J López-Sendón

Hospital Universitario La Paz, Madrid, Madrid, Spain

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Publications (54)214.96 Total impact

  • José López-Sendón
    World Pumps 06/2010; 10(1). DOI:10.1016/S1131-3587(10)70009-1
  • José López-Sendón · Almudena Castro Conde
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    ABSTRACT: The treatment of chronic stable angina is specified by European Society of Cardiology guidelines, which have been accepted by the Spanish Society of Cardiology. Treatment involves the use of medical therapy and myocardial revascularization, as appropriate. The guidelines recommend that all patients should undergo counseling and receive appropriate medication for the secondary prevention of ischemic heart disease in addition to drugs for controlling ischemia. High-risk patients can be easily identified using simple clinical risk scores. More detailed risk stratification may involve carrying out tests to detecting ischemia occurring while the patient is receiving optimal medical treatment, and coronary angiography. Factors associated with an increased risk include age, ischemia severity, left ventricular function, persistent ischemia on optimal medical treatment, and co-morbid conditions. The medical treatments used for controlling myocardial ischemia include beta-blockers, calcium channel blockers, nitrates, potassium channel blockers, If current inhibitors, and late sodium current inhibitors. Beta-blockers are still considered as first-line therapy, although data from recent clinical trials suggest that new anti-ischemic agents can provide greater benefits in a wide range of patients, observations that will be reflected in future versions of clinical practice guidelines. Currently there is some controversy about revascularization and new data from recent studies could have an influence on treatment strategies. However, at present, myocardial revascularization must be considered in patients with uncontrolled ischemia despite optimal medical therapy as well as in high-risk patients with lesions that are suitable for revascularization.
    World Pumps 06/2010; 10(1). DOI:10.1016/S1131-3587(10)70012-1
  • J. López-Sendón
    Revista Clínica Española 04/2010; 210(4):168-170. DOI:10.1016/j.rce.2009.11.013 · 1.31 Impact Factor
  • J López-Sendón
    Revista Clínica Española 03/2010; 210(4):168-70. · 1.31 Impact Factor
  • J Fernández de Bobadilla · J López-Sendón
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    ABSTRACT: Heart failure (HF) is more prevalent and evolves more rapidly in patients with renal failure (RF). Renal failure not only produces myocardial damage, but also induces the development of clinical heart failure thus making the treatment of these patients more difficult. The incidence of HF in patients with RF is around 15%. Renal function in patients with RF is lower than in the general population. This is true for patients with preserved and depressed left ventricular ejection fraction (LVEF). HF mortality increases 30% for every 1-mg/dL increase in creatinine and renal function should always be considered when assessing the cardiovascular risk and therapeutic alternatives of cardiovascular patients. Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers and aldosterone blockers may cause acute renal failure and serum creatinine and potassium should be closely monitored. Chronic RF is a human model of accelerated atherosclerosis. It induces a rapid progression of coronary atherosclerosis and make atherosclerotic plaques more vulnerable to acute coronary syndromes (ACS) because of coagulation changes inherent to RF. Ischemia is also more frequent due to the imbalance between oxygen requirements and supplies. Chronic RF is associated with a worse outcome in patients with ACS and increases the risk of bleeding, and is associated with a higher mortality in patients under surgical or percutaneous coronary revascularization. Of the patients treated with an interventional coronary procedure (ICP), 3,3% suffer acute RF. Saline administration at a dose of 1 ml/kg/h for 12 hours before and 12 hours after ICP prevents the development of acute RF. Although the role of N-acetylcysteine is under discussion, taking into account the favourable risk profile of this drug, it seems reasonable to administer N-acetylcysteine in addition to saline administration. In ACS patients with severe RF, the risk of severe bleeding depends upon the anticoagulation regimen, increasing particularly when unfractionated heparin is used in combination with GP IIb/IIIa inhibitors.
    Medicina Clínica 06/2009; 132 Suppl 1:48-54. · 1.25 Impact Factor
  • J. Fernández de Bobadilla · J. López-Sendón
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    ABSTRACT: Heart failure (HF) is more prevalent and evolves more rapidly in patients with renal failure (RF). Renal failure not only produces myocardial damage, but also induces the development of clinical heart failure thus making the treatment of these patients more difficult. The incidence of HF in patients with RF is around 15%. Renal function in patients with RF is lower than in the general population. This is true for patients with preserved and depressed left ventricular ejection fraction (LVEF). HF mortality increases 30% for every 1-mg/dL increase in creatinine and renal function should always be considered when assessing the cardiovascular risk and therapeutic alternatives of cardiovascular patients. Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers and aldosterone blockers may cause acute renal failure and serum creatinine and potassium should be closely monitored. Chronic RF is a human model of accelerated atherosclerosis. It induces a rapid progression of coronary atherosclerosis and make atherosclerotic plaques more vulnerable to acute coronary syndromes (ACS) because of coagulation changes inherent to RF. Ischemia is also more frequent due to the imbalance between oxygen requirements and supplies. Chronic RF is associated with a worse outcome in patients with ACS and increases the risk of bleeding, and is associated with a higher mortality in patients under surgical or percutaneous coronary revascularization. Of the patients treated with an interventional coronary procedure (ICP), 3,3% suffer acute RF. Saline administration at a dose of 1ml/kg/h for 12 hours before and 12 hours after ICP prevents the development of acute RF. Although the role of N-acetylcisteine is under discussion, taking into account the favourable risk profile of this drug, it seems reasonable to administer N-acetylcisteine in addition to saline administration. In ACS patients with severe RF, the risk of severe bleeding depends upon the anticoagulation regimen, increasing particulary when unfractionated heparin is used in combination with GP IIb/IIIa inhibitors.
    Medicina Clínica 05/2009; 132:48-54. DOI:10.1016/S0025-7753(09)70963-7 · 1.25 Impact Factor
  • Source
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 02/2009; 28(1):115-6. · 0.53 Impact Factor
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    ABSTRACT: Out of hospital sudden death constitutes a major sanitary problem. Early diagnosis and treatment are considered as the most important factors related with short term prognosis. However, there is little information about the outcome of patients admitted to the hospital after a successful recovery from an episode of sudden death outside the hospital. The objective of this study was to analyze the prognosis of patients who initially recovered after an episode of out-of-hospital cardiac arrest and who were admitted to the coronary or intensive care unit. The clinical characteristics and outcome of 110 consecutive patients admitted to the coronary and intensive care units after an episode of extrahospital sudden death, who initially recovered with success, were retrospectively studied. A total of 33 (30%) patients were discharged alive and without severe neurological damage, 67 (61%) patients died before discharge from hospital and 77 (70%) died or presented severe and permanent neurological damage. The latter group versus those who survived was older (63.6 +/- 13.5 vs 55.2 +/- 12.6 years old; p < 0.006) and had a longer delay in the beginning of cardiopulmonary resuscitation (8.3 vs 2.8 min.; p < 0.01). Mortality or severe neurological damage rate was higher in the group of those who had asystolia than in those with ventricular fibrillation in the first ECG (84% vs 55%), in those who arrived to the hospital unconscious (73.7% vs 15.4%) and in those who arrived in functional class IV (81% vs 16.6%). Up to 30% of the patients admitted after an episode of extrahospital cardiac arrest were discharged alive and without severe neurological damage. Advanced age, functional class IV and the delay of cardiopulmonary resuscitation are related to a unfavorable outcome.
    Revista Espa de Cardiologia 08/2001; 54(7):832-7. · 3.34 Impact Factor
  • J López-Sendón · E López De Sá
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    ABSTRACT: An expert committee of the European Society of Cardiology and the American College of Cardiology recently redefined the criteria for the diagnosis of myocardial infarction. The new nomenclature is based on the use of new, biochemical markers of myocardial necrosis (troponin, CK-MB mass) which are more sensitive and specific than those previously used (CK, CK-MB activity). The new criteria adapts to the real possibilities in clinical practice and presents the inconvenient of differing from the established criteria used as epidemiologic, prognostic and therapeutic references. Nonetheless, since there had been different criteria for diagnosing myocardial infarction in the past, the new nomenclature will represent a common way of referring a diagnosis with important practical implications.
    Revista Espa de Cardiologia 07/2001; 54(6):669-74. · 3.34 Impact Factor
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    ABSTRACT: The aim of this study was to analyze the differences in regional diastolic function between viable and non-viable myocardium when assessed by pulsed-wave Doppler tissue imaging performed in basal conditions. The study population included 21 patients with three-vessel disease and regional systolic dysfunction. These patients underwent transthoracic echocardiographic study and pulsed-wave Doppler tissue imaging in basal conditions and, in addition, stress echocardiography with dobutamine performed by a different investigator. Three-hundred and twenty-two segments were studied, 140 of which (43%) had systolic dysfunction. Of the 140 segments with systolic dysfunction, 52 (37%) were considered hypokinetic by transthoracic echocardiography, 80 (57%) akinetic and 8 (6%) dyskinetic. As assessed by dobutamine echocardiography, 67 segments (48%) were considered viable and 73 (52%) non-viable. Viable segments had a higher peak velocity of the early diastolic wave e (5.5 +/- 1.9 vs. 4.7 +/- 2.0 cm/s; p = 0.03). An e/a ratio < 1 was more frequent in non-viable versus non-viable segments (52 vs. 70%; p < 0.05). There were no differences in relation to regional isovolumetric relaxation time and peak velocity of a wave. Although peak velocity of s wave was lower in non-viable segments, differences were not statistically significant. Compared with non-viable segments, viable myocardial segments have less impaired regional diastolic function as assessed by pulsed-wave Doppler tissue imaging.
    Revista Espa de Cardiologia 05/2001; 54(5):592-6. · 3.34 Impact Factor
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    ABSTRACT: Patients with acute myocardial infarction (MI) and cardiogenic shock constitute a very high risk subset despite an aggressive management. The objective of this study was to evaluate if the results of early coronary angioplasty in patients with acute myocardial infarction and cardiogenic shock have changed over the last years, and to address which role the recent adjuvant therapies have played in this evolution. From 1991 to April 1999, 94 patients with acute MI and cardiogenic shock were treated with coronary angioplasty within the first 12 hours from the onset of symptoms. Temporal changes of the utilization of adjuvant therapies and operators experience were studied over these years, as well as their impact on the angiographic results and in-hospital outcome. Over the years, a progressive and significant increase on the use of coronary stents and c7E3Fab was observed, as well as an increased number of primary angioplasties performed per month. The proportion of patients treated with intraaortic balloon pump did not changed significantly over the years. An angiographic successful result (< 50% residual stenosis and TIMI flow 2 or 3) and a final TIMI grade 3 flow were obtained in 76 (80.9%) and 61 (64.9%) patients, respectively. The angiographic success rate progressively increased over the years, from 72.3% in patients treated before 1994 to 94.1% in those admitted in 1998Eth 1999 (p for trend 0.0409). The proportion of patients with a final TIMI grade 3 flow also grew progressively over the years: from 36.4% before 1994 to 76.5% after 1997 (p for trend 0. 0209). The overall in-hospital mortality rate was 63.8% (60 patients), and there was no significant change in mortality rate over the years. Therefore, apart from the growing operators experience, we have observed an incremental change in the use of coronary stents and c7E3 Fab (abciximab) in patients with acute myocardial infarction and cardiogenic shock treated with early coronary angioplasty. All these factors have led to an improvement in the angiographic results, although this change has not meant a significant reduction of mortality.
    The Journal of invasive cardiology 01/2001; 12(12):597-604. · 0.82 Impact Factor
  • J López-Sendón
    Revista Espa de Cardiologia 05/2000; 53(4):477-8. · 3.34 Impact Factor
  • E López de Sá · J López-Sendón · R Rubio · J L Delcán
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    ABSTRACT: The classification of the unstable angina syndrome has represented one of the main objectives of the cardiologists in the two last decades. The ambiguous definition of this syndrome has led to the phenomenon that numerous classifications have been achieved, based especially in the different clinical presentations of this syndrome, that are neither clearly matched with a different physiopathology nor with the prognosis. On the other hand, the validation of the majority of the classifications have been attempted through studies of selected populations with an insufficient number of patients in a syndrome with a wide spectrum of clinical presentation, pathophysiology and prognosis. On this basis, the existing classifications do not fully satisfy the scientific community, which is confirmed by the periodical appearance of new proposals. In our setting, the classifications which are most applied are those of the Spanish Society of Cardiology and Braunwald's Classification. Both offer the usefulness of their simplicity, since they only consider clinical aspects, but sustain the previously mentioned inconveniences. A more practical classification could possibly be based exclusively on physiopathological or prognostic characteristics, which allow a more adequate management of these patients.
    Revista Espa de Cardiologia 02/1999; 52 Suppl 1:46-54. · 3.34 Impact Factor
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    ABSTRACT: Atheroma plaque rupture with liberation of tissue factor activates the coagulation cascade and plateletes, leading to the formation of intracoronary thrombi in many patients with acute coronary syndromes. In this process, tissue factor, thrombin, Factor Xa and fibrin play a major role. This review analyses the clinical efficacy of the antithrombotic drugs: fractionated heparin, low molecular or fractionated heparins, direct thrombin inhibitors, specific Xa factor inhibitors and inhibitors of the tissue factor pathway in patients with unstable angina and non-Q wave myocardial infarction. Enoxaparin, a low molecular weight fractionated heparin, has shown to be associated with a greater clinical efficacy, superior to that achieved with conventional heparin anticoagulation or treatment with aspirin, and probably should be considered as the antithrombotic of choice. Present clinical research should be aimed at the identification of patients with greater benefit, new treatment protocols with other antithrombotic drugs and the efficacy in special situations such as invasive coronary interventions or the association with other drug like, thrombolytic agents or new antiplatelet antiaggregants.
    Revista Espa de Cardiologia 02/1999; 52 Suppl 1:76-89. · 3.34 Impact Factor
  • Source
    E. López de Sá · J. López-Sendon · A. Bethencourt · X. Bosch
    Journal of the American College of Cardiology 12/1998; 31:79-79. DOI:10.1016/S0735-1097(98)80989-3 · 15.34 Impact Factor
  • J López-Sendón · E López de Sá · R Rubio · J L Delcán
    Revista Clínica Española 10/1998; 198 Suppl 1:40-3. · 1.31 Impact Factor
  • Coronary Artery Disease 04/1996; 7(3):217-23. · 1.30 Impact Factor
  • Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 12/1995; 14(11):923-5. · 0.53 Impact Factor
  • J López-Sendón · E López de Sá · J F Bobadilla · R Rubio · J Bermejo · J L Delcán
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    ABSTRACT: In patients with acute myocardial infarction (AMI) thrombolysis reduces the infarct area, preserves ventricular function and improves survival. This effect is more significant in men with age between 65 and 75 years, anterior ST segment elevation or branch block, during the first 6 hours of evolution. In this review the comparative studies with placebo and between different fibrinolytic agents, in different doses or in combination are reviewed, and the drug selection, the actual impact or fibrinolysis and future directions of thrombolysis in patients with AMI are discussed. Reperfusion is highest with the use of double bolus tPA of front-loaded rapid tPA infusion. Reocclusion is more frequent after tPA and minimal after urokinase or the combination of tPA and urokinase. In the GISSI-2 and ISIS-3 studies, the mortality of patients treated with streptokinase, tPA or APSAC was similar. However, in the GUSTO study, with front loaded, rapid infusion of tPA, mortality was lower than with streptokinase, although this effect was only statistically significant in patients with anterior infarction or age < 75 years. Bleeding is more common with tPA, and allergic reactions are more frequent after streptokinase and APSAC than after tPA or urokinase. Symptomatic hypotension and bradycardia are also more frequent after streptokinase or APSAC, specially in patients with right ventricular infarction. Streptokinase and APSAC generate antibodies that may neutralize the effect of a second administration even years after the first dose. On the basis of the current clinical evidence it is not possible to recommend the use of a single fibrinolytic and, due to its lowest cost, streptokinase could be considered the first choice. However, in patients with previous thrombolysis, as well as in those with right ventricular infarction, the drug of choice should be tPA or urokinase; in young patients with anterior infarction tPA is more effective and in patients with difficult controls (mobile CCU, emergency wards, etc.) APSAC or urokinase may be considered the agent of choice because their easier administration. In spite of clear evidence of the efficacy of the thrombolytic therapy, it is only used in 20%-30% of the patients with AMI, and probably there is a selection of low risk patients. For these reasons, the impact of thrombolysis in the whole population of AMI is probably lower than it could be. Future directions for the use of thrombolytic agents include a better selection of the candidates and the drug to be used as well as the early administration of thrombolytics, even before the admission to the CCU.
    Revista Espa de Cardiologia 06/1995; 48(6):407-39. · 3.34 Impact Factor
  • J López-Sendón · E López de Sá · J L Delcán
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    ABSTRACT: For many years ischemic heart disease involving the right ventricle had received little attention. During the last 15 years, the initial works of Cohn, Isner, and others spawned a number of clinical and experimental studies that extended the understanding of the pathophysiology of ischemia in the right ventricle. Most of the work has been done in the setting of acute myocardial infarction, and information is still lacking in other conditions, such as chronic ischemic heart disease and perioperative right ventricular dysfunction. Acute right ventricular infarction rarely occurs in the absence of left ventricular necrosis and in most cases is the extension of an inferior left ventricular infarct. The majority of patients with right ventricular infarction only exhibit subtle signs of ischemic dysfunction. Elevated right atrial pressure is found only in the typical syndrome of elevated venous pressure; low output syndrome can be found only in 20% of the cases, and cardiogenic shock secondary to right ventricular necrosis is found only in 10%. It is also important to note that there is not a clear correlation between the severity of ischemic right ventricular dysfunction and the necrotic area. The discrepancy may be due to ischemia without necrosis of the right ventricular wall (stunned myocardium), but the intact pericardium and the necrosis of the interventricular septum may also play an important role. In the most severe form of ischemic right ventricular dysfunction, the entire right ventricular wall is akinetic. Right atrial, right ventricular, and pulmonary artery pressures become similar in magnitude and shape, and the pulmonary valve is opened during diastole, demonstrating a passive blood flow from the right atrium to the left ventricle through the low resistance pulmonary capillary bed. Volume loading, administration of dopamine or dobutamine, and careful use of vasodilators under hemodynamic monitoring are the therapeutic measures to control the severe forms of acute ischemic right ventricular dysfunction. The use of thrombolytic agents has decreased the incidence of right ventricular dysfunction after acute myocardial infarction. Mortality is high in the severe forms of acute ischemic right ventricular dysfunction, but after discharge from hospital the prognosis is good and right heart failure is unusual, even in those patients with shock during the first days of evolution of the infarct.
    Cardiovascular Drugs and Therapy 06/1994; 8 Suppl 2:393-406. · 2.95 Impact Factor

Publication Stats

250 Citations
214.96 Total Impact Points

Institutions

  • 1988–2010
    • Hospital Universitario La Paz
      • Servicio de Cardiología
      Madrid, Madrid, Spain
  • 2001
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
  • 1994–2001
    • Hospital General Universitario Gregorio Marañón
      • Department of Cardiology
      Madrid, Madrid, Spain
  • 1996
    • Complutense University of Madrid
      Madrid, Madrid, Spain
  • 1979
    • Universidad Autónoma de Madrid
      • Department of Medicine
      Madrid, Madrid, Spain