Alejandro Diego - Academia.edu (original) (raw)

Papers by Alejandro Diego

Research paper thumbnail of Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM+75 Registry

Revista Española de Cardiología (English Edition), 2016

Research paper thumbnail of Platelet Reactivity and Stent Thrombosis: Still Some Issues to Solve. Authors' reply

Journal of the American College of Cardiology, Sep 1, 2009

Research paper thumbnail of Latrogenic coronary-cameral fistula after percutaneous intervention on the right coronary artery

Research paper thumbnail of Post-treatment platelet reactivity predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome

Revista española de cardiología, 2009

Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The ob... more Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography. Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 +/- 21% vs. 43 +/- 21%; P.049) and higher PPR (204 +/- 60 vs. 155 +/- 67 platelet reaction units [PRU]; p= 0.006) were significantly associ...

Research paper thumbnail of Acute otitis media severity: Association with cytokine gene polymorphisms and other risk factors

International Journal of Pediatric Otorhinolaryngology, 2011

Background-We have previously shown an association between polymorphisms of proinflammatory cytok... more Background-We have previously shown an association between polymorphisms of proinflammatory cytokine genes and susceptibility to upper respiratory tract infection and acute otitis media. It has not been known whether polymorphisms or risk factors are associated with the severity of acute otitis media.

Research paper thumbnail of Platelet Reactivity and Stent Thrombosis: Still Some Issues to Solve

Journal of the American College of Cardiology, 2009

Research paper thumbnail of Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis

Hepatology, 2002

Short-term carvedilol administration is more powerful than propranolol in decreasing hepatic veno... more Short-term carvedilol administration is more powerful than propranolol in decreasing hepatic venous pressure gradient (HVPG) in cirrhotic patients, but induces arterial hypotension that may prevent its long-term use in portal hypertensive patients. This study compared the HVPG reduction and safety of long-term carvedilol and propranolol. Fifty-one cirrhotic patients were randomly assigned to receive carvedilol (n = 26) and propranolol (n = 25).

Research paper thumbnail of Response to steroids in de novo autoimmune hepatitis after liver transplantation

Hepatology, 2002

Graft dysfunction associated with autoimmune phenomena has been recently described in liver trans... more Graft dysfunction associated with autoimmune phenomena has been recently described in liver transplant recipients without previous autoimmune disease. However, the natural history, diagnostic criteria, and definitive therapeutic approach of de novo autoimmune hepatitis (de novo AIH) are poorly understood. We report 12 cases of de novo AIH 27.9 ؎ 24.5 months after liver transplantation: the outcome of 7 patients treated with steroids is compared with a group of 5 nontreated patients. Nontreated patients lost the graft after 5.8 ؎ 2.6 months from de novo AIH onset. All treated patients were alive after 48.4 ؎ 14 (29-65) months from de novo AIH onset, and none of them lost the graft. However, 5 patients relapsed in relation to steroid tapering. All patients presented an atypical antiliver/ kidney cytosolic autoantibody, associated to classical autoantibodies in 10 cases. Histological study showed several degrees of lobular necrosis and inflammatory infiltrate. HLA antigen frequencies and matching were compared with 2 control groups (16 orthotopic liver transplantation [LTX] patients without de novo AIH and 929 healthy blood donors); de novo AIH patients showed a higher prevalence of HLA-DR3 (54.5% vs. 25.9%, P ‫؍‬ .04) than healthy controls, which was not observed in LTX patients without de novo AIH. In conclusion, this new disease should be included in the differential diagnosis of unexplained graft dysfunction. In addition, treatment with steroids results in a dramatically improved outcome. However, maintenance therapy is usually required. (HEPATOLOGY 2002;35:349-356.) Abbreviations: LTX, orthotopic liver transplantation; AD, autoimmune disease; de novo AIH: de novo autoimmune hepatitis; Atypical-LKC, atypical anti-liver/kidney cytosolic autoantibody; IIF, indirect immunofluorescence; ANA, antinuclear antibodies; SMA, anti-smooth muscle antibody; LKM-1, type 1 liver-kidney microsomal antibody; LC1, type 1 liver cytosol antibody; HBV, hepatitis B virus; HCV, hepatitis C virus; CMV, cytomegalovirus; AIH, autoimmune hepatitis.

Research paper thumbnail of Carvedilol, a new nonselective beta-blocker with intrinsic anti-alpha1-adrenergic activity, has a greater portal hypotensive effect than propranolol in patients with cirrhosis

Hepatology, 1999

Only some patients show a substantial hepatic venous pressure gradient (HVPG) reduction after pro... more Only some patients show a substantial hepatic venous pressure gradient (HVPG) reduction after propranolol, which makes it desirable to investigate drugs with greater portal hypotensive effect. The aim of this study was to investigate whether carvedilol, a nonselective beta-blocker with anti-alpha1-adrenergic activity, may cause a greater HVPG reduction than propranolol. Thirty-five cirrhotic patients had hemodynamic measurements before and after the random administration of carvedilol (n = 14), propranolol (n = 14), or placebo (n = 7). Carvedilol markedly reduced HVPG, from 19.5 +/- 1.3 to 15.4 +/- 1 mm Hg (P <.0001). This HVPG reduction was greater than after propranolol (-20.4 +/- 2 vs. -12.7 +/- 2%, P <.05). Moreover, carvedilol decreased HVPG greater than 20% of baseline values or to </=12 mm Hg in a greater proportion of patients (64% vs. 14%, P <.05). Both drugs caused similar reductions in hepatic and azygos blood flows, suggesting that the greater HVPG decrease by carvedilol was because of reduced hepatic and portocollateral resistance. Propranolol caused greater reductions in heart rate and cardiac output than carvedilol, whereas carvedilol caused a greater decrease in mean arterial pressure (-23.1 vs. -11%, P <.05). Thus, carvedilol has a greater portal hypotensive effect than propranolol in patients with cirrhosis, suggesting a greater therapeutic potential. However, it causes arterial hypotension, which calls for careful evaluation before its long-term use.

Research paper thumbnail of Letter by de Miguel Castro et al Regarding Article, "Cardiovascular Death and Nonfatal Myocardial Infarction in Acute Coronary Syndrome Patients Receiving Coronary Stenting Are Predicted by Residual Platelet Reactivity to ADP Detected by a Point-of-Care Assay: A 12-Month Follow-Up

Circulation, 2009

http://circ.ahajournals.org/cgi/content/full/120/13/e98 located on the World Wide Web at:

Research paper thumbnail of TIMI myocardial perfusion frame count: Turning blush into numbers

Catheterization and Cardiovascular Interventions, 2011

Research paper thumbnail of Undersizing the Stents in Saphenous Vein Grafts: By How Much?

The American Journal of Cardiology, 2010

Research paper thumbnail of Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM+75 Registry

Revista Española de Cardiología (English Edition), 2016

Research paper thumbnail of Mitral valve replacement in heavily calcified annulus

The Annals of Thoracic Surgery, 2010

1. Pektok E, Sierra J, Cikirikcioglu M, Müller H, Myers PO, Kalangos A. Midterm results of valve ... more 1. Pektok E, Sierra J, Cikirikcioglu M, Müller H, Myers PO, Kalangos A. Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis. Ann Thorac Surg 2010;89:1180 -6. 2. Muehrcke D. Invited commentary. Ann Thorac Surg 2010;89: 1186 -7. 3. Kalangos A, Sierra J, Vala D, et al. Annuloplasty for valve repair with a new biodegradable ring: an experimental study. J Heart Valve Dis 2006;15:783-90. 4. Mrowczynksi W, Mrozinski B, Walpoth BH, Pawelec-Wojtalik M, Kalangos A. Does a biodegradable ring enable growth of the native tricuspid annulus? [Abstract] Presented at:

Research paper thumbnail of Giant left main coronary artery to right atrium fistula

Heart Asia, 2010

Aneurysmal arterial origin of coronary fistulae is an extremely rare combination. We report a cas... more Aneurysmal arterial origin of coronary fistulae is an extremely rare combination. We report a case of a giant left main coronary artery to right atrium fistula in a 48-year-old male. We describe the clinical course and management options.

Research paper thumbnail of Vasomotor response to different endothelium-dependent vasodilators in an animal model

The Journal of Invasive Cardiology, Jul 1, 2012

BACKGROUND AND OBJECTIVES: Incomplete re-endothelialization of stents can be revealed as paradoxi... more BACKGROUND AND OBJECTIVES: Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with endothelium-dependent vasodilators. As no consensus exists about the best method or agent, our objective is to analyze the response to different drugs in a coronary swine model.METHODS: Twenty-seven stents were implanted in 9 domestic swine. The vessel diameter of proximal and distal segments (≥5 mm) was assessed immediately post implantation. Different endothelium-dependent vasodilators were used: intracoronary (IC) acetylcholine, 20 μg (A2) and 40 μg (A4), IC serotonin (S), 100 μg, and isoproterenol (I), intravenous infusion. The results are presented as constriction (%) compared with maximal vasodilation with IC nitroglycerin (N, 200 μg).RESULTS: In 10 vessels (37%), A4 provoked an occlusive spasm. Acetylcholine induced a higher degree of vasoconstriction (A4, 42 ± 39%; A2, 16 ± 14%) than the rest of the agonists (S, 6 ± 12%; I, 6 ± 11%; P<.01). The constriction rate was not related to the induced hemodynamic changes.CONCLUSIONS: After focal endothelial denudation in a coronary swine model, the constriction rate induced by different endothelium-dependent vasodilators is highly variable. The highest value is observed after IC acetylcholine bolus. The constriction rate does not correlate with the observed hemodynamic changes.

Research paper thumbnail of Effect of basal aggregability and response to clopidogrel therapy on myocardial damage after percutaneous coronary intervention in non ST-segment elevation acute coronary syndromes

Research paper thumbnail of Investigación traslacional en isquemia, infarto de miocardio y reperfusión

Revista Española de Cardiología Suplementos, 2013

Uno de los grandes campos de investigación cardiovascular ha sido clásicamente el de la cardiopat... more Uno de los grandes campos de investigación cardiovascular ha sido clásicamente el de la cardiopatía isquémica, principal causa de muerte en Europa 1 . El crecimiento exponencial de la investigación regenerativa cardiovascular ha motivado una apresurada transposición de los hallazgos obtenidos en la investigación básica al campo clínico. Por motivos económicos y por la amplia disponibilidad de cepas de animales que presentan deficiencias naturales o provocadas, gran parte de estas observaciones se han realizado en pequeños mamíferos, ratas y ratones. Que los resultados obtenidos en estos animales sean extrapolables a los humanos es discutible en muchos sentidos. Aunque en el aspecto de biología celular básica estos modelos son válidos, la simple discrepancia de tamaño de la masa miocárdica (< 100 mg en el ratón frente a 500 g en el ser humano) ya representa una discrepancia de varios órdenes de magnitud. Esta es una de las razones para buscar mejores modelos en este campo. En concreto, y por las similitudes anatómicas, fisiológicas y patológicas, el cerdo es el mejor modelo animal para el estudio de la cardiopatía isquémica y sus potenciales tratamientos 2 . Persisten otras importantes diferencias a este respecto, pues en la mayoría de los modelos experimentales se R E S U M E N Desde los modelos de corazón aislado ex vivo hasta los de oclusión de arterias coronarias por técnicas quirúrgicas o endovasculares en animales, la investigación preclínica se ha desarrollado en los distintos aspectos de la isquemia, la necrosis y la reperfusión del miocardio. En el campo de la isquemia cardiaca, estos ensayos han permitido desarrollar múltiples vías de tratamiento eficaces en su posterior uso clínico. Las estrategias de recanalización de la arteria ocluida que causa el infarto, aplicadas cuanto antes mejor («tiempo es músculo»), son las principales armas para reducir el tamaño de la necrosis, con un impacto positivo en el pronóstico posterior. Sin embargo, la propia reperfusión causa un daño que agrava las consecuencias del infarto. Muchas terapias contra el daño por reperfusión se han ensayado con éxito en modelos animales (distintos tratamientos farmacológicos o formas de condicionamiento cardiaco), pero no se han demostrado eficaces en su posterior aplicación clínica. La explosión de la medicina regenerativa ha sido particularmente importante en el terreno cardiovascular, y su desarrollo exige el mejor banco de pruebas preclínico posible. El continuo perfeccionamiento de estos modelos animales persigue encontrar el modelo perfecto, aquel que reproduzca cada una de las características que observamos en la biología y la patología humanas.

Research paper thumbnail of Vasomotor response to different endothelium-dependent vasodilators in an animal model

The Journal of invasive cardiology, 2012

Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with e... more Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with endothelium-dependent vasodilators. As no consensus exists about the best method or agent, our objective is to analyze the response to different drugs in a coronary swine model. Twenty-seven stents were implanted in 9 domestic swine. The vessel diameter of proximal and distal segments (≥5 mm) was assessed immediately post implantation. Different endothelium-dependent vasodilators were used: intracoronary (IC) acetylcholine, 20 μg (A2) and 40 μg (A4), IC serotonin (S), 100 μg, and isoproterenol (I), intravenous infusion. The results are presented as constriction (%) compared with maximal vasodilation with IC nitroglycerin (N, 200 μg). In 10 vessels (37%), A4 provoked an occlusive spasm. Acetylcholine induced a higher degree of vasoconstriction (A4, 42 ± 39%; A2, 16 ± 14%) than the rest of the agonists (S, 6 ± 12%; I, 6 ± 11%; P<.01). The constriction rate was not related to the induced ...

Research paper thumbnail of TCT-502 Efficacy and safety of switching from clopidogrel to prasugrel in diabetic patients with acute coronary syndromes treated with drug-elunting stents: results of the ESCAPADA study

Journal of the American College of Cardiology, 2014

Research paper thumbnail of Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM+75 Registry

Revista Española de Cardiología (English Edition), 2016

Research paper thumbnail of Platelet Reactivity and Stent Thrombosis: Still Some Issues to Solve. Authors' reply

Journal of the American College of Cardiology, Sep 1, 2009

Research paper thumbnail of Latrogenic coronary-cameral fistula after percutaneous intervention on the right coronary artery

Research paper thumbnail of Post-treatment platelet reactivity predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome

Revista española de cardiología, 2009

Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The ob... more Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography. Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 +/- 21% vs. 43 +/- 21%; P.049) and higher PPR (204 +/- 60 vs. 155 +/- 67 platelet reaction units [PRU]; p= 0.006) were significantly associ...

Research paper thumbnail of Acute otitis media severity: Association with cytokine gene polymorphisms and other risk factors

International Journal of Pediatric Otorhinolaryngology, 2011

Background-We have previously shown an association between polymorphisms of proinflammatory cytok... more Background-We have previously shown an association between polymorphisms of proinflammatory cytokine genes and susceptibility to upper respiratory tract infection and acute otitis media. It has not been known whether polymorphisms or risk factors are associated with the severity of acute otitis media.

Research paper thumbnail of Platelet Reactivity and Stent Thrombosis: Still Some Issues to Solve

Journal of the American College of Cardiology, 2009

Research paper thumbnail of Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis

Hepatology, 2002

Short-term carvedilol administration is more powerful than propranolol in decreasing hepatic veno... more Short-term carvedilol administration is more powerful than propranolol in decreasing hepatic venous pressure gradient (HVPG) in cirrhotic patients, but induces arterial hypotension that may prevent its long-term use in portal hypertensive patients. This study compared the HVPG reduction and safety of long-term carvedilol and propranolol. Fifty-one cirrhotic patients were randomly assigned to receive carvedilol (n = 26) and propranolol (n = 25).

Research paper thumbnail of Response to steroids in de novo autoimmune hepatitis after liver transplantation

Hepatology, 2002

Graft dysfunction associated with autoimmune phenomena has been recently described in liver trans... more Graft dysfunction associated with autoimmune phenomena has been recently described in liver transplant recipients without previous autoimmune disease. However, the natural history, diagnostic criteria, and definitive therapeutic approach of de novo autoimmune hepatitis (de novo AIH) are poorly understood. We report 12 cases of de novo AIH 27.9 ؎ 24.5 months after liver transplantation: the outcome of 7 patients treated with steroids is compared with a group of 5 nontreated patients. Nontreated patients lost the graft after 5.8 ؎ 2.6 months from de novo AIH onset. All treated patients were alive after 48.4 ؎ 14 (29-65) months from de novo AIH onset, and none of them lost the graft. However, 5 patients relapsed in relation to steroid tapering. All patients presented an atypical antiliver/ kidney cytosolic autoantibody, associated to classical autoantibodies in 10 cases. Histological study showed several degrees of lobular necrosis and inflammatory infiltrate. HLA antigen frequencies and matching were compared with 2 control groups (16 orthotopic liver transplantation [LTX] patients without de novo AIH and 929 healthy blood donors); de novo AIH patients showed a higher prevalence of HLA-DR3 (54.5% vs. 25.9%, P ‫؍‬ .04) than healthy controls, which was not observed in LTX patients without de novo AIH. In conclusion, this new disease should be included in the differential diagnosis of unexplained graft dysfunction. In addition, treatment with steroids results in a dramatically improved outcome. However, maintenance therapy is usually required. (HEPATOLOGY 2002;35:349-356.) Abbreviations: LTX, orthotopic liver transplantation; AD, autoimmune disease; de novo AIH: de novo autoimmune hepatitis; Atypical-LKC, atypical anti-liver/kidney cytosolic autoantibody; IIF, indirect immunofluorescence; ANA, antinuclear antibodies; SMA, anti-smooth muscle antibody; LKM-1, type 1 liver-kidney microsomal antibody; LC1, type 1 liver cytosol antibody; HBV, hepatitis B virus; HCV, hepatitis C virus; CMV, cytomegalovirus; AIH, autoimmune hepatitis.

Research paper thumbnail of Carvedilol, a new nonselective beta-blocker with intrinsic anti-alpha1-adrenergic activity, has a greater portal hypotensive effect than propranolol in patients with cirrhosis

Hepatology, 1999

Only some patients show a substantial hepatic venous pressure gradient (HVPG) reduction after pro... more Only some patients show a substantial hepatic venous pressure gradient (HVPG) reduction after propranolol, which makes it desirable to investigate drugs with greater portal hypotensive effect. The aim of this study was to investigate whether carvedilol, a nonselective beta-blocker with anti-alpha1-adrenergic activity, may cause a greater HVPG reduction than propranolol. Thirty-five cirrhotic patients had hemodynamic measurements before and after the random administration of carvedilol (n = 14), propranolol (n = 14), or placebo (n = 7). Carvedilol markedly reduced HVPG, from 19.5 +/- 1.3 to 15.4 +/- 1 mm Hg (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). This HVPG reduction was greater than after propranolol (-20.4 +/- 2 vs. -12.7 +/- 2%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Moreover, carvedilol decreased HVPG greater than 20% of baseline values or to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=12 mm Hg in a greater proportion of patients (64% vs. 14%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Both drugs caused similar reductions in hepatic and azygos blood flows, suggesting that the greater HVPG decrease by carvedilol was because of reduced hepatic and portocollateral resistance. Propranolol caused greater reductions in heart rate and cardiac output than carvedilol, whereas carvedilol caused a greater decrease in mean arterial pressure (-23.1 vs. -11%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Thus, carvedilol has a greater portal hypotensive effect than propranolol in patients with cirrhosis, suggesting a greater therapeutic potential. However, it causes arterial hypotension, which calls for careful evaluation before its long-term use.

Research paper thumbnail of Letter by de Miguel Castro et al Regarding Article, "Cardiovascular Death and Nonfatal Myocardial Infarction in Acute Coronary Syndrome Patients Receiving Coronary Stenting Are Predicted by Residual Platelet Reactivity to ADP Detected by a Point-of-Care Assay: A 12-Month Follow-Up

Circulation, 2009

http://circ.ahajournals.org/cgi/content/full/120/13/e98 located on the World Wide Web at:

Research paper thumbnail of TIMI myocardial perfusion frame count: Turning blush into numbers

Catheterization and Cardiovascular Interventions, 2011

Research paper thumbnail of Undersizing the Stents in Saphenous Vein Grafts: By How Much?

The American Journal of Cardiology, 2010

Research paper thumbnail of Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM+75 Registry

Revista Española de Cardiología (English Edition), 2016

Research paper thumbnail of Mitral valve replacement in heavily calcified annulus

The Annals of Thoracic Surgery, 2010

1. Pektok E, Sierra J, Cikirikcioglu M, Müller H, Myers PO, Kalangos A. Midterm results of valve ... more 1. Pektok E, Sierra J, Cikirikcioglu M, Müller H, Myers PO, Kalangos A. Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis. Ann Thorac Surg 2010;89:1180 -6. 2. Muehrcke D. Invited commentary. Ann Thorac Surg 2010;89: 1186 -7. 3. Kalangos A, Sierra J, Vala D, et al. Annuloplasty for valve repair with a new biodegradable ring: an experimental study. J Heart Valve Dis 2006;15:783-90. 4. Mrowczynksi W, Mrozinski B, Walpoth BH, Pawelec-Wojtalik M, Kalangos A. Does a biodegradable ring enable growth of the native tricuspid annulus? [Abstract] Presented at:

Research paper thumbnail of Giant left main coronary artery to right atrium fistula

Heart Asia, 2010

Aneurysmal arterial origin of coronary fistulae is an extremely rare combination. We report a cas... more Aneurysmal arterial origin of coronary fistulae is an extremely rare combination. We report a case of a giant left main coronary artery to right atrium fistula in a 48-year-old male. We describe the clinical course and management options.

Research paper thumbnail of Vasomotor response to different endothelium-dependent vasodilators in an animal model

The Journal of Invasive Cardiology, Jul 1, 2012

BACKGROUND AND OBJECTIVES: Incomplete re-endothelialization of stents can be revealed as paradoxi... more BACKGROUND AND OBJECTIVES: Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with endothelium-dependent vasodilators. As no consensus exists about the best method or agent, our objective is to analyze the response to different drugs in a coronary swine model.METHODS: Twenty-seven stents were implanted in 9 domestic swine. The vessel diameter of proximal and distal segments (≥5 mm) was assessed immediately post implantation. Different endothelium-dependent vasodilators were used: intracoronary (IC) acetylcholine, 20 μg (A2) and 40 μg (A4), IC serotonin (S), 100 μg, and isoproterenol (I), intravenous infusion. The results are presented as constriction (%) compared with maximal vasodilation with IC nitroglycerin (N, 200 μg).RESULTS: In 10 vessels (37%), A4 provoked an occlusive spasm. Acetylcholine induced a higher degree of vasoconstriction (A4, 42 ± 39%; A2, 16 ± 14%) than the rest of the agonists (S, 6 ± 12%; I, 6 ± 11%; P<.01). The constriction rate was not related to the induced hemodynamic changes.CONCLUSIONS: After focal endothelial denudation in a coronary swine model, the constriction rate induced by different endothelium-dependent vasodilators is highly variable. The highest value is observed after IC acetylcholine bolus. The constriction rate does not correlate with the observed hemodynamic changes.

Research paper thumbnail of Effect of basal aggregability and response to clopidogrel therapy on myocardial damage after percutaneous coronary intervention in non ST-segment elevation acute coronary syndromes

Research paper thumbnail of Investigación traslacional en isquemia, infarto de miocardio y reperfusión

Revista Española de Cardiología Suplementos, 2013

Uno de los grandes campos de investigación cardiovascular ha sido clásicamente el de la cardiopat... more Uno de los grandes campos de investigación cardiovascular ha sido clásicamente el de la cardiopatía isquémica, principal causa de muerte en Europa 1 . El crecimiento exponencial de la investigación regenerativa cardiovascular ha motivado una apresurada transposición de los hallazgos obtenidos en la investigación básica al campo clínico. Por motivos económicos y por la amplia disponibilidad de cepas de animales que presentan deficiencias naturales o provocadas, gran parte de estas observaciones se han realizado en pequeños mamíferos, ratas y ratones. Que los resultados obtenidos en estos animales sean extrapolables a los humanos es discutible en muchos sentidos. Aunque en el aspecto de biología celular básica estos modelos son válidos, la simple discrepancia de tamaño de la masa miocárdica (< 100 mg en el ratón frente a 500 g en el ser humano) ya representa una discrepancia de varios órdenes de magnitud. Esta es una de las razones para buscar mejores modelos en este campo. En concreto, y por las similitudes anatómicas, fisiológicas y patológicas, el cerdo es el mejor modelo animal para el estudio de la cardiopatía isquémica y sus potenciales tratamientos 2 . Persisten otras importantes diferencias a este respecto, pues en la mayoría de los modelos experimentales se R E S U M E N Desde los modelos de corazón aislado ex vivo hasta los de oclusión de arterias coronarias por técnicas quirúrgicas o endovasculares en animales, la investigación preclínica se ha desarrollado en los distintos aspectos de la isquemia, la necrosis y la reperfusión del miocardio. En el campo de la isquemia cardiaca, estos ensayos han permitido desarrollar múltiples vías de tratamiento eficaces en su posterior uso clínico. Las estrategias de recanalización de la arteria ocluida que causa el infarto, aplicadas cuanto antes mejor («tiempo es músculo»), son las principales armas para reducir el tamaño de la necrosis, con un impacto positivo en el pronóstico posterior. Sin embargo, la propia reperfusión causa un daño que agrava las consecuencias del infarto. Muchas terapias contra el daño por reperfusión se han ensayado con éxito en modelos animales (distintos tratamientos farmacológicos o formas de condicionamiento cardiaco), pero no se han demostrado eficaces en su posterior aplicación clínica. La explosión de la medicina regenerativa ha sido particularmente importante en el terreno cardiovascular, y su desarrollo exige el mejor banco de pruebas preclínico posible. El continuo perfeccionamiento de estos modelos animales persigue encontrar el modelo perfecto, aquel que reproduzca cada una de las características que observamos en la biología y la patología humanas.

Research paper thumbnail of Vasomotor response to different endothelium-dependent vasodilators in an animal model

The Journal of invasive cardiology, 2012

Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with e... more Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with endothelium-dependent vasodilators. As no consensus exists about the best method or agent, our objective is to analyze the response to different drugs in a coronary swine model. Twenty-seven stents were implanted in 9 domestic swine. The vessel diameter of proximal and distal segments (≥5 mm) was assessed immediately post implantation. Different endothelium-dependent vasodilators were used: intracoronary (IC) acetylcholine, 20 μg (A2) and 40 μg (A4), IC serotonin (S), 100 μg, and isoproterenol (I), intravenous infusion. The results are presented as constriction (%) compared with maximal vasodilation with IC nitroglycerin (N, 200 μg). In 10 vessels (37%), A4 provoked an occlusive spasm. Acetylcholine induced a higher degree of vasoconstriction (A4, 42 ± 39%; A2, 16 ± 14%) than the rest of the agonists (S, 6 ± 12%; I, 6 ± 11%; P<.01). The constriction rate was not related to the induced ...

Research paper thumbnail of TCT-502 Efficacy and safety of switching from clopidogrel to prasugrel in diabetic patients with acute coronary syndromes treated with drug-elunting stents: results of the ESCAPADA study

Journal of the American College of Cardiology, 2014