Vicente Bodí

University of Valencia, Valenza, Valencia, Spain

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Publications (93)280.68 Total impact

  • International Journal of Cardiology. 11/2014; 177(1):8–10.
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    ABSTRACT: Introducción y objetivos No se conoce el valor pronóstico incremental que aporta la isquemia miocárdica inducible respecto a la necrosis determinada por resonancia magnética cardiaca de estrés en pacientes con función ventricular izquierda deprimida. Se determina el valor pronóstico de la necrosis y la isquemia en pacientes con función ventricular izquierda deprimida remitidos a exploración por resonancia magnética de estrés con perfusión de dipiridamol. Métodos En un registro multicéntrico basado en el uso de resonancia magnética de estrés, se determinó la presencia (≥ 2 segmentos) de realce tardío de contraste y defectos de perfusión y su asociación con eventos mayores (muerte cardiaca e infarto no mortal). Resultados De un total de 391 pacientes, se identificó defecto de perfusión o realce tardío en 224 (57%) y 237 (61%). Durante el seguimiento (mediana, 96 semanas), se produjeron 47 eventos mayores (12%): 25 muertes cardiacas y 22 infartos de miocardio. Los pacientes con eventos mayores presentaron mayor extensión de los defectos de perfusión (6 frente a 3 segmentos; p < 0,001), pero no del realce tardío (5 frente a 3 segmentos; p = 0,1). La tasa de eventos mayores fue significativamente superior en presencia de defectos de perfusión (el 17 frente al 5%; p = 0,0005), pero no cuando había realce tardío (el 14 frente al 9%; p = 0,1). Se clasificó a los pacientes en los cuatro grupos siguientes: ausencia de defecto de perfusión y ausencia de realce tardío (n = 124), presencia de realce tardío y ausencia de defecto de perfusión (n = 43), presencia de realce tardío y presencia de defecto de perfusión (n = 195), y ausencia de realce tardío y presencia de defecto de perfusión (n = 29). Las tasas de eventos fueron del 5, el 7, el 16 y el 24% respectivamente (p de tendencia = 0,003). En un modelo de regresión multivariable, solamente el defecto de perfusión predijo los eventos clínicos (hazard ratio = 2,86; intervalo de confianza del 95%, 1,37-5,95; p = 0,002), pero el realce tardío no (hazard ratio = 1,70; intervalo de confianza del 95%, 0,90-3,22; p = 0,105). Conclusiones En los pacientes con la función ventricular izquierda deprimida, la isquemia inducible es el más potente predictor de futuros eventos mayores.
    Revista Espanola de Cardiologia 09/2014; · 3.20 Impact Factor
  • International journal of cardiology. 08/2014;
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    ABSTRACT: Background Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model. Methods A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain. 101 consecutive STEMI patients were randomized to undergo primary angioplasty followed by PCON or primary angioplasty alone (non-PCON). Using late gadolinium enhancement cardiovascular magnetic resonance, infarct size and MVO were quantified (% of left ventricular mass). In swine, using an angioplasty balloon-induced anterior STEMI model, MVO was defined as the % of area at risk without thioflavin-S staining. Results In patients, PCON (n = 49) in comparison with non-PCON (n = 52) did not significantly reduce MVO (0 [0–1.02]% vs. 0 [0–2.1]% p = 0.2) or IS (18 ± 13% vs. 21 ± 14%, p = 0.2). MVO (> 1 segment in the 17-segment model) occurred in 12/49 (25%) PCON and in 18/52 (35%) non-PCON patients, p = 0.3. No significant differences were observed between PCON and non-PCON patients in left ventricular volumes, ejection fraction or the extent of hemorrhage. In the swine model, MVO occurred in 4/6 (67%) PCON and in 4/6 (67%) non-PCON pigs, p = 0.9. The extent of MVO (10 ± 7% vs. 10 ± 8%, p = 0.9) and infarct size (23 ± 14% vs. 24 ± 10%, p = 0.8) was not reduced in PCON compared with non-PCON pigs. Conclusions Ischemic postconditioning does not significantly reduce microvascular obstruction in ST-segment elevation myocardial infarction. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT01898546.
    International Journal of Cardiology. 07/2014; 175(1):138–146.
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    ABSTRACT: Introducción y objetivos Conocer la mortalidad y el manejo actuales de los pacientes ingresados por sospecha de síndrome coronario agudo en España. El último registro disponible (2004-2005) reportó una mortalidad hospitalaria del 5,7%. Métodos Se incluyó a los pacientes ingresados consecutivamente de enero a junio de 2012 en 44 hospitales seleccionados al azar. Se recogió la evolución en el ingreso y los eventos a 6 meses. Resultados Se incluyó a 2.557 pacientes ingresados con sospecha de síndrome coronario agudo: 788 (30,8%) con elevación del segmento ST, 1.602 (62,7%) sin elevación del segmento ST y 167 (6,5%) con síndrome coronario agudo inclasificable. La mortalidad hospitalaria fue del 4,1% (el 6,6, el 2,4 y el 7,8% respectivamente), significativamente menor que la registrada en 2004-2005. Se realizó tratamiento de reperfusión (más frecuentemente intervención coronaria percutánea primaria) en el 85,7% de los pacientes con elevación del segmento ST atendidos en < 12 h. La mediana del tiempo desde el primer contacto médico hasta la trombolisis fue 40 min y hasta el inflado del balón, 120 min. Al 80,6% de los pacientes sin elevación del segmento ST, se les realizó coronariografía; al 52,0%, intervención percutánea, y al 6,4%, se le indicó cirugía. La prescripción de tratamientos de prevención secundaria al alta aumentó respecto a registros previos. La mortalidad a 6 meses entre los pacientes dados de alta con vida (seguimiento disponible en el 97,1%) fue del 3,8%. Conclusiones La mortalidad de los pacientes con síndrome coronario agudo en España ha disminuido respecto a los últimos datos disponibles, en paralelo a un uso más frecuente de los principales tratamientos recomendados.
    Revista Espanola de Cardiologia 06/2014; · 3.20 Impact Factor
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    ABSTRACT: Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model.
    International journal of cardiology. 05/2014;
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    ABSTRACT: Introduction and objectives The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. Methods In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. Results In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly higher in the presence of perfusion defects (17% vs 5%; P =.0005) but not of late enhancement (14% vs 9%; P =.1). Patients were categorized into 4 groups: absence of perfusion defect and absence of late enhancement (n = 124), presence of late enhancement and absence of perfusion defect (n = 43), presence of perfusion defect and presence of late enhancement (n = 195), absence of late enhancement and presence of perfusion defect (n = 29). Event rate was 5%, 7%, 16%, and 24%, respectively (P for trend = .003). In a multivariate regression model, only perfusion defect (hazard ratio = 2.86; 95% confidence interval, 1.37-5.95]; P = .002) but not late enhancement (hazard ratio = 1.70; 95% confidence interval, 0.90–3.22; P =.105) predicted events. Conclusions In depressed left ventricular function, the presence of inducible ischemia is the strongest predictor of major events. Full English text available from:www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2014;
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    ABSTRACT: Introduction and objectives To identify the current mortality and management of patients admitted for suspected acute coronary syndrome in Spain. The last available registry (2004-2005) reported an in-hospital mortality of 5.7%. Methods The study included patients consecutively admitted between January and June 2012 at 44 hospitals selected at random. Information was collected on clinical course at admission and on events at 6 months. Results A total of 2557 patients admitted with suspected acute coronary syndrome were included: 788 (30.8%) with ST-segment elevation, 1602 (62.7%) without ST-segment elevation, and 167 (6.5%) with unclassified acute coronary syndrome. In-hospital mortality was 4.1% (6.6%, 2.4%, and 7.8% respectively), significantly lower than that observed for 2004-2005. Reperfusion treatment (most commonly, primary percutaneous coronary intervention) was administered to 85.7% of patients with ST-segment elevation attended within 12 h. The median time from first medical contact to thrombolysis was 40 min and to balloon inflation, 120 min. Among patients without ST-segment elevation, coronary angiography was performed in 80.6%, percutaneous intervention in 52.0%, and surgery in 6.4%. Secondary prevention treatments at discharge was prescribed more often than in earlier registries. In patients alive at discharge (follow-up available for 97.1%), 6-month mortality was 3.8%. Conclusions Mortality among patients with acute coronary syndrome in Spain was lower than that reported in the most recent published studies, in parallel with a more frequent use of the main treatments recommended. Full English text available from: www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2014;
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    ABSTRACT: The aim of this study was to establish reference values for segmental myocardial strain measured by magnetic resonance (MR) cardiac tagging in order to characterize the regional function of the heart. We characterized the left ventricular (LV) systolic deformation in 39 subjects (26 women and 13 men, age 58.8 ± 11.6 years) whose cardiological study had not revealed any significant abnormality. The deformation was measured from MR-tagged (Siemens 1.5T MR) images using an algorithm based on sine wave modeling. Circumferential and radial peak systolic strain values along with the torsion angle and circumferential-longitudinal (CL) shear were determined in 16 LV segments in order to settle the reference values for these parameters. Circumferential strain was highest at the anterior and lateral walls (-20.2 ± 4.0% and -21.8 ± 4.3%, respectively; P < 0.05) and was lowest at the base level (-17.2 ± 3.1% vs. -20.1 ± 3.1% "mid level," P < 0.05; -17.2 ± 3.1% vs. -20.3 ± 3.0% "apical level," P < 0.05). Radial strain highest values were from inferior and lateral walls (13.7 ± 7.4% and 12.8 ± 7.8%, respectively; P < 0.05) and it was lowest medially (9.4 ± 4.1% vs. 13.1 ± 4.1% "base level," P < 0.05; 9.4 ± 4.1% vs. 12.1 ± 4.4% "apical level," P < 0.05). Torsion angle (counterclockwise when viewed from the apex) increased with the distance from the base (7.9 ± 2.4° vs. 16.8 ± 4.4°, P < 0.05), and the highest and lowest values were found at lateral (medial lateral: 12.0 ± 4.4°, apical lateral: 25.1 ± 6.4°, P < 0.05) and septal wall (medial septal: 3.6 ± 2.1°, apical septal: 8.3 ± 5.3°, P < 0.05), respectively. These differences were found again in CL shear values, around the LV circumference. However, CL shear remained constant with increasing distance from the base (9.1 ± 2.6°, medium and 9.8 ± 2.4°, apex). In summary, this study provides reference values for the assessment of regional myocardial function by MR cardiac tagging. Comparison of patient deformation parameters with normal deformation patterns may permit early detection of regional systolic dysfunction.J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 12/2013; · 2.57 Impact Factor
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    ABSTRACT: In patients with ST-segment elevation myocardial infarction (STEMI) reperfused with primary coronary intervention (PCI), the dynamics of endothelial cell (EC) viability, apoptosis and necrosis and its relationship with the structural consequences on the left ventricle have not been addressed so far. In 20 STEMI patients, we incubated human umbilical vein endothelial cells (HUVECs) with serum drawn before reperfusion and subsequently afterwards (24h, 96h, 30 days). Viability, apoptosis and necrosis percentages were evaluated by flow cytometry. Values were compared with 12 age- and sex-matched control subjects with normal coronary arteries. Cardiac magnetic resonance (CMR) was performed during the first week after infarction. Serum from STEMI patients induced a progressive loss of EC viability, with a nadir of 67.7±10.2% at 96h (baseline: 75±6%, controls: 80.2±3.9%, p<0.001 in both cases). This was owed to an increase of apoptosis that peaked at 96h after reperfusion (15.2±7.1% vs. 11±6 at baseline and 5.8±1.6% in controls, p<0.001 in both cases). However, no significant dynamic changes in EC necrosis were detected. Extensive myocardial oedema (>30%, median of left ventricular mass) was the only CMR variable significantly associated with a higher percentage of EC apoptosis at 96 hours (extensive vs. non extensive oedema: 18.3±6.8% vs. 12.1±6.3%, p<0.05). Dynamic changes in EC viability occur in the setting of STEMI patients reperfused with PCI, that these changes peak late after reperfusion, that they are mainly the result of an increase of apoptosis and are associated with the presence of extensive myocardial oedema. This article is protected by copyright. All rights reserved.
    European Journal of Clinical Investigation 10/2013; · 3.37 Impact Factor
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    ABSTRACT: Despite recent advances in the diagnosis of myocardial ischemia, its biochemical identification in patients with acute chest pain is still a challenge, and alternative approaches for further improvement are needed. Metabolic alterations are the first consequences of acute myocardial ischemia. Metabolomics coupled with potent multivariate analyses allows for a simultaneous and relative quantification of thousands of different metabolites within a given sample. Thus, this discipline might exert a great impact on medical practice in cardiovascular medicine by providing a wealth of relevant biochemical data. Metabolomics is a promising tool to improve current, single biomarker-based approaches by identifying metabolic biosignatures that embody global biochemical changes in disease. This is especially relevant for conditions requiring early treatment like myocardial ischemia. This review discusses the potential application of metabolomics in the diagnosis of myocardial ischemia.
    Journal of Cardiovascular Translational Research 08/2013; · 3.06 Impact Factor
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    ABSTRACT: Data on right ventricular (RV) involvement in anterior myocardial infarction are scarce. The presence of RV microvascular obstruction (MVO) in this context has not been analyzed yet. The aim of the present study was to characterize the presence of MVO in the RV in a controlled experimental swine model of reperfused anterior myocardial infarction. Left anterior descending (LAD) artery-perfused area (thioflavin-S staining after selective infusion in LAD artery), infarct size (lack of triphenyltetrazolium-chloride staining) and MVO (lack of thioflavin-S staining in the core of the infarcted area) in the RV were studied. A quantitative (% of the ventricular volume) and semiquantitative (number of segments involved) analysis was carried out both in the RV and LV in a 90-min left anterior descending balloon occlusion and 3-day reperfusion model in swine (n=15). RV infarction and RV MVO (>1 segment) were detected in 9 (60%) and 6 (40%) cases respectively. Mean LAD-perfused area, infarct size and MVO in the RV were 33.8±13%, 13.53±11.7% and 3.4±4.5%. Haematoxylin and eosin stains and electron microscopy of the RV-MVO areas demonstrated generalized cardiomyocyte necrosis and inflammatory infiltration along with patched hemorrhagic areas. Ex-vivo nuclear magnetic resonance (T2* sequences) microimaging of RV-MVO showed, in comparison with remote non-infarcted territories, marked hypointense zones (corresponding to necrosis, inflammation and hemorrhage) in the core of hyperintense regions (corresponding to edema). In reperfused anterior myocardial infarction, MVO is frequently present in the RV. It is associated with severe histologic repercussion on the RV wall. Nuclear magnetic resonance appears as a promising technique for the noninvasive detection of this phenomenon. Further studies are warranted to evaluate the pathophysiological and clinical implications.
    Thrombosis Research 08/2013; · 3.13 Impact Factor
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    ABSTRACT: Objective The aim of this study was to relate the contractile reserve in infarction segments to the dysfunction at rest and to the residual coronary stenosis. Methods The study group consisted of 95 patients with a first myocardial infarction. Contrast left ventricular at baseline and after dobutamine infusion at 7.5 Êg/kg/min and coronary angiograms were performed. The centerline method was used to quantify the extent of dysfunction (percentage of chords with dysfunction in the territory of the infarction artery) and its maximum severity (maximum units of standard deviation [SD] below the normal wall motion reference). Reduction of dysfunction extent with dobutamine was measured. Results On increasing baseline dysfunction severity, both the magnitude of the response to dobutamine (. 2 SD [n = 12] = 33 ±} 19%, > 2 SD ≤ 3 SD [n = 20] = 20 ±} 16%, > 3 SD ≤ 4 SD [n = 35] = 16 ±} 19%, > 4 SD ±} 5 SD [n = 15] = 9 ±} 13%, > 5 SD [n = 13] = 3 ±} 4%, p = 0,0001), and the number of patients with a significant (. 15%) positive response (. 2 SD = 12 [100%], > 2 SD ≤ 3 SD = 11 [55%], > 3 SD ≤ 4 SD = 17 [49%], > 4 SD ≤ 5 SD = 3 [20%]; > 5 SD = 0%, p < 0,0001) decreased. There were no differences in dobutamine improvement among the subgroups with (n = 84) or without (n = 11) significant stenosis in the infarction artery (18 ±} 15 vs 16 ±} 18%), or between the subgroups with a patent (n = 76, 18 ±} 19%) or occluded (n = 19, 11 ±} 11%) artery. Conclusions Dobutamine response is related to dysfunction severity in the infarction area: when the severity is ≤ 2 (high positive response prevalence) or > 5 (high negative response prevalence), dobutamine testing does not seem indicate. The existence of residual coronary stenosis does not attenuate contractile reserve at low dobutamine doses.
    Revista Espa de Cardiologia 07/2013; 53(5):617–624. · 3.20 Impact Factor
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    ABSTRACT: Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p < .0001) and a larger SS at 6 months (5 [2-6] vs. 3 [1-5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.
    The international journal of cardiovascular imaging 06/2013; · 2.15 Impact Factor
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. METHODS: One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed. RESULTS: During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying >50% transmural necrosis, P<.001). CONCLUSIONS: A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. Full English text available from: www.revespcardiol.org/en.
    Revista Espa de Cardiologia 05/2013; · 3.20 Impact Factor
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    ABSTRACT: BACKGROUND: The complex anatomy of the aortic annulus warrants the use of three dimensional (3D) modalities for prosthesis sizing in transcatheter aortic valve implantation (TAVI). Multislice computed tomography (MSCT) has been used for this purpose, but its use may be restricted because of contrast administration. 3D transesophageal echocardiography (3D-TEE) lacks this limitation and data on comparison with MSCT is scarce. We compared 3D-TEE with MSCT for prosthesis sizing in TAVI. METHODS: Aortic annulus diameters in the sagittal and coronal plane and annulus areas in 3D-TEE and MSCT were compared in 57 patients undergoing TAVI. Final prosthesis size was left at the operator's discretion and the agreement with 3D-TEE and MSCT was calculated. RESULTS: Sagittal diameters on 3D-TEE and MSCT correlated well (r=.754, p<.0001) and means were comparable (22.3±2.1 vs. 22.5±2.3mm; p=0.2; mean difference: -0.3mm [-3.3-2.8]). On 3D-TEE, coronal diameter and annulus area were significantly smaller (p<.0001 for both) with moderate correlation (r=0.454 and r=0.592). Interobserver variability was comparable for both modalities. TAVI was successful in all patients with no severe post-procedural insufficiency. Final prosthesis size was best predicted by sagittal annulus diameters in 84% and 79% by 3D-TEE and MSCT, respectively. Agreement between both modalities was 77%. CONCLUSIONS: Annulus diameters and areas for pre-procedural TAVI assessment by 3D-TEE are significantly smaller than MSCT with exception of sagittal diameters. Using sagittal diameters, both modalities predicted well final prosthesis size and excellent procedural results were obtained. 3D-TEE can thus be a useful alternative in patients with contraindications to MSCT.
    International journal of cardiology 05/2013; · 6.18 Impact Factor
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    ABSTRACT: BACKGROUND: Prognostic implications of echocardiographic assessment of pulmonary hypertension (PH) in non-selected patients hospitalized for acute heart failure (AHF) are not clearly defined. The aim of this study was to evaluate the association between echocardiography-derived PH in AHF and 1-year all-cause mortality. METHODS: We prospectively included 1210 consecutive patients admitted for AHF. Patients with significant heart valve disease were excluded. Pulmonary arterial systolic pressure (PASP) was estimated using transthoracic echocardiography during hospitalization (mean time after admission 96±24h). Patients were categorized as follows: non-measurable, normal PASP (PASP≤35mmHg), mild (PASP 36-45mmHg), moderate (PASP 46-60mmHg) and severe PH (PASP >60mmHg). The independent association between PASP and 1-year mortality was assessed with Cox regression analysis. RESULTS: At 1-year follow-up, 232 (19.2%) deaths were registered. PASP was measured in 502 (41.6%) patients with a median of 46 [38-55] mmHg. The distribution of population was: 708 (58.5%), 76 (6.3%), 147 (12.1%), 190 (15.7%) and 89 (7.4%) for non-measurable, normal PASP, mild, moderate and severe PH, respectively. One-year mortality was lower for patients with normal PASP (1.32 per 10 person-years), intermediate for patients with non-measurable, mild and moderate PH (2.48, 2.46 and 2.62 per 10 persons-year, respectively) and higher for those with severe PH (4.89 per 10 person-years). After multivariate adjustment, only patients with PASP >60mmHg displayed significant adjusted increase in the risk of 1-year all-cause mortality, compared to patients with normal PASP (HR=2.56; CI 95%: 1.05-6.22, p=0.038). CONCLUSIONS: In AHF, severe pulmonary hypertension derived by echocardiography is an independent predictor of 1-year-mortality.
    European Journal of Internal Medicine 05/2013; · 2.30 Impact Factor
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    ABSTRACT: OBJECTIVES: This study sought to predict the value of tumor marker carbohydrate antigen 125 (CA125) before and after transcatheter aortic valve implantation (TAVI) for all-cause death and a composite endpoint of death, admission for heart failure, myocardial infarction, and stroke (major adverse cardiac events [MACE]). BACKGROUND: Risk stratification after TAVI remains challenging. The use of biomarkers in this setting represents an unmet need. METHODS: CA125 was measured in 228 patients before and after TAVI. The association with outcomes was assessed using parametric Cox regression and joint modeling for baseline and longitudinal analyses, respectively. CA125 was evaluated as logarithm transformation and dichotomized by its median value (M1 ≤15.7 U/ml vs. M2 >15.7 U/ml). RESULTS: At a median follow-up of 183 days (interquartile range: 63 to 365) and 144 days (interquartile range: 56 to 365), 50 patients (22%) died and 75 patients (33%) experienced MACE. A 3-fold increase in the rates for death and MACE was observed in patients above the median (M2 vs. M1) of CA125 (5.2 vs. 1.6 per 10 person-years and 8.3 vs. 3.3 per 10 person-years, respectively; p for both <0.001). In a multivariable analysis adjusted for logistic EuroSCORE, New York Heart Association functional class III/IV, and device success, baseline values of CA125 (M2 vs. M1) independently predicted death (hazard ratio [HR]: 2.18; 95% confidence interval [CI]: 1.11 to 4.26; p = 0.023) and MACE (HR: 1.77; 95% CI: 1.05 to 2.98; p = 0.031). In the longitudinal analysis, lnCA125 as a time-varying exposure, was highly associated with both endpoints: HR: 1.47; 95% CI: 1.01 to 2.14; p = 0.043 and HR: 2.26; 95% CI: 1.28 to 3.98; p = 0.005, for death and MACE, respectively. CONCLUSIONS: Serum levels of CA125 before and after TAVI independently predict death and MACE.
    JACC. Cardiovascular Interventions 05/2013; 6(5):487-496. · 1.07 Impact Factor
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    ABSTRACT: OBJECTIVES: To report our center's experience using veno-arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI). BACKGROUND: In TAVI, short-term mortality closely relates to life threatening procedural complications. VaECMO can be used to stabilize the patient in emergency situations. However, for the prophylactic use of vaECMO in very high-risk patients undergoing TAVI there is no experience. METHODS: From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in 8 cases (7%): ventricular perforation (n=3), hemodynamic instability/cardiogenic shock (n=4), hemodynamic deterioration due to ventricular tachycardia (n=1). Since August 2011, during 83 procedures, prophylactic vaECMO was systematically used in very high-risk patients (n=9, 11%) and emergency ECMO in one case (1%) due to ventricular perforation. RESULTS: Median logistic EuroScore in prophylactic vaECMO patients was considerably higher compared to the remaining TAVI population (30% vs. 15%, p=.0003) while in patients with emergency vaECMO it was comparable (18% vs. 15%, p=.08). Comparing prophylactic to emergency vaECMO, procedural success and 30-day mortality were 100% vs. 44% (p=.03) and 0% vs. 44% (p=.02), respectively. Major vascular complications and rate of life threatening bleeding did not differ between both groups (11% vs. 11%, p=.99 and 11% vs. 33%, p=.3) and were not vaECMO-related. CONCLUSIONS: Life-threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high-risk patients is safe and may be advocated in selected cases. © 2013 Wiley-Liss, Inc.
    Catheterization and Cardiovascular Interventions 04/2013; · 2.51 Impact Factor
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    Revista Española de Cardiología. 01/2013; 66(1):5–11.

Publication Stats

522 Citations
280.68 Total Impact Points

Institutions

  • 2006–2014
    • University of Valencia
      • • Department of Pathology
      • • Departamento de Medicina
      Valenza, Valencia, Spain
  • 2002–2014
    • Hospital Clínico Universitario de Valencia
      Valenza, Valencia, Spain
  • 2013
    • Deutsches Herzzentrum München
      München, Bavaria, Germany
    • Requena General Hospital
      Valenza, Valencia, Spain
  • 2012–2013
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
    • University Hospital Regensburg
      • Klinik und Poliklinik für Innere Medizin II
      Regensburg, Bavaria, Germany
  • 2010–2013
    • Fundación de Investigación del Hospital Clínico Universitario de Valencia INCLIVA
      Valenza, Valencia, Spain
  • 2006–2012
    • Polytechnical University of Valencia
      • Centre of Biomaterial and Tissue Engineering (CBIT)
      Valenza, Valencia, Spain
  • 2011
    • Hospital Francesc De Borja De Gandia
      Gandía, Valencia, Spain