Francisco J Chorro

Fundación de Investigación del Hospital Clínico Universitario de Valencia INCLIVA, Valenza, Valencia, Spain

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Publications (278)812.26 Total impact

  • International Journal of Cardiology. 11/2014; 177(1):8–10.
  • Revista Española de Cardiología (English Edition). 09/2014;
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    ABSTRACT: Introducción y objetivos La duración anormal del intervalo QT o su dispersión se han asociado con un incremento en el riesgo de arritmias ventriculares. Se analiza el posible efecto arritmogénico de sus variaciones inducidas mediante enfriamiento y calentamiento local epicárdico. Métodos En 10 corazones aislados de conejo, se modificó escalonadamente la temperatura de una región epicárdica del ventrículo izquierdo (22 a 42 °C), registrando simultáneamente los electrogramas en dicha zona y en otra del mismo ventrículo. En ritmo sinusal, se determinó el QT y el intervalo de recuperación de la activación y, mediante estimulación programada, la velocidad de conducción y la inducción de arritmias ventriculares. Resultados En la zona modificada respecto al valor basal (37 °C), el QT se prolongó en hipotermia máxima (195 ± 47 frente a 149 ± 12 ms; p < 0,05) y se acortó en hipertermia (143 ± 18 frente a 152 ± 27 ms; p < 0,05). El intervalo de recuperación de la activación tuvo el mismo comportamiento. La velocidad de conducción disminuyó en hipotermia y aumentó en hipertermia. No hubo cambios en la otra zona. Se observaron respuestas repetitivas en cinco experimentos, pero no se encontró dependencia entre su aparición y las condiciones de hipotermia e hipertermia inducidas (p > 0,34). Conclusiones En el modelo experimental empleado, las variaciones locales de la temperatura epicárdica modulan el intervalo QT, el intervalo de recuperación de la activación y la velocidad de conducción. Las heterogeneidades inducidas no han favorecido la inducción de arritmias ventriculares.
    Revista Espanola de Cardiologia 08/2014; · 3.20 Impact Factor
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    ABSTRACT: The changes in renal function that occurred in patients with acute decompensated heart failure (ADHF) are prevalent, and have multifactorial etiology and dissimilar prognosis. To what extent the prognostic role of such changes may vary according to the presence of renal insufficiency at admission is not clear. Accordingly, we sought to determine whether early creatinine changes (ΔCr) (admission to 48-72 hours) had an effect on 1-year mortality relative to the presence of renal insufficiency at admission.
    European heart journal. Acute cardiovascular care. 07/2014;
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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: Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome. Methods A total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire) and comorbidity (Charlson and simple comorbidity indexes). The outcomes were post-discharge mortality and the composite of death/myocardial infarction during a 30 month median follow-up. Results Seventy-four (22%) patients died and 105 (31%) suffered the composite endpoint. Through univariable analysis, all individual geriatric indexes were associated to outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (AUC = 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: HR = 1.25, 95% CI = 1.15-1.36, p = 0.0001; composite endpoint: HR = 1.16, 95% CI 1.09-1.24, p = 0.0001). A Green score ≥5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (AUC = 0.823 versus 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% CI 1.4-43.5; integrated discrimination improvement 4.0, 95% CI 0.8-9.0). The incremental predictive information was even greater over the GRACE score. Conclusions Frailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.
    American Heart Journal 07/2014; · 4.50 Impact Factor
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    ABSTRACT: High-sensitivity troponin (hs-cTn) is substituting conventional cTn for evaluation of chest pain. Our aim was to assess the impact on patient management and outcome.
    Heart (British Cardiac Society) 06/2014; · 5.01 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: Background Tissue Doppler–derived transmitral to mitral annular early diastolic velocity ratio (E/Ea), as a noninvasive estimation of left ventricular (LV) filling pressures, is a strong prognosticator in various cardiac scenarios including chronic heart failure; nevertheless, its utility for risk stratification in the whole spectrum of acute heart failure (AHF) patients remains elusive. Thus, the aim of this study was to determine the association between E/Ea ratio and 1-year mortality in nonselected patients with AHF.Methods The study included 417 consecutive patients admitted for AHF. Twenty-two patients were excluded due to nonaccurate Ea measurements, leaving the final sample to be 395 patients. E-wave, septal, and lateral Ea velocities were measured following initial stabilization and according to current recommendations. The association of mean E/Ea ratio with all-cause mortality was assessed using Cox regression analysis.ResultsAt a median follow-up of 306 days (interquartile range, 118–564), 89 deaths (22.5%) were registered. Mean age and E/Ea ratio were 72 ± 11.5 and 20 ± 3. Proportion of LV ejection fraction ≥50% was 47%. In multivariate analysis, after adjusting for well-known prognostic factors, including natriuretic peptides, E/Ea ratio was linearly associated with an increase risk of all-cause mortality (HR 1.04, 95% CI 1.03–1.05; P < 0.001, per increase in one unit of E/Ea). The threshold of risk was identified above 20. No significant interactions among the most important subgroups were found.Conclusion In AHF patients, tissue Doppler imaging derived E/Ea ratio is independently associated with an increased risk of all-cause mortality.
    Echocardiography 05/2014; · 1.26 Impact Factor
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    ABSTRACT: The use of loop diuretics in acute heart failure (AHF) is largely empirical and has been associated with renal function impairment by reducing renal perfusion but also renal improvement by decreasing renal venous congestion. Antigen carbohydrate 125 (CA125) has emerged as a proxy for fluid overload. We sought to evaluate whether the early changes in creatinine (ΔCr) induced by intravenous furosemide doses (ivFD) differ among clinical groups defined by overload status (CA125) and creatinine on admission (Cr). We included 526 consecutive patients admitted for AHF. All patients received intravenous furosemide for the first 48hours. CA125 and Cr were dichotomized at 35 U/ml and 1.4mg/dl, respectively, and grouped as follows: C1 [Cr <1.4, CA125 ≤35 (n=151)]; C2 [Cr <1.4, CA125 >35 (n=241)]; C3 [Cr ≥1.4, CA125 ≤35 (n=45)]; and C4 [Cr ≥1.4, CA125 >35 (n=89)]. Clinicians in charge of the management of patients were blind to CA125 values. ΔCr was estimated as the absolute difference in Cr between admission and 48-72 hours. Multivariable linear regression analysis was used for modeling purposes. The adjusted analysis showed a differential effect of ivFD on ΔCr. Per increase in 20mg/day of ivFD, the mean ΔCr was 0.010mg/dl (p=0.464) in C1, 0.002mg/dl (p=0.831) in C2, 0.045mg/dl (p=0.032) in C3, and -0.045mg/dl (p<0.001) in C4 (omnibus p<0.001). A similar pattern of response was observed in a validation cohort. In patients with AHF, the magnitude and direction of ΔCr attributable to ivFD were differentially associated with values of CA125 and Cr on admission.
    International journal of cardiology 04/2014; · 6.18 Impact Factor
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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 Española de Cardiología (English Edition). 01/2014;
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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 Abnormal QT interval durations and dispersions have been associated with increased risk of ventricular arrhythmias. The present study examines the possible arrhythmogenic effect of inducing QT interval variations through local epicardial cooling and warming. Methods In 10 isolated rabbit hearts, the temperatures of epicardial regions of the left ventricle were modified in a stepwise manner (from 22 °C to 42 °C) with simultaneous electrogram recording in these regions and in others of the same ventricle. QT and activation-recovery intervals were determined during sinus rhythm, whereas conduction velocity and ventricular arrhythmia induction were determined during programmed stimulation. Results In the area modified from baseline temperature (37 °C), the QT (standard deviation) was prolonged with maximum hypothermia (195 [47] vs 149 [12] ms; P < .05) and shortened with hyperthermia (143 [18] vs 152 [27] ms; P < .05). The same behavior was displayed for the activation-recovery interval. The conduction velocity decreased with hypothermia and increased with hyperthermia. No changes were seen in the other unmodified area. Repetitive responses were seen in 5 experiments, but no relationship was found between their occurrence and hypothermia or hyperthermia (P > .34). Conclusions In the experimental model employed, local variations in the epicardial temperature modulate the QT interval, activation-recovery interval, and conduction velocity. Induction of heterogeneities did not promote ventricular arrhythmia occurrence. Full English text available from: www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2014;
  • 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: Background: Red blood cell distribution width (RDW) has been found to be an independent predictor for adverse outcome in patients with heart failure (HF), but there are no data on the association of longitudinal RDW with all-cause mortality and occurrence of anemia. Methods and Results: 1,702 patients discharged from a previous admission for acute HF (AHF) were included. RDW was measured during the available longitudinal history of the patient. Joint modeling and Multistate Markov were used for the analysis. The median RDW at baseline was 15.0% (IQR: 14.0-16.5), and 45.6% of patients had anemia. At a median follow-up of 1.5 years (IQR: 0.45-3.25), 713 patients died. The last RDW-trajectory value and cumulative RDW-trajectory mean were predictive of mortality (HR, 1.18; 95% CI: 1.12-1.24; and HR, 1.12; 95% CI: 1.08-1.16, respectively; P<0.001 for both). This effect, however, varied according the anemia status (P for interaction<0.001), being more pronounced in absence of anemia [HR=1.31 (95% CI: 1.22-1.42) and HR=1.48 (95% CI: 1.33-1.64)] compared to those with anemia [HR=1.08 (95% CI: 1.04-1.13), 1.12 (95% CI: 1.06-1.18)]. Longitudinal RDW (per 1% increasing) was also independently associated with incident anemia [HR=1.10 (95% CI: 1.03-1.18) P=0.002]. Conclusions: Following an admission for AHF, higher longitudinal RDW values over time were associated to an increased risk for both developing anemia and dying. The effect on mortality was more pronounced among non-anemic patients.
    Circulation Journal 11/2013; · 3.58 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: In recent years, there has been a proliferation of new biomarkers with potential prognostic implication in heart failure (HF). Nevertheless, most of them do not fulfill the required criteria for being used in daily clinical practice. Tumor marker antigen carbohydrate 125 (CA125), a glycoprotein widely used for ovarian cancer monitoring, is synthesized by epithelial serous cells in response to fluid accumulation and/or cytokine stimuli. This glycoprotein has been emerged as a potential biomarker in HF. Plasma CA125 correlates with clinical, hemodynamic, and echocardiographic parameters related to the severity of the disease. High levels have shown to be present in the majority of acutely decompensated patients, and in this setting, it has shown to be independently related to mortality or subsequent admission for acute HF. In addition, certain characteristics such as wide availability and the close correlation between plasma changes with disease severity and clinical outcomes have increased the interest of researchers about the potential of this glycoprotein for monitoring and guiding therapy in HF. In this article, we have reviewed the available evidence supporting the potential role of CA125 as a biomarker in HF.
    Heart Failure Reviews 08/2013; · 4.45 Impact Factor

Publication Stats

1k Citations
812.26 Total Impact Points

Institutions

  • 2010–2014
    • Fundación de Investigación del Hospital Clínico Universitario de Valencia INCLIVA
      Valenza, Valencia, Spain
  • 1991–2014
    • University of Valencia
      • • Department of Pathology
      • • Departamento de Fisiología
      • • Departamento de Medicina
      Valenza, Valencia, Spain
  • 1990–2014
    • Hospital Clínico Universitario de Valencia
      Valenza, Valencia, Spain
  • 2012
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
  • 2011–2012
    • Universidad Itaca
      Teotitlán del Camino, Oaxaca, Mexico
  • 1999–2012
    • Polytechnical University of Valencia
      • Centre of Biomaterial and Tissue Engineering (CBIT)
      Valenza, Valencia, Spain
    • Hospital Marina Baixa
      Villajoyosa, Valencia, Spain
  • 2002–2007
    • Hospital la Magdalena
      Castellón, Valencia, Spain