Federico Soria

Consorcio Hospital General Universitario de Valencia, Valencia, Valencia, Spain

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Publications (22)69.09 Total impact

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    ABSTRACT: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. Patients 40 years of age or older who had been admitted with acute coronary syndrome (ACS) to one of the 94 hospitals participating in the Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome (PAMISCA) study were included. Patients were divided into two groups based on their resting heart rate (HR ≥ or < 70 bpm). Complications were recording during a follow-up period of 1 year. There were 1054 ACS patients analyzed (43.5% with ST segment elevation and 56.5% without elevation). Mean age was 66.6 ± 11.7 years, 70.6% were male and 29.4% of subjects were female. During follow-up, more patients in the HR ≥ 70 bpm group were hospitalized for heart failure and they also had a higher mortality rate. In the multivariate analysis, a heart rate of ≥ 70 bpm was independently related to overall mortality during the follow-up period (hazard ratio 2.5; 95% confidence interval, 1.26-4.97, P = 0.009). A resting heart rate ≥ 70 bpm in patients who survive an ACS is an indicator of a high risk of suffering cardiovascular events during follow-up.
    World Journal of Cardiology (WJC) 01/2012; 4(1):15-9. DOI:10.4330/wjc.v4.i1.15 · 2.06 Impact Factor
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    ABSTRACT: Diabetes mellitus and low ankle brachial index (ABI) are both conditions associated with an increased cardiovascular risk. In the setting of an acute coronary syndrome (ACS), diabetes is associated with increased mortality, but little is known regarding a low ABI. The aim of the study was to evaluate the prevalence of diabetes and low ABI in patients after an ACS and their prognostic value. 1156 patients ≥40 years admitted with an ACS were screened with ABI previous to hospital discharge to investigate the presence of peripheral arterial disease (PAD) (ABI value≤0.9). 1054 were finally followed for one year. Patients were stratified according to diabetes and PAD status. The primary endpoint of the study was all-cause mortality. The prevalence of diabetes was 36% and PAD was 39.9%. After a median follow up of 382 days, 59 patients died (5.6%), the majority from a cardiovascular event. In both diabetic and nondiabetic patients, the presence of PAD was significantly associated with an increased incidence of the primary event. After adjustment for several prognostic variables, patients with diabetes and PAD had an increased risk of mortality (HR 4.05 (95% CI 1.86-8.83)). PAD and diabetic patients had an intermediate and similar incidence of cardiovascular events. Our results show that the presence of an ABI≤0.9 predicts cardiovascular risk to the same extent as diabetes, and the combination of diabetes and PAD is a powerful tool after an ACS to predict the occurrence of an adverse event.
    International journal of cardiology 08/2011; 151(1):84-8. DOI:10.1016/j.ijcard.2010.04.097 · 6.18 Impact Factor
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    ABSTRACT: Age is one the factors associated with poor prognosis in acute coronary syndromes (ACS) and elderly patients are a high-risk collective with few parameters for mid-term cardiovascular stratification. We aimed to assess the predictive value of ankle-brachial index (ABI) in patients (> 75 years) for 1-year mortality after an ACS. Prospective, observational and multicentre study of ACS patients in whom ABI was assessed during hospitalization. A total of 1·054 patients were included, mean age 66·6 (11·7) years from whom 26·6% were > 75 years. Elderly patients showed more history of cardiovascular disease and higher prevalence of all risk factors, except current smoking. Angiography and revascularization were performed less frequently in the elderly. Patients > 75 years showed higher presence of three vessel coronary disease and received fewer guideline-recommended treatments. Patients who died through the follow-up, mean time 387·9 ± 7·2 days, had lower ABI (0·73 ± 0·24 vs. 0·92 ± 0·22; P < 0·01), also in the elderly patients (0·73 ± 0·24 vs. 0·86 ± 0·23; P < 0·01). Cox regression analysis identified age > 75 years (HR: 2·30; IC 95% 1·26-4·18; P < 0·01) and ABI < 0·90 (HR: 3·58; IC 95% 1·80-7·15; P < 0·01) as risk factors for to 1-year mortality. Mortality was similar in elderly patients with ABI > 0·90 and young patients with ABI < 0·90; the worst prognosis was observed in elderly patients with ABI < 0·90 (HR: 10·01; 95% CI 3·74-27·15). Elderly patients represent a relevant collective of patients with ACS and are treated less optimally. ABI predicts 1-year mortality after an ACS in elderly patients.
    European Journal of Clinical Investigation 04/2011; 41(12):1268-74. DOI:10.1111/j.1365-2362.2011.02533.x · 2.83 Impact Factor
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    ABSTRACT: The impact of target organ damage (TOD) clustering in hypertensive patients with established cardiovascular disease has not been clearly defined. Multicentre, observational and prospective study of 1054 consecutive patients with acute coronary syndromes (ACSs). The objective was describing the impact of TOD on first-year mortality. Ankle-brachial index (ABI), left ventricular hypertrophy and renal dysfunction were assessed during hospital stay. Hypertensive patients accounted for 80% of the cohort and had slightly higher mean age, higher prevalence of risk factors, previous cardiovascular disease and TOD. During follow-up, mean time 387.9 (7.2) days and median 382 (364.0-430.0) days, mortality rate tended to be higher in hypertensive patients (6.1 versus 3.5%; P=0.16). Cox regression survival analysis identified pathological ABI as the only TOD independently associated with mortality. When assessed globally, the presence of at least one TOD predicted mortality only in patients with hypertension and differences in mortality rate appeared very early in the follow-up. A linear increase in mortality rate was observed with the clustering of TOD: 2.0%, if no TOD was present, 7.6% in one TOD, 11.1% in two TODs and 20.0%, if three TODs were present. An increased risk in the combined end point of ischaemic events was observed in hypertensive patients without TOD (odds ratio (OR): 3.18; 95% confidence interval (CI): 1.31-7.70; P=0.01) and was still higher in patients with hypertension and TOD (OR: 4.61; 95% CI: 1.90-11.80; P<0.01). TOD predicts mortality and ischaemic events of hypertensive patients after ACS.
    Journal of human hypertension 12/2010; 25(10):600-7. DOI:10.1038/jhh.2010.109 · 2.69 Impact Factor
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    ABSTRACT: Introduction and objectives The presence of peripheral arterial disease in patients with coronary artery disease is associated with a poor cardiovascular outcome. However, the majority of affected patients are asymptomatic and the condition is underdiagnosed. The ankle-brachial index (ABI) provides a simple method of diagnosis. The aim of this study was to assess the usefulness of an abnormal ABI for identifying multivessel coronary artery disease in patients with acute coronary syndrome (ACS). Methods We analyzed data on all ACS patients included in the PAMISCA multicenter study (with 94 participating hospitals) who underwent catheterization during admission. Patients were diagnosed with multivessel coronary disease if two or more major epicardial vessels or the left main coronary artery, or both, were affected. An ABI ≤0.9 or >1.4 was considered abnormal. Results The study included 1031 patients with a mean age of 67.7 years. Of these, 542 had multivessel disease (52.6%). Compare with those without multivessel disease, these patients were older (66.6 years vs. 62.6 years; P<.001), had higher prevalences of hypertension (65.9% vs. 56.2%; P<.005), diabetes mellitus (40.6% vs. 26.0%; P<.001) and hypercholesterolemia (89.1% vs. 80.4%; P<.001), and were more likely to have a history of cardiovascular disease (30.1% vs. 13.9%; P<.001) or an abnormal ABI (45.4% vs. 30.3%; P<.001). Multivariate analysis showed that the presence of an abnormal ABI was associated with an increased risk of multivessel disease (odds ratio=1.58; 95% confidence interval, 1.16-2.15; P<.05). Conclusions In patients with ACS, an abnormal ABI was independently associated with the risk of multivessel coronary artery disease.
    Revista Espa de Cardiologia 01/2010; 63(1):54-59. DOI:10.1016/S0300-8932(10)70009-9 · 3.34 Impact Factor
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    ABSTRACT: The presence of peripheral arterial disease in patients with coronary artery disease is associated with a poor cardiovascular outcome. However, the majority of affected patients are asymptomatic and the condition is underdiagnosed. The ankle-brachial index (ABI) provides a simple method of diagnosis. The aim of this study was to assess the usefulness of an abnormal ABI for identifying multivessel coronary artery disease in patients with acute coronary syndrome (ACS). We analyzed data on all ACS patients included in the PAMISCA multicenter study (with 94 participating hospitals) who underwent catheterization during admission. Patients were diagnosed with multivessel coronary disease if two or more major epicardial vessels or the left main coronary artery, or both, were affected. An ABI <or=0.9 or >1.4 was considered abnormal. The study included 1031 patients with a mean age of 67.7 years. Of these, 542 had multivessel disease (52.6%). Compare with those without multivessel disease, these patients were older (66.6 years vs. 62.6 years; P< .001), had higher prevalences of hypertension (65.9% vs. 56.2%; P< .005), diabetes mellitus (40.6% vs. 26.0%; P< .001) and hypercholesterolemia (89.1% vs. 80.4%; P< .001), and were more likely to have a history of cardiovascular disease (30.1% vs. 13.9%; P< .001) or an abnormal ABI (45.4% vs. 30.3%; P< .001). Multivariate analysis showed that the presence of an abnormal ABI was associated with an increased risk of multivessel disease (odds ratio=1.58; 95% confidence interval, 1.16-2.15; P< .05). In patients with ACS, an abnormal ABI was independently associated with the risk of multivessel coronary artery disease.
    Revista Espa de Cardiologia 01/2010; 63(1):54-9. DOI:10.1016/S1885-5857(10)70009-8 · 3.34 Impact Factor
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    ABSTRACT: Observational studies report poor prognosis of patients after acute coronary syndrome (ACS) in the presence of previous peripheral arterial disease (PAD), but data on subclinical PAD are scarce. This study was designed to assess the predictive value of clinical and subclinical PAD in the follow-up of patients after an ACS. We included 1,054 patients hospitalized for an ACS who survived the acute phase. Patients were divided into 3 groups: clinical PAD (previously diagnosed PAD or intermittent claudication), subclinical PAD (defined as ankle-brachial index <or=0.9 or >1.4), and no PAD. Clinical PAD was present in 150 patients (14.2%) and 298 cases of subclinical PAD were detected (28.3%). Patients with PAD (clinical and subclinical PAD) were significantly older and had a higher prevalence of hypertension and diabetes mellitus than those without PAD. During the 1-year follow-up, 59 patients died (5.6%). Previous PAD (hazard ratio 4.38, 95% confidence interval 1.96 to 9.82, p <0.001) and subclinical PAD (hazard ratio 2.35, 95% confidence interval 1.05 to 5.23, p <0.05) were associated with increased cardiovascular mortality. Moreover, patients with clinical PAD had higher rates of major cardiovascular events (myocardial infarction, angina, and heart failure) than patients with subclinical PAD or without PAD. In conclusion, beyond clinical PAD, measurement of ankle-brachial index after ACS provides substantial information on intermediate-term prognosis.
    The American journal of cardiology 12/2009; 104(11):1494-8. DOI:10.1016/j.amjcard.2009.07.014 · 3.43 Impact Factor
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    ABSTRACT: The aim was to evaluate the usefulness of urinary N-terminal fragment of B-type natriuretic peptide (NTproBNP) measurement for predicting the presence of left ventricular hypertrophy (LVH) in 160 asymptomatic patients with essential hypertension. The urinary NTproBNP/creatinine ratio was higher in patients with LVH than in either those without LVH (P<.0001) or control subjects (P<.0001). Multivariate linear regression analysis identified age (P=.034), left ventricular mass index (P=.026) and serum NT-proBNP level (P=.001) as predictors of the urinary peptide level. The area under the curve for the NT-proBNP/creatinine ratio was 0.71±0.04 (P<.0001) for identifying LVH. Logistic regression analysis showed that the NT-proBNP: creatinine ratio was a predictor of LVH (odds ratio=4.074; P=.009). In conclusion, the urinary NT-proBNP concentration is a new marker that could be useful for identifying LVH in subjects with essential hypertension.
    Revista Espa de Cardiologia 11/2009; 62(11):1322-1325. DOI:10.1016/S0300-8932(09)73085-4 · 3.34 Impact Factor
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    ABSTRACT: The aim was to evaluate the usefulness of urinary N-terminal fragment of B-type natriuretic peptide (NT-proBNP) measurement for predicting the presence of left ventricular hypertrophy (LVH) in 160 asymptomatic patients with essential hypertension. The urinary NT-proBNP/creatinine ratio was higher in patients with LVH than in either those without LVH (P< .0001) or control subjects (P< .0001). Multivariate linear regression analysis identified age (P=.034), left ventricular mass index (P=.026) and serum NT-proBNP level (P=.001) as predictors of the urinary peptide level. The area under the curve for the NT-proBNP/creatinine ratio was 0.71+/-0.04 (P< .0001) for identifying LVH. Logistic regression analysis showed that the NT-proBNP: creatinine ratio was a predictor of LVH (odds ratio=4.074; P=.009). In conclusion, the urinary NT-proBNP concentration is a new marker that could be useful for identifying LVH in subjects with essential hypertension.
    Revista Espa de Cardiologia 11/2009; 62(11):1322-5. DOI:10.1016/S1885-5857(09)73360-2 · 3.34 Impact Factor
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    ABSTRACT: To determine the feasibility of real-time three-dimensional transoesophageal echocardiography (3D-TOE) in the evaluation of aortic valve stenosis, to study its reliability, and to test the concordance of this new method when compared with transthoracic two-dimensional echocardiography (2D-TTE) as the diagnostic standard. Fifty-nine consecutive patients with moderate-to-severe aortic valve stenosis were assessed by means of 2D-TTE and 3D-TOE by independent blinded observers. Aortic valve planimetry was possible in 94.9% of patients. Inter-observer intraclass correlation coefficients (ICC) were 0.892 (CI 95% 0.818-0.936; P < 0.001), and 0.871 (CI 95% 0.780-0.925; P < 0.001) for 2D-TTE and 3D-TOE, respectively. Bland-Altman plot showed a mean difference in aortic valve area (AVA) of 0.040 cm(2), with 2D-TTE yielding larger values than 3D-TOE. ICC of both methods was 0.724 (CI 95% 0.530-0.839; P < 0.001). Assessment of AVA by means of 3D-TOE is feasible in most patients with aortic valve stenosis. Reliability of the measurement is good. However, there is some disagreement with standard 2D-TTE that needs further investigation.
    European Heart Journal – Cardiovascular Imaging 10/2009; 11(1):9-13. DOI:10.1093/ejechocard/jep154 · 2.65 Impact Factor
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    ABSTRACT: Peripheral arterial disease (PAD) is associated with an increased risk of cardiovascular morbidity and mortality. Nevertheless, many patients are asymptomatic, and this condition frequently remains underdiagnosed. An ankle-brachial index (ABI) of less than 0.9 is a noninvasive and simple marker in the diagnosis of PAD and is also predictive of target organ damage in hypertension. The prognostic value of such measurements in hypertensive patients with acute coronary syndrome (ACS) is unknown. The Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome registry is a multicentre, observational and prospective study that aims to describe the prevalence of and prognosis for PAD, diagnosed by ABI in hypertensive patients with ACS. One thousand one hundred and one hypertensive patients with ACS and at least 40 years of age were prospectively studied. Mean age of the population was 67.4 (11.4) years, and 67.7% were men. The prevalence of ABI less than 0.9 was 42.6% (469 patients). This subgroup was significantly older, had a higher prevalence of diabetes, previous coronary heart disease or stroke, left ventricular hypertrophy and more severe coronary lesions. Hospital mortality was higher in hypertensive patients with ABI less than 0.9 (2.3 vs. 0.2%; P< 0.01). An ABI less than 0.9 was associated with an increased risk of heart failure after ACS (odds ratio, 1.4; P=0.04), higher hospital mortality (odds ratio, 13.0; P=0.03) and the composite endpoint of mortality, heart failure and angina (odds ratio, 1.4; P=0.03). Asymptomatic PAD is highly prevalent in hypertensive patients with ACS. An ABI less than 0.9 identifies a subset of patients with more extensive target organ damage and higher risk of hospital cardiovascular complications after an ACS.
    Journal of Hypertension 02/2009; 27(2):341-7. DOI:10.1097/HJH.0b013e3283199193 · 4.22 Impact Factor
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    ABSTRACT: A significant proportion of patients with ischemic heart disease have associated peripheral arterial disease (PAD), but many are asymptomatic and this condition remains underdiagnosed. We aimed to study the prevalence of PAD in patients with an acute coronary syndrome (ACS) and to evaluate its influence in hospital clinical outcomes. The PAMISCA register is a prospective, multicenter study involving patients >or=40 years old with ACS admitted to selected Spanish hospitals. All patients had their ankle-brachial index (ABI) measured between days 3 and 7 after the ischemic event. 1410 ACS patients (71.4% male) were included. PAD determined by ABI was documented in 561 patients (39.8%). Factors independently related to PAD were age (OR: 1.04; 95% CI: 1.03-1.06; p<0.001), smoking (OR: 1.88; 95% CI: 1.41-2.49; p<0.0001), diabetes (OR: 1.30; 95% CI: 1.02-1.65; p<0.05), previous cardiac disease (OR: 1.54; 95% CI: 1.22-1.95; p<0.001) and previous cerebrovascular disease (OR: 1.90; 95% CI: 1.28-2.80; p<0.001). Following the ACS, an ABI<or=0.90 was associated with increased cardiovascular mortality (OR: 5.45; 95% CI: 1.16-25.59; p<0.05) and a higher risk of cardiovascular complications. The prevalence of PAD in patients >or=40 years presenting with ACS is high and it is associated with increased cardiovascular risk.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 09/2008; 36(2):189-96. DOI:10.1016/j.ejvs.2008.02.004 · 3.07 Impact Factor
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    ABSTRACT: Multiple studies have focused on the influence of obesity on natriuretic peptide levels. However, the effect of obesity on amino-terminal propeptide of B-type natriuretic peptide (NT-proBNP) levels in hypertensive (HT) patients remains uncertain. We studied 252 asymptomatic patients (60 +/- 13 years, 136 men) with essential HT. A routine physical examination, anthropometry, laboratory analyses, echo-Doppler study, and NT-proBNP level determination were performed. NT-proBNP levels were similar in both obese and nonobese HT (median 56 (25-130) pg/ml vs. median 51 (26-129) pg/ml, P = 0.488). No significant differences were found in obese or nonobese patients with left ventricular hypertrophy (LVH) (median 135 (73-425) pg/ml vs. median 151 (64-274) pg/ml, P = 0.597). The area under the curve was 0.89 +/- 0.03 for NT-proBNP to diagnose LVH in the obese HT patients and 0.88 +/- 0.03 in the nonobese. A logistic regression analysis showed that age, gender, and left ventricular mass index (LVMI) were independent predictors of NT-proBNP levels. Body mass index (BMI) was not significantly associated with NT-proBNP in LVH HT patients. Obesity is not statistically associated with NT-proBNP levels in HT asymptomatic patients. The same results were observed in our group of patients with LVH. These data are in contrast with those previously found in heart failure, and raise questions about the role of obesity per se as primary cause of decreased NT-proBNP levels in other pathophysiological conditions.
    American Journal of Hypertension 08/2008; 21(7):820-5. DOI:10.1038/ajh.2008.173 · 3.40 Impact Factor
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    ABSTRACT: Although aortic regurgitation is a diastolic phenomenon, it has been observed during systole in a few cases. Our aims were to determine the incidence of systolic aortic regurgitation in routine clinical practice and to investigate the clinical profiles of patients with the condition. An exhaustive prospective study of all investigations performed by a hospital echocardiographic unit over one month was carried out. Systolic aortic regurgitation was detected in five out of a total of 216 investigations (2.3%). In all cases, the patient had some degree of heart failure. Overall, the condition was present in 5.9% of patients with heart failure. In one patient with atrial fibrillation, systolic aortic regurgitation disappeared and the patient's clinical status improved after atrioventricular node modulation using a cryoablation catheter. Systolic aortic regurgitation was not an exceptional occurrence in hospitalized patients. Moreover, it tended to be specifically associated with heart failure.
    Revista Espa de Cardiologia 08/2008; 61(7):771-4. DOI:10.1016/S1885-5857(08)60214-5 · 3.34 Impact Factor
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    ABSTRACT: Although aortic regurgitation is a diastolic phenomenon, it has been observed during systole in a few cases. Our aims were to determine the incidence of systolic aortic regurgitation in routine clinical practice and to investigate the clinical profiles of patients with the condition. An exhaustive prospective study of all investigations performed by a hospital echocardiographic unit over one month was carried out. Systolic aortic regurgitation was detected in five out of a total of 216 investigations (2.3%). In all cases, the patient had some degree of heart failure. Overall, the condition was present in 5.9% of patients with heart failure. In one patient with atrial fibrillation, systolic aortic regurgitation disappeared and the patient's clinical status improved after atrioventricular node modulation using a cryoablation catheter. Systolic aortic regurgitation was not an exceptional occurrence in hospitalized patients. Moreover, it tended to be specifically associated with heart failure.
    Revista Espa de Cardiologia 07/2008; 61(7):771-774. DOI:10.1157/13123999 · 3.34 Impact Factor
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    ABSTRACT: This case report shows the use of bedside transthoracic contrast echocardiography in the diagnosis of subacute myocardial rupture after acute myocardial infarction and indication of urgent surgery. Usefulness of intraoperative transesophageal echocardiography for detection of sudden complete myocardial rupture leading to pericardial tamponade during anesthetic induction, and prompt lifesaving surgical procedure are also presented.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 08/2007; 20(7):906.e5-8. DOI:10.1016/j.echo.2006.12.008 · 3.99 Impact Factor
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    ABSTRACT: It is thought that femoral injection of agitated saline contrast is better for detecting patent foramen ovale than antecubital injection mainly because of the nature of intraatrial flow where the venae cavae enter the heart. Our aim was to investigate the effect of the contrast injection site on the degree of right atrial opacification seen on intracardiac echocardiography. The degree of right atrial opacification after each femoral or antecubital injection of saline contrast was scored from 0-4 in 21 patients. It was shown that the degree of right atrial opacification was greater after femoral than antecubital injection (3.76 vs. 1.62; P<.001). Future studies comparing the two routes of saline contrast injection should control for the degree of right atrial opacification.
    Revista Espa de Cardiologia 07/2007; 60(6):660-3. · 3.34 Impact Factor
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    ABSTRACT: It is thought that femoral injection of agitated saline contrast is better for detecting patent foramen ovale than antecubital injection mainly because of the nature of intraatrial flow where the venae cavae enter the heart. Our aim was to investigate the effect of the contrast injection site on the degree of right atrial opacification seen on intracardiac echocardiography. The degree of right atrial opacification after each femoral or antecubital injection of saline contrast was scored from 0–4 in 21 patients. It was shown that the degree of right atrial opacification was greater after femoral than antecubital injection (3.76 vs. 1.62; P<.001). Future studies comparing the two routes of saline contrast injection should control for the degree of right atrial opacification.
    Revista Espa de Cardiologia 06/2007; 60(6):660-663. DOI:10.1157/13107124 · 3.34 Impact Factor
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    ABSTRACT: Patent foramen ovale (PFO) of the interatrial septum is a cardiac foetal remnant, which frequent persistence in adulthood has important implications in a variety of clinical conditions. Echographic diagnosis of PFO is based on detection of interatrial shunt by means of contrast microbubbles identification after venous injection of a first-generation echographic contrast agent. Current recommendations propose venous femoral injection of contrast for enhanced echographic detection of PFO instead of venous brachial administration, as femoral injection has been shown to have higher sensitivity for PFO detection. Inferior vena cava inflow directed toward interatrial septum has been considered the explanation for increased sensitivity of femoral delivery of contrast. In the present paper, it is hypothesised that the main determinants of these differences between injection sites are technical factors related to right atrial contrast opacification and proper transient right atrial pressure rise, rather than intraatrial flow streaming. Effects of inferior vena cava inflow stream, although significant during foetal life, would be negligible after birth. Rationale and evidence, basis for further research, and practical implications leading to a simpler and safer routine technique for echographic detection of PFO are presented and discussed.
    Medical Hypotheses 02/2007; 68(6):1378-81. DOI:10.1016/j.mehy.2006.10.042 · 1.15 Impact Factor
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    ABSTRACT: OR-20Key Words: Hypertension, Offspring, Diastolic Function