lesser ejection fractions for both ventricles. No important differences were recorded in the clinical situation or hemodynamic parameters of patients with advanced heart failure accepted for transplantation, according to the background cardiac disease. This observation could be due to the homogenization by strict transplant waiting list inclusion criteria.
    Transplantation Proceedings 10/2007; 39(7):2341-3. · 0.95 Impact Factor
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    ABSTRACT: Preoperative pulmonary hypertension is an adverse prognostic factor for early morbidity-mortality after heart transplantation (HT). The persistence of hypertension is likewise associated with a poorer patient prognosis. The present study investigated the evolution of right cardiac pressures in the first year after HT with respect to the background cardiac disease. This study of 60 consecutive patients subjected to HT analyzed the baseline clinical characteristics and mean right atrial and right ventricle systolic and diastolic pressures in a pre-HT study and during biopsies performed in the first 2 weeks as well as at 1, 3, 6, 9, and 12 months after transplantation. The study excluded retransplantations, heart and lung transplantations, and pediatric patients, as well as patients not subjected to biopsy because of early mortality. The mean patient age was 50 years (83% males); 31.7% were diabetics, and 33% showed hypertension. The background heart disease was of ischemic origin in 35% of cases, and consisted of dilated myocardiopathy in 33%, with a mean left ventricle ejection fraction (LVEF) of 23% and a mean pulmonary artery systolic pressure of 50.1 mm Hg. During the postoperative course, an important decrease versus baseline was observed in right heart pressures as soon as 2 weeks post-HT, with a drop in right ventricle (RV) systolic pressure from 50.3 +/- 13.7 to 42.5 +/- 10.4 mm Hg (P = .013), and a drop in RV diastolic pressure from 17.4 +/- 5.8 to 14.2 +/- 4.1 mm Hg (P = .007). This decreased tendency continued to a more moderate extent to the third month, after which the pressures stabilized. The same behavior was observed in patients with diseases of ischemic origin and in those with dilated myocardiopathy. In our series, right cardiac pressures showed an important decrease in the first days after HT, with stabilization by the third month--though without returning to normal values and without modifications in the first year after transplantation. No differences in this evolutive trend were seen according to the type of background heart disease.
    Transplantation Proceedings 10/2007; 39(7):2368-71. · 0.95 Impact Factor
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    ABSTRACT: Cardiac allograft vasculopathy (CAV) is a disease that significantly limits the survival of transplant patients intravascular ultrasound (IVUS) is considered the method of choice for its diagnosis. von Willebrand factor (vWf) has been used as a marker of endothelial malfunction. We sought to evaluate the usefulness of vWf as a CAV marker. We prospectively analyzed 22 cardiac transplant subjects, on whom we performed a first study using coronary angiography and IVUS at 36 +/- 3 days and a second study at 598 +/- 49 days. During the follow-up period, five vWf serum controls were performed per patient. We analyzed the results with the repeated-measures ANOVA test and a ROC curve. CAV was detected in 10 (45.5%) of the 22 patients. Although vWf levels tended to diminish progressively during evolution, this trend was not statistically significant (P = .3). However, differences were appreciated based on the presence versus absence of CAV (298 +/- 139 mg/dL versus 212 +/- 105 mg/dL, P = .02). The ROC curve showed a sensitivity of 40%, a specificity of 83%, and a negative predictive value of 82% with a cutoff point of 300 mg/dL. Subjects with CAV showed significantly higher vWf serum concentrations, particularly during the preliminary phases of cardiac transplantation decreasing during its evolution. This marker could be useful for early screening of CAV.
    Transplantation Proceedings 11/2006; 38(8):2566-8. · 0.95 Impact Factor
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    ABSTRACT: The study was performed to test the influence of the jet spatial disposition on the correlation degree between the measurement of the jet width at its origin and the severity of mitral prosthetic regurgitation by transesophageal Doppler color flow imaging. In 165 patients with mitral valve prosthesis which were submitted for transesophageal echocardiography examination due to suspected prosthetic dysfunction, we studied 126 with pathological mitral regurgitation. On these patients, studies of jet spatial disposition, maximum width in its origin and severity quantification by means of maximum regurgitation area were performed. For the free jet group of patients (90), jet width at its origin correlated with maximal regurgitation area (r = 0.75); whereas for the wall jet group (36), the correlation degree was 0.59. We observed a relationship (p < 0.05) between severe mitral regurgitation assessed by maximal regurgitant jet size and jet width > or = 5 mm in both groups: the sensitivity and specificity of 72.7% and 95% respectively for free jets, and 70.7% and 64.4% for wall jets. The correlation between the area measurement and the width in its origin is better for free jets than for wall jets. A statistically significant relationship between the presence of severe mitral regurgitation and width in its origin > or = 5 mm could be observed, independently of the jet spatial disposition.
    Revista Espa de Cardiologia 01/1999; 52(1):31-6. · 3.20 Impact Factor
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    ABSTRACT: Introduction and objectives. The study was performed to test the influence of the jet spatial disposition on the correlation degree between the measurement of the jet width at its origin and the severiry of mitral prosthetic regurgitation by transesophageal Doppler color flow imaging. Material and methods. In 165 patients with mitral valve prosthesis which were submitted for transesophageal echocardiography examination due to suspected prosthetic dysfunction, we studied 126 with pathological mitral regurgitation. On these patients, studies of jet spatial disposition, maximun width in its origin and severity quantification by means of maximun regurgitation area were performed. Results. For the free jet group of patients (90), jet width at its origin correlated with maximal regurgitation area (r = 0.75); whereas for the wall jet group (36), the correlation degree was 0.59. We observed a relationship (p < 0.05) between severe mitral regurgitation assessed by maximal regurgitant jet size and jet width 3 5 mm in both groups: the sensitivity and specificity of 72.7% and 95% respectively for free jets, and 70.7% and 64.4% for wall jets. Conclusions. The correlation between the area measurement and the width in its origin is better for free jets than for wall jets. A statiscally significant relationship between the presence of severe mitral regurgitation and width in its origin 3 5 mm could be observed, independently of the jet spatial disposition.
    Revista Española de Cardiología. 52(1):31–36.