Juan Ignacio Pérez-Calvo

Hospital Juan Ramón Jiménez, Huelva, Huelva, Andalusia, Spain

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Publications (60)203.69 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cystatin C (CysC) are predictors of adverse outcomes in acute heart failure. This study assess whether NT-proBNP variations might provide independent information in addition to that obtained from CysC levels. NT-proBNP levels were assessed in patients admitted due to acute heart failure using an observational study. Patients were classified as follows: group 1, those with a decrease in NT-proBNP levels of at least 30% from admission to 4 weeks after discharge; group 2, those with no significant changes in levels; and group 3, those who showed an increase in NT-proBNP of 30%. A multivariable Cox regression model and c-statistics were used. The primary end-point was all-cause mortality at 1-year follow-up. A total of 195 patients completed the follow-up. The mortality rate reached 20.5% (40 patients); 14 out of the 32 in group 3. The cumulative incidence of death, according to the change in NT-proBNP and Kaplan-Meier analysis, showed a significant increase in group 3 (log-rank P = 0.004). In the multivariable analysis, NT-proBNP variation for group 3 (hazard ratio 4.27; P <0.001) and for group 2 (hazard ratio 2.19; P = 0.043) in comparison with group 1 were independently associated with all-cause mortality, as well as anemia, hyponatremia, and admission CysC levels. Patients in group 3, and those with levels of serum CysC above the median, were also associated with slight increase in mortality. An increase of at least 30% in NT-proBNP levels after hospitalization is related to all-cause mortality in patients with acute heart failure and provides supplementary prognostic information in patients with high levels of CysC. A decrease in NT-proBNP of at least 30% is a desirable target to achieve.
    Journal of Cardiovascular Medicine 02/2014; · 2.66 Impact Factor
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    ABSTRACT: This study was conducted to determine whether galectin-3 (Gal3), a β-galactoside-binding lectin, has usefulness to predict outcomes in patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF). We measured Gal3, urea, creatinine and natriuretic peptides on admission in 419 selected patients with HF and LVEF over 45%. The primary endpoint was all-cause mortality and/or readmission at one-year follow-up. Multivariable Cox proportional hazards models were generated for Gal3 and classical risk factors. We also evaluated the reclassification of patients on the basis of the different score category after adding Gal3 levels. A total of 219 patients had combined adverse events, and 129 patients died during the follow-up. Kaplan-Meir survival curve showed significantly increased primary endpoint and all-cause mortality according to quartiles of Gal3 (log rank, P<0.001). Serum Gal3 levels above median (13.8ng/ml) was a significant predictor of primary endpoint risk after adjustment for age, estimated glomerular filtration rate, anemia, diabetes, serum sodium, brain natriuretic peptide levels, NYHA class and urea, respectively (hazard ratio 1.43, 95% CI 1.07-1.91 P=0.015). The reclassification index increased significantly after addition of Gal3 (9.5%, P<0.001) and the integrated discrimination index was 0.022, (P=0.001). The clinical prediction model with Gal3 increased the c-statistic from 0.711 to 0.731 (difference of 0.020, P=0.001). Serum Gal3 is a strong and independent predictor of unfavorable outcomes in patients with HF and preserved LVEF. We also demonstrated the improvement of adding the new biomarker to the model.
    International journal of cardiology 11/2013; 169(3):177-82. · 6.18 Impact Factor
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    ABSTRACT: Background Renal dysfunction is common in patients with heart failure (HF) and is associated with high mortality. This relationship is well established in HF and reduced ejection fraction (HFREF), however, it is not fully understood in HF and preserved ejection fraction (HFPEF). The aim of this study was to determine the impact of renal dysfunction on all-cause mortality in HFPEF patients and to evaluate the clinical characteristics of patients that deteriorate renal function in the first year of follow-up. Methods We evaluated the patients with HFPEF included in the RICA registry. This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF. Estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and plasma creatinine concentrations were used for renal function assessment at admission and after one year of follow up. Results A total of 455 patients (mean age 78±8.1years; 62% women) were included, of whom 265 (58.2%) had eGFR<60mL/min/1.73m2. After adjustment for covariates, only lower admission eGFR remained significantly predictive of all-cause mortality (HR 2.97; 95% CI 1.59–5.53). After one year of follow-up 16.6% of patients deteriorated at least 25% of eGFR. These patients were more likely to be diabetic (54.5% vs 42.6%; p=0.039) and had a higher rate of prescription of mineralcorticoid receptor antagonist (MRA) agents (47% vs 23.3%; p<0.001). Conclusion Renal dysfunction is frequently associated with HFPEF. eGFR below normal is strongly associated with mortality. Further decline of renal function is frequent especially among diabetic and patients treated with MRA agents.
    European Journal of Internal Medicine 10/2013; 24(7):677-683. · 2.05 Impact Factor
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    ABSTRACT: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (eGFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. The aim of this study was to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for adverse outcomes more accurately than the MDRD equation in a hospitalized cohort of patients with acute decompensated heart failure (ADHF). A total of 526 subjects with ADHF were studied. Blood was collected within 48 hours from admission. eGFR was calculated with the use of MDRD and CKD-EPI equations. The occurrences of mortality and heart failure (HF) hospitalization were recorded. Over the study period (median 365 days [interquartile range 238-370]), 305 patients (58%) died or were rehospitalized for HF. Areas under the receiver operator characteristic curves for CKD-EPI CysC and CKD-EPI creatinine-CysC equations were significantly higher than that for the MDRD equation, especially in patients with >60 mL min(-1) 1.73 m(-2). After multivariate adjustment, all eGFR equations were independent predictors of adverse outcomes (P < .001). However, only CKD-EPI CysC and CKD-EPI creatinine-CysC equations were associated with significant improvement in reclassification analyses (net reclassification improvements 10.8% and 12.5%, respectively). In patients with ADHF, CysC-based CKD-EPI equations were superior to the MDRD equation for predicting mortality and/or HF hospitalization especially in patients with >60 mL min(-1) 1.73 m(-2), and both CKD-EPI equations improved clinical risk stratification.
    Journal of cardiac failure 08/2013; 19(8):583-91. · 3.25 Impact Factor
  • Francesc Formiga, Oscar Aramburu-Bodas, Juan Ignacio Pérez-Calvo
    European Journal of Heart Failure 07/2013; · 5.25 Impact Factor
  • Journal of the American College of Cardiology 04/2013; 61(16):1748–1749. · 14.09 Impact Factor
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    ABSTRACT: Background and objectiveThe cardiorenal syndrome (CRS) includes numerous pathologies affecting the heart and kidney. The objective of this study is to know the characteristics and prognosis of the CRS in patients with acute coronary syndrome (ACS).Patients and methodA prospective study of 87 patients with ACS with and without ST-segment elevation at high risk and heart failure. We analysed the presence of CRS and its relationship with epidemiological variables, clinical, analytical and complementary explorations. Through a Cox regression model we investigated its relationship with mortality in the subsequent 6 months of the event.ResultsPatients with CRS (43.7%) were more frequently women, older, with more prior cardiovascular disease and a profile of higher risk. The prognosis was significantly worse in this group and the CRS was an independent predictor of mortality (hazard ratio 3.08; 95% confidence interval 1.13-8,40; P = .029).Conclusions The presence of CRS has an influence in the prognosis of patients who suffer an ACS high-risk and increases the likelihood of dying during 6 months after the event.
    Medicina Clínica. 10/2012; 139(10):437–440.
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    ABSTRACT: Cystatin C (CysC) is a good prognostic marker in heart failure. However, there is not much information of CysC combined with other biomarkers in acute heart failure (AHF). To assess prognostic value of CysC and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients hospitalized for AHF with no apparent deterioration of renal function. Prospective, multicenter, observational study. CysC and NTpro-BNP were measured in patients consecutively admitted with a diagnosis of AHF. Patients with, NTpro-BNP concentration above 900 pg/mL and serum creatinine below 1.3mg/dL, were included for statistical analysis. End-point of the study was all-cause mortality during a 12-month follow-up. 526 patients with AHF and NTpro-BNP concentration above 900 pg/mL were included in the study. From this group, 367 patients (69.8%) had serum creatinine below 1.3mg/dL. Receiver operating characteristic (ROC) curves were used to determine the best cut-off value for CysC. Patients with a concentration of CsyC above 1.25mg/dL had a 37.8% mortality rate, vs. 13.6% for those below cut-off (p<0.001). After Cox proportional hazard model, age, CysC, low total cholesterol and HF with preserved ejection fraction remained significantly associated with all-cause mortality during one-year follow-up. In AHF and normal or slightly impaired renal function, performance of CysC may be superior to NT-proBNP. Hence, CysC may be the preferred biomarker in the assessment of patients with AHF and slightly impaired renal function.
    European Journal of Internal Medicine 10/2012; 23(7):599-603. · 2.05 Impact Factor
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    ABSTRACT: The cardiorenal syndrome (CRS) includes numerous pathologies affecting the heart and kidney. The objective of this study is to know the characteristics and prognosis of the CRS in patients with acute coronary syndrome (ACS). A prospective study of 87 patients with ACS with and without ST-segment elevation at high risk and heart failure. We analysed the presence of CRS and its relationship with epidemiological variables, clinical, analytical and complementary explorations. Through a Cox regression model we investigated its relationship with mortality in the subsequent 6 months of the event. Patients with CRS (43.7%) were more frequently women, older, with more prior cardiovascular disease and a profile of higher risk. The prognosis was significantly worse in this group and the CRS was an independent predictor of mortality (hazard ratio 3.08; 95% confidence interval 1.13-8,40; P=.029). The presence of CRS has an influence in the prognosis of patients who suffer an ACS high-risk and increases the likelihood of dying during 6 months after the event.
    Medicina Clínica 09/2012; 139(10):437-40. · 1.40 Impact Factor
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    Journal of General Internal Medicine 09/2012; 27(11):1571. · 3.28 Impact Factor
  • Medicina Clínica. 06/2012; 139(3):135–136.
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    Journal of General Internal Medicine 05/2012; 27(8):892. · 3.28 Impact Factor
  • Medicina Clínica 04/2012; 139(3):135-6; author reply 137. · 1.40 Impact Factor
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    ABSTRACT: Hyperglycemia is a frequent observation in the acute coronary syndrome. We analyzed the relationship between hyperglycemia on admission and patients with acute coronary syndrome. Prospective study of 455 patients with acute coronary syndrome with and without elevation of ST segment with high risk according to ACA/AHA criteria. We divided the sample according to the median glycemia on admission into < 139 mg/dl and ≥ 139 mg/dl. We studied the analytic, electrocardiography, echocardiography and epidemiologic variables. Using the Cox Proportional Hazard Model, we analyzed their relationship with the mortality as principal variable during a six-month period after the acute coronary syndrome. Mean age was 64.3 ± 12.7 years, 80.4% were male and 21.8% had been diagnosed with diabetes. Mean glycemia on admission was 163.3 ± 71.8 mg/dl. Forty-seven patients died (10.3%), Mean glycemia of those who had died was 189.8 ± 78.8 mg/dl compared to 160.3 ± 70.4 mg/dl in the survival group (P = 0.003). Patients with hyperglycemia on admission ≥ 139 mg/dl had higher mortality, hazard ratio (HR) =2.98 (confidence interval [CI 95%]: 1.06-8.4; P = 0.039). Elderly patients, being a male, having ventricular dysfunction and initial decrease of blood pressure also showed an independent relationship with mortality. Hyperglycemia on admission ≥ 139 mg/dl in acute coronary syndrome patients is associated with a higher risk of death in the following six months, independently of diabetes or other risk factors known.
    Revista Clínica Española 06/2011; 211(6):275-82. · 2.01 Impact Factor
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    ABSTRACT: The prognostic value of NT-proBNP levels in patients admitted to hospital due to acute exacerbations of chronic pulmonary diseases (CPDs) is unknown. Internal Medicine units at two general hospitals. NT-proBNP levels were obtained within 72 h after admission in 192 consecutive patients with acute exacerbations of CPDs and no history of heart failure or diuretic treatment. Clinical characteristics and main outcomes were assessed over a 12-month follow-up. NT-proBNP cut-points for outcomes were obtained by ROC (receiver operating characteristics) curve analysis. Chronic obstructive lung disease (69.3%) and chronic asthma (22.4%) were the most prevalent CPDs, and non-pneumonic acute respiratory infection (72.4%) and pneumonia (22.9%) were the most frequent causes of exacerbation. Atrial flutter or fibrillation rate was 11%. During the one-year follow-up period, 22 patients died, 42 were re-admitted, 46 received new long-term oxygen therapy, and 39 received new diuretic treatment. NT-proBNP values correlated with hospitalisation days. NT-proBNP values over 587.9 pg/ml were associated with significantly raised one-year mortality (OR=3.90; 95% IC 1.46-10.47; p=0.006) and over 782.2 pg/ml with cardio-pulmonary deaths (OR=6.38; 95% IC 1.91-21.3; p=0.002). That association persisted after adjustment for age, gender, creatinine levels and cardiac rhythm. NT-proBNP values over 628.7 pg/ml were associated with significantly higher probability of new diuretic treatment (OR=4.38; IC 95% 2.07-9.25; p<0.001). The negative predictive values for these cut-points ranged from 89% to 97%. NT-proBNP levels below 587.9 pg/ml in patients with acute exacerbations of CPD were associated with favourable one-year outcomes.
    European Journal of Internal Medicine 04/2011; 22(2):167-71. · 2.05 Impact Factor
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    ABSTRACT: Cystatin C (CysC) is an antiprotease useful for measuring kidney function. Beyond such property, it carries significant prognostic information in several fields of cardiovascular diseases. We review data that support CysC as a prognostic factor in cardiovascular diseases among healthy elderly, hypertensive and heart failure patients. In addition, it has been speculated that CysC may be an early marker of ventricular remodelling, primarily involved in its pathogenesis, as a local antiprotease. Its role in physiopathology and clinical issues of cardiovascular pathology is yet to be elucidated.
    Medicina Clínica 02/2011; 136(4):158-62. · 1.40 Impact Factor
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    ABSTRACT: The response to Enzyme Replacement Therapy (ERT) in Hunter syndrome (MPS II) occurs early in most of the patients after its initiation and continues during the first 12-18 months. However, almost all the patients with MPS II have severe forms of the disease and death occurs prematurely. More than 90% of subjects die before 25 years, and only a minority will survive after the age of 30. There is very limited information on early response to ERT among adult patients with Hunter's syndrome. We report the case of a 31 year-old male with MPS II, with a remarkably severe joint disability, but mild cognitive impairment, who was treated with idursulfase for six months. The pattern of response observed, was similar to what can be expected in younger patients. The amelioration in joint mobility observed in this case suggests that older patients with advanced articular involvement may benefit from idursulfase, even when therapy is started in later stages of the disease.
    Revista Clínica Española 01/2011; 211(7):e42–e45. · 2.01 Impact Factor
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    ABSTRACT: Cystatin C (CysC) is an antiprotease useful for measuring kidney function. Beyond such property, it carries significant prognostic information in several fields of cardiovascular diseases. We review data that support CysC as a prognostic factor in cardiovascular diseases among healthy elderly, hypertensive and heart failure patients. In addition, it has been speculated that CysC may be an early marker of ventricular remodelling, primarily involved in its pathogenesis, as a local antiprotease. Its role in physiopathology and clinical issues of cardiovascular pathology is yet to be elucidated.
    Medicina Clinica - MED CLIN. 01/2011; 136(4):158-162.
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    ABSTRACT: To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF). The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been suggested that this presentation may be a specific disorder, but their mechanisms and clinical relationships are poorly defined. We evaluated the association between initial BP (systolic, diastolic and mean BP) with readmission and mortality, as well as potential interactions with age, clinical characteristics, renal function, left ventricular dysfunction, comorbidities and treatment. By using Cox regression models the association between each outcome and BP was tested. A total of 581 patients (77.5-years-old, range 51-100) were included. At admission, mean BP in quartiles was 77.09 mm Hg (53.3-85.0) (Q1); 91.46 mm Hg (85.0-96.7) (Q2); 103.41 mm Hg (96.7-109.9) (Q3) and 124.79 mm Hg (109.9-209.0) (Q4). Median duration of follow-up was 8 months [95% confidence interval (CI) 5.2-11.1]. Mortality was 15.5% (Q1), 9.2% (Q2), 12.6% (Q3) and 7.3% (Q4). Interquartile hazard ratio (95% CIs) for mortality was 0.40 (0.19-0.85) P=0.017. Body mass index (BMI) was higher in Q4 29.59 k/m2 than in Q1 28.25 k/m2 (P=0.018). There were no differences in age, clinical antecedents, renal function, comorbidities or severity of HF between groups. Higher mean BP at admission is associated with significantly lower mortality during follow-up, in patients hospitalized for HF. With the exception of BMI, positively correlated with blood pressure, this relationship is independent of other clinical factors and medications.
    QJM: monthly journal of the Association of Physicians 11/2010; 104(4):325-33. · 2.36 Impact Factor
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    ABSTRACT: Brain natriuretic peptide (BNP) is produced and released mainly from ventricles. BNP has been shown to be useful in diagnosis and prognosis in heart failure and some pulmonary conditions. The aim of this study is to analyse whether NT-proBNP has a prognostic value in chronic pulmonary patients without overt heart failure. We conducted an observational and prospective study. We included 192 patients admitted to the Internal Medicine Departments of Hospital Clinico "Lozano Blesa" (Zaragoza, Spain) and "Virgen de la Luz" (Cuenca, Spain) with acute exacerbation of pulmonary disease. Blood samples were taken to determine NT-proBNP concentrations. All patients were followed for 6 months after admission. 6,3% of patients died, 22,9% were prescribed with home oxygen-therapy, 18,2% received a diuretic prescription and 21,9% were re-admitted at least once during the follow-up period. Mean NT-proBNP was 1180pg/ml. A concentration above 500pg/ml and 350pg/ml of NT-proBNP was useful to predict mortality and diuretic prescription respectively. Among patients with acute exacerbations of chronic pulmonary disease, NT-proBNP could be a prognostic factor to identify those at risk of death or worst clinical development.
    Medicina Clínica 10/2010; 135(10):441-6. · 1.40 Impact Factor

Publication Stats

204 Citations
203.69 Total Impact Points

Institutions

  • 2013
    • Hospital Juan Ramón Jiménez, Huelva
      Huelva, Andalusia, Spain
    • Hospital Universitario Henares
      Madrid, Madrid, Spain
    • Hospital Universitari de Bellvitge
      l'Hospitalet de Llobregat, Catalonia, Spain
  • 1999–2013
    • Hospital Clínico Universitario Lozano Blesa, Zaragoza
      Caesaraugusta, Aragon, Spain
  • 2012
    • Hospital General De La Defensa De San Fernando
      San Fernanando, Andalusia, Spain
  • 1997–2012
    • University of Zaragoza
      • • Department of Biochemistry and Molecular and Cellular Biology
      • • Department of Physical Chemistry
      • • Faculty of Sciences (CIENCIAS)
      Caesaraugusta, Aragon, Spain
  • 2001
    • Hospital Universitario Miguel Servet
      Caesaraugusta, Aragon, Spain