Ernesto Dalli - Academia.edu (original) (raw)
Papers by Ernesto Dalli
Clínical Cardiology, 2022
Background: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limi... more Background: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers. Methods: We included 67 low-risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10-month cardiac telerehabilitation (CTR) program or an 8-week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ-5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups. Results: The intention-to-treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS-min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56-2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA-I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non-HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return-to-work time was reduced with the telerehabilitation strategy. Conclusion: This system allows minimal in-hospital training and prolonged follow-up. This strategy showed better results than CBCR.
Revista de fitoterapia, 2009
Stroke, Apr 1, 1988
Reversible Ischemic Neurologic Deficit in a Patient With the Kearns-Sayre Syndrome To the Editor:... more Reversible Ischemic Neurologic Deficit in a Patient With the Kearns-Sayre Syndrome To the Editor: We have read with interest the paper published in Stroke by Biller et al 1 about the uncommon occurrence of cerebral infarction in patients with inherited neuromuscular diseases despite cardiac involvement. Cardiac injury, mainly conduction disturbances or complete heart block, is one of the hallmarks of Kearns-Sayre syndrome. Recently we have had the opportunity to study a patient with Kearns-Sayre syndrome who developed a cerebrovascular insult. To our knowledge this is the first report of cerebral infarction in this condition. A 42-year-old woman came to the hospital with left-sided weakness of sudden onset. She was the youngest of five siblings. Her gestation, birth, and early neonatal life were normal. At 15 years of age, decreased visual acuity and hearing loss developed, but no medical care was required. Over the previous year the patient had experienced unsteadiness of gait and progressive deterioration of vision and hearing. In the previous 10 years, she had been treated in another hospital because of syncopal episodes. Two years after the beginning of this hospitalization, a permanent pacemaker was inserted for complete heart block. On examination, the patient Was a thin woman of short stature (140 cm). Complete external ophthalmoplegia was present. Fundoscopic examination disclosed retinitis pigmentosa, and audiometry confirmed decreased auditory acuity bilaterally. There was left facial paresis plus left-sided weakness. Ataxia with bilateral dysmetria was present as well. X-ray of her chest revealed a pacemaker and mild cardiomegary. Echocardiography disclosed mild tricuspid insufficiency and left ventricular and left atrial enlargement with poor left ventricular function. Elecrroencephalography was diffusely slow and computed tomography (CT scan) of the brain showed mild cerebral and cerebellar atrophy and lacunar infarcts. Calcification of the basal ganglia was not observed. There was elevated cerebrospinal fluid protein concentration (102 mg/100 ml) and an abnormal glucose tolerance curve. Hormonal studies were normal. Results of muscle biopsy showed "ragged red" fibers. Following hospital admission, her left-sided weakness progressively improved to complete recovery. One sister of the patient had retinitis pigmentosa, but no further studies were done. In 1958, Kearns and Sayre 2 described two cases of the clinical triad consisting of progressive external ophthalmoplegia, retinitis pigmentosa, and heart block. The triad is essential for the diagnosis, 3 but many other findings have also been reported. 4 The syndrome is sporadic, but familial forms have been reported. 5 The only well-documented cardiac abnormality in this syndrome is heart block, 4 but in 1980 Darsee et al 7 reported the presence of mitral valve prolapse in a patient with Kearns-Sayre syndrome. Cardiomyopathy has been described but poorly documented.*-' Our patient had the classic triad of the syndrome plus other signs. She had a permanent pacemaker because of complete heart block and syncope, but on the last hospital admission, echocardiographic studies showed moderate cardiomegary and poor ventricular function compatible with cardiomyopathy. We attributed infarction to cardiogenic cerebral embolism despite pacemaker control of complete heart block and no evidence of arrhythmia.
Revista Espanola De Cardiologia, Dec 1, 2017
Revista de fitoterapia, 2004
International Journal of Cardiology, 2011
Background: Risk stratification of patients with unstable angina or non-ST-segment elevation myoc... more Background: Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. Methods: We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, Pselectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. Results: At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a "higher risk" compared to those classified as being at a "lower risk". Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30-and 360day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. Conclusions: Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.
Phytomedicine, Jun 1, 2011
Crataegus laevigata is a medicinal plant most commonly used for the treatment of heart failure an... more Crataegus laevigata is a medicinal plant most commonly used for the treatment of heart failure and psychosomatic disorders. Based on previous experimental findings, this double-blind placebo-controlled study was aimed at finding beneficial effects of C. laevigata on biomarkers of coronary heart disease (CHD). The study included 49 diabetic subjects with chronic CHD who were randomly assigned to the treatment for 6 months with either a micronized flower and leaf preparation of C. laevigata (400 mg three times a day) or a matching placebo. Blood cell count, lipid profile, C-reactive protein, neutrophil elastase (NE) and malondialdehyde were analyzed in plasma at baseline, at one month and six months. The main results were that NE decreased in the C. laevigata group compared to the placebo group. In the C. laevigata group, baseline figures (median and interquartile range) were 35.8 (4.5) and in the placebo group 31 (5.9). At the end of the study, values were 33.2 (4.7) ng/ml and 36.7 (2.2) ng/ml, respectively; p < 0.0001. C. laevigata, added to statins, decreased LDL cholesterol (LDL-C) (mean ± SD) from 105 ± 28.5 mg/dl at baseline to 92.7 ± 25.1 mg/dl at 6 months (p = 0.03), and non-HDL cholesterol from 131 ± 37.5 mg/dl to 119.6 ± 33 mg/dl (p < 0.001). Differences between groups did not reach statistical significance at 6 months. No significant changes were observed in the rest of parameters. In conclusion, C. laevigata decreased NE and showed a trend to lower LDL-C compared to placebo as add-on-treatment for diabetic subjects with chronic CHD.
Clinical Cardiology, Dec 24, 2021
BackgroundCenter‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limita... more BackgroundCenter‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers.MethodsWe included 67 low‐risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10‐month cardiac telerehabilitation (CTR) program or an 8‐week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ‐5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups.ResultsThe intention‐to‐treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS‐min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56–2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA‐I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non‐HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return‐to‐work time was reduced with the telerehabilitation strategy.ConclusionThis system allows minimal in‐hospital training and prolonged follow‐up. This strategy showed better results than CBCR.
International Journal of Cardiology, Feb 1, 1990
Non-Hodgkin lymphomas are frequent in patients with human immune deficiency virus positive antibo... more Non-Hodgkin lymphomas are frequent in patients with human immune deficiency virus positive antibodies. Exceptional instances of cardiac involvement have been described. We report a case of non-Hodgkin's lymphoma and massive cardiac involvement with antemortem echocardiographic assessment. Use of echocardiography in lymphomas-associated AIDS could help in discovering further cases of cardiac involvement.
American Heart Journal, Oct 1, 1987
Journal of Electrocardiology, 1991
Epicardial electrodes were applied to 12 thoractomized dogs to determine the effects of trains of... more Epicardial electrodes were applied to 12 thoractomized dogs to determine the effects of trains of subthreshold conditioning stimuli (TSc) on ventricular refractoriness when delivered preceding a premature suprathreshold stimulus (S2). Several factors were analyzed: (1) the influence of TSc pulse frequency (100-900 Hz); (2) the delay between TSc and S2 (1 or 10 ms); (3) the distance between the electrodes for the emission of TSc and S2 (same electrodes or different electrodes at 3 mm); and (4) S2 current intensity (two-or fourfold diastolic threshold). The TSc (mean current intensity 0.33 mA, range 0.1-0.7) were found to significantly prolong the effective ventricular refractory period (EVRP) at all train pulse frequencies. The EVRP increment was progressively greater as pulse frequency was increased, the maximum EVRP increment being at 900 Hz (mean 50.8 2 32.3 ms; maximum increment 130 ms). On increasing S2 current intensity, the EVRP increment was less (maximum value 35 ms) and less consistent (in four of six dogs); in two cases the EVRP was shortened. The increase in delay between TSc and S2 attenuated the EVRP prolongation, which was present in only three of six dogs tested, and the EVRP was shortened in two dogs. There was no EVRP prolongation at any TSc pulse frequency when TSc and S2 were delivered at different electrodes. Thus TSc decreases myocardial ventricular excitability, prolonging EVRP in direct proportion to TSc pulse frequency. However, this property is limited by S2 current intensity as well as the time and distance between TSc and S2.
Revista Española de Cardiología (English Edition), 2017
Revista Española de Cardiología (English Edition)
Revista Española de Cardiología
International Journal of Cardiology
Background: A 10-month strategy of cardiac telerehabilitation (CTR) improved outcomes over a stan... more Background: A 10-month strategy of cardiac telerehabilitation (CTR) improved outcomes over a standard centrebased cardiac rehabilitation (CBCR), as recently published. We hypothesised that prolonged telerehabilitation could also improve proinflammatory status and lipoprotein particle composition. Methods: A randomised controlled trial compared a prolonged CTR program with CBCR in post-ACS patients. Patient's age was 18-72 years with low-risk criteria. Blood samples were drawn at baseline, at 4-and 10-months follow-up. Advanced lipoprotein characterization was performed using the NMR-based Liposcale test. Signals from glycoproteins (GlycA and GlycB) were also assessed. Results: The final analysis included 31 patients in the CTR group and 25 patients in the CBCR group. GlycA decreased in the CTR group (p = 0,007). LDL particle number (LDL-P) increase in both groups, but it was at the expense of small-sized LDL in the CBCR group (p = 0.012). Triglycerides in intermediate-density lipoprotein (IDL-TG) increased only in the CBCR group (p = 0.043). The triglyceride-to-HDL (TG/HDL) ratio decreased only in the CTR group (p = 0.006). The TG/HDL ratio was correlated with GlycA (Spearman's correlation coefficient: 0.558, p < 0.001) but not with CRP (p = 0.101). Conclusions: Our results showed that a 10-month CTR program reduced GlycA levels, the TG/HDL ratio and avoided unfavourable long-term changes in lipoprotein particle composition.
Pharmacological actions of hawthorn (Crataegus sp.) are well-known being based on basic and exper... more Pharmacological actions of hawthorn (Crataegus sp.) are well-known being based on basic and experimental research. Its inotropic positive action and the prolongation of the action potential sustain its use in heart failure. According to the SPICE study, it seems not to add benefit to the current treatment of heart failure, with the exception of a possible decrease of the sudden death in subjects with a ejection fraction superior to 25%. Its content, especially in proanthocianidins, might confer other therapeutic possibilities. The cellular protection against ischemia, the modulation of the activated inflammatory cells and its antioxidant effect, can provide a role in atherothrombotic diseases. The pharmacological and dosing studies, being based on standardized products, will complete and clarify the extent of the therapeutic field of this plant.
Revista De Fitoterapia, 2004
Revista Española de Cardiología, 2002
Introducción y objetivos. La dilatación mediada por flujo (DMF) es dependiente del endotelio y pu... more Introducción y objetivos. La dilatación mediada por flujo (DMF) es dependiente del endotelio y puede estudiarse con ultrasonidos en la arteria humeral. Quisimos conocer la localización idónea de la oclusión arterial para analizar adecuadamente la DMF en tres grupos de varones adultos. Sujetos y métodos. Se incluyó a 160 sujetos, con edad media de 58,5 ± 7,8 años: 40 sujetos sanos, 80 con factores de riesgo cardiovascular y 40 pacientes con IAM. En un subgrupo de 60 sujetos-los primeros 10, 30 y 20 de cada grupo, respectivamente-se evaluó la DMF por duplicado, tras oclusión en el brazo y en el antebrazo para inducir la hiperemia. Resultados. En el subestudio inicial, tras oclusión proximal, la DMF fue 7,6 ± 2,4% en sujetos sanos, 5,1 ± 2,2% en sujetos con factores de riesgo (p < 0,0001), y 3,5 ± 2,2% en pacientes con IAM (p < 0,041 respecto al grupo con factores de riesgo). La DMF tras compresión distal fue respectivamente: 4,6 ± 1,5%, 2,3 ± 2,1% (p < 0,006), y 2,2 ± 1,9%, sin diferencias estadísticamente significativas entre los grupos con factores de riesgo e IAM. En el resto se evaluó la DMF mediante compresión proximal por aportar datos más precisos, según estaba previsto. Globalmente, la DMF en los 160 sujetos estudiados fue 7,8 ± 3,1%, 5 ± 26% (p < 0,0001) y 3,3 ± 3% (p < 0,004, respecto al grupo con factores de riesgo), respectivamente. La DMF se relacionó directamente con el cHDL e inversamente con el diámetro basal y número de factores de riesgo. Conclusión. La oclusión proximal es el método óptimo para estudiar la DMF al conseguir una mejor estratificación de los sujetos con disfunción endotelial. Esta técnica permite demostrar que en el IAM se produce un empeoramiento de la función endotelial.
![Research paper thumbnail of [Brachial artery flow-mediated dilation in healthy men, men with risk factors, and men with acute myocardial infarction. Importance of occlusion-cuff position]](https://attachments.academia-assets.com/97291648/thumbnails/1.jpg)
](Revista española de cardiología, 2002
Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the br... more Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the brachial artery. We sought to determine the most suitable position for the occlusion cuff for the study of FMD in three groups of adult men. We included 160 subjects, mean age 58.5 7.8 years: 40 healthy subjects, 80 with cardiovascular risk factors, and 40 patients with AMI. In a subgroup of 60 subjects, the first 10, 30, and 20 of each group, respectively, FMD was evaluated twice, after upper arm occlusion and forearm occlusion to induce hyperemia. In the initial substudy, the FMD after upper arm occlusion was 7.6 2.4% in healthy subjects, 5.1 2.2% in men with risk factors (p < 0.0001), and 3.5 2.2% in AMI patients (p < 0.041, with respect to the risk-factor group). FMD after forearm occlusion was 4.6 1.5%, 2.3 2.1% (p < 0.006), and 2.2 1.9%, respectively, with no significant statistical differences between the risk-factor and AMI groups. Only upper arm occlusion was performed in...
Clínical Cardiology, 2022
Background: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limi... more Background: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers. Methods: We included 67 low-risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10-month cardiac telerehabilitation (CTR) program or an 8-week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ-5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups. Results: The intention-to-treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS-min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56-2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA-I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non-HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return-to-work time was reduced with the telerehabilitation strategy. Conclusion: This system allows minimal in-hospital training and prolonged follow-up. This strategy showed better results than CBCR.
Revista de fitoterapia, 2009
Stroke, Apr 1, 1988
Reversible Ischemic Neurologic Deficit in a Patient With the Kearns-Sayre Syndrome To the Editor:... more Reversible Ischemic Neurologic Deficit in a Patient With the Kearns-Sayre Syndrome To the Editor: We have read with interest the paper published in Stroke by Biller et al 1 about the uncommon occurrence of cerebral infarction in patients with inherited neuromuscular diseases despite cardiac involvement. Cardiac injury, mainly conduction disturbances or complete heart block, is one of the hallmarks of Kearns-Sayre syndrome. Recently we have had the opportunity to study a patient with Kearns-Sayre syndrome who developed a cerebrovascular insult. To our knowledge this is the first report of cerebral infarction in this condition. A 42-year-old woman came to the hospital with left-sided weakness of sudden onset. She was the youngest of five siblings. Her gestation, birth, and early neonatal life were normal. At 15 years of age, decreased visual acuity and hearing loss developed, but no medical care was required. Over the previous year the patient had experienced unsteadiness of gait and progressive deterioration of vision and hearing. In the previous 10 years, she had been treated in another hospital because of syncopal episodes. Two years after the beginning of this hospitalization, a permanent pacemaker was inserted for complete heart block. On examination, the patient Was a thin woman of short stature (140 cm). Complete external ophthalmoplegia was present. Fundoscopic examination disclosed retinitis pigmentosa, and audiometry confirmed decreased auditory acuity bilaterally. There was left facial paresis plus left-sided weakness. Ataxia with bilateral dysmetria was present as well. X-ray of her chest revealed a pacemaker and mild cardiomegary. Echocardiography disclosed mild tricuspid insufficiency and left ventricular and left atrial enlargement with poor left ventricular function. Elecrroencephalography was diffusely slow and computed tomography (CT scan) of the brain showed mild cerebral and cerebellar atrophy and lacunar infarcts. Calcification of the basal ganglia was not observed. There was elevated cerebrospinal fluid protein concentration (102 mg/100 ml) and an abnormal glucose tolerance curve. Hormonal studies were normal. Results of muscle biopsy showed "ragged red" fibers. Following hospital admission, her left-sided weakness progressively improved to complete recovery. One sister of the patient had retinitis pigmentosa, but no further studies were done. In 1958, Kearns and Sayre 2 described two cases of the clinical triad consisting of progressive external ophthalmoplegia, retinitis pigmentosa, and heart block. The triad is essential for the diagnosis, 3 but many other findings have also been reported. 4 The syndrome is sporadic, but familial forms have been reported. 5 The only well-documented cardiac abnormality in this syndrome is heart block, 4 but in 1980 Darsee et al 7 reported the presence of mitral valve prolapse in a patient with Kearns-Sayre syndrome. Cardiomyopathy has been described but poorly documented.*-' Our patient had the classic triad of the syndrome plus other signs. She had a permanent pacemaker because of complete heart block and syncope, but on the last hospital admission, echocardiographic studies showed moderate cardiomegary and poor ventricular function compatible with cardiomyopathy. We attributed infarction to cardiogenic cerebral embolism despite pacemaker control of complete heart block and no evidence of arrhythmia.
Revista Espanola De Cardiologia, Dec 1, 2017
Revista de fitoterapia, 2004
International Journal of Cardiology, 2011
Background: Risk stratification of patients with unstable angina or non-ST-segment elevation myoc... more Background: Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. Methods: We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, Pselectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. Results: At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a "higher risk" compared to those classified as being at a "lower risk". Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30-and 360day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. Conclusions: Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.
Phytomedicine, Jun 1, 2011
Crataegus laevigata is a medicinal plant most commonly used for the treatment of heart failure an... more Crataegus laevigata is a medicinal plant most commonly used for the treatment of heart failure and psychosomatic disorders. Based on previous experimental findings, this double-blind placebo-controlled study was aimed at finding beneficial effects of C. laevigata on biomarkers of coronary heart disease (CHD). The study included 49 diabetic subjects with chronic CHD who were randomly assigned to the treatment for 6 months with either a micronized flower and leaf preparation of C. laevigata (400 mg three times a day) or a matching placebo. Blood cell count, lipid profile, C-reactive protein, neutrophil elastase (NE) and malondialdehyde were analyzed in plasma at baseline, at one month and six months. The main results were that NE decreased in the C. laevigata group compared to the placebo group. In the C. laevigata group, baseline figures (median and interquartile range) were 35.8 (4.5) and in the placebo group 31 (5.9). At the end of the study, values were 33.2 (4.7) ng/ml and 36.7 (2.2) ng/ml, respectively; p < 0.0001. C. laevigata, added to statins, decreased LDL cholesterol (LDL-C) (mean ± SD) from 105 ± 28.5 mg/dl at baseline to 92.7 ± 25.1 mg/dl at 6 months (p = 0.03), and non-HDL cholesterol from 131 ± 37.5 mg/dl to 119.6 ± 33 mg/dl (p < 0.001). Differences between groups did not reach statistical significance at 6 months. No significant changes were observed in the rest of parameters. In conclusion, C. laevigata decreased NE and showed a trend to lower LDL-C compared to placebo as add-on-treatment for diabetic subjects with chronic CHD.
Clinical Cardiology, Dec 24, 2021
BackgroundCenter‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limita... more BackgroundCenter‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers.MethodsWe included 67 low‐risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10‐month cardiac telerehabilitation (CTR) program or an 8‐week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ‐5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups.ResultsThe intention‐to‐treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS‐min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56–2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA‐I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non‐HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return‐to‐work time was reduced with the telerehabilitation strategy.ConclusionThis system allows minimal in‐hospital training and prolonged follow‐up. This strategy showed better results than CBCR.
International Journal of Cardiology, Feb 1, 1990
Non-Hodgkin lymphomas are frequent in patients with human immune deficiency virus positive antibo... more Non-Hodgkin lymphomas are frequent in patients with human immune deficiency virus positive antibodies. Exceptional instances of cardiac involvement have been described. We report a case of non-Hodgkin's lymphoma and massive cardiac involvement with antemortem echocardiographic assessment. Use of echocardiography in lymphomas-associated AIDS could help in discovering further cases of cardiac involvement.
American Heart Journal, Oct 1, 1987
Journal of Electrocardiology, 1991
Epicardial electrodes were applied to 12 thoractomized dogs to determine the effects of trains of... more Epicardial electrodes were applied to 12 thoractomized dogs to determine the effects of trains of subthreshold conditioning stimuli (TSc) on ventricular refractoriness when delivered preceding a premature suprathreshold stimulus (S2). Several factors were analyzed: (1) the influence of TSc pulse frequency (100-900 Hz); (2) the delay between TSc and S2 (1 or 10 ms); (3) the distance between the electrodes for the emission of TSc and S2 (same electrodes or different electrodes at 3 mm); and (4) S2 current intensity (two-or fourfold diastolic threshold). The TSc (mean current intensity 0.33 mA, range 0.1-0.7) were found to significantly prolong the effective ventricular refractory period (EVRP) at all train pulse frequencies. The EVRP increment was progressively greater as pulse frequency was increased, the maximum EVRP increment being at 900 Hz (mean 50.8 2 32.3 ms; maximum increment 130 ms). On increasing S2 current intensity, the EVRP increment was less (maximum value 35 ms) and less consistent (in four of six dogs); in two cases the EVRP was shortened. The increase in delay between TSc and S2 attenuated the EVRP prolongation, which was present in only three of six dogs tested, and the EVRP was shortened in two dogs. There was no EVRP prolongation at any TSc pulse frequency when TSc and S2 were delivered at different electrodes. Thus TSc decreases myocardial ventricular excitability, prolonging EVRP in direct proportion to TSc pulse frequency. However, this property is limited by S2 current intensity as well as the time and distance between TSc and S2.
Revista Española de Cardiología (English Edition), 2017
Revista Española de Cardiología (English Edition)
Revista Española de Cardiología
International Journal of Cardiology
Background: A 10-month strategy of cardiac telerehabilitation (CTR) improved outcomes over a stan... more Background: A 10-month strategy of cardiac telerehabilitation (CTR) improved outcomes over a standard centrebased cardiac rehabilitation (CBCR), as recently published. We hypothesised that prolonged telerehabilitation could also improve proinflammatory status and lipoprotein particle composition. Methods: A randomised controlled trial compared a prolonged CTR program with CBCR in post-ACS patients. Patient's age was 18-72 years with low-risk criteria. Blood samples were drawn at baseline, at 4-and 10-months follow-up. Advanced lipoprotein characterization was performed using the NMR-based Liposcale test. Signals from glycoproteins (GlycA and GlycB) were also assessed. Results: The final analysis included 31 patients in the CTR group and 25 patients in the CBCR group. GlycA decreased in the CTR group (p = 0,007). LDL particle number (LDL-P) increase in both groups, but it was at the expense of small-sized LDL in the CBCR group (p = 0.012). Triglycerides in intermediate-density lipoprotein (IDL-TG) increased only in the CBCR group (p = 0.043). The triglyceride-to-HDL (TG/HDL) ratio decreased only in the CTR group (p = 0.006). The TG/HDL ratio was correlated with GlycA (Spearman's correlation coefficient: 0.558, p < 0.001) but not with CRP (p = 0.101). Conclusions: Our results showed that a 10-month CTR program reduced GlycA levels, the TG/HDL ratio and avoided unfavourable long-term changes in lipoprotein particle composition.
Pharmacological actions of hawthorn (Crataegus sp.) are well-known being based on basic and exper... more Pharmacological actions of hawthorn (Crataegus sp.) are well-known being based on basic and experimental research. Its inotropic positive action and the prolongation of the action potential sustain its use in heart failure. According to the SPICE study, it seems not to add benefit to the current treatment of heart failure, with the exception of a possible decrease of the sudden death in subjects with a ejection fraction superior to 25%. Its content, especially in proanthocianidins, might confer other therapeutic possibilities. The cellular protection against ischemia, the modulation of the activated inflammatory cells and its antioxidant effect, can provide a role in atherothrombotic diseases. The pharmacological and dosing studies, being based on standardized products, will complete and clarify the extent of the therapeutic field of this plant.
Revista De Fitoterapia, 2004
Revista Española de Cardiología, 2002
Introducción y objetivos. La dilatación mediada por flujo (DMF) es dependiente del endotelio y pu... more Introducción y objetivos. La dilatación mediada por flujo (DMF) es dependiente del endotelio y puede estudiarse con ultrasonidos en la arteria humeral. Quisimos conocer la localización idónea de la oclusión arterial para analizar adecuadamente la DMF en tres grupos de varones adultos. Sujetos y métodos. Se incluyó a 160 sujetos, con edad media de 58,5 ± 7,8 años: 40 sujetos sanos, 80 con factores de riesgo cardiovascular y 40 pacientes con IAM. En un subgrupo de 60 sujetos-los primeros 10, 30 y 20 de cada grupo, respectivamente-se evaluó la DMF por duplicado, tras oclusión en el brazo y en el antebrazo para inducir la hiperemia. Resultados. En el subestudio inicial, tras oclusión proximal, la DMF fue 7,6 ± 2,4% en sujetos sanos, 5,1 ± 2,2% en sujetos con factores de riesgo (p < 0,0001), y 3,5 ± 2,2% en pacientes con IAM (p < 0,041 respecto al grupo con factores de riesgo). La DMF tras compresión distal fue respectivamente: 4,6 ± 1,5%, 2,3 ± 2,1% (p < 0,006), y 2,2 ± 1,9%, sin diferencias estadísticamente significativas entre los grupos con factores de riesgo e IAM. En el resto se evaluó la DMF mediante compresión proximal por aportar datos más precisos, según estaba previsto. Globalmente, la DMF en los 160 sujetos estudiados fue 7,8 ± 3,1%, 5 ± 26% (p < 0,0001) y 3,3 ± 3% (p < 0,004, respecto al grupo con factores de riesgo), respectivamente. La DMF se relacionó directamente con el cHDL e inversamente con el diámetro basal y número de factores de riesgo. Conclusión. La oclusión proximal es el método óptimo para estudiar la DMF al conseguir una mejor estratificación de los sujetos con disfunción endotelial. Esta técnica permite demostrar que en el IAM se produce un empeoramiento de la función endotelial.
Revista española de cardiología, 2002
Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the br... more Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the brachial artery. We sought to determine the most suitable position for the occlusion cuff for the study of FMD in three groups of adult men. We included 160 subjects, mean age 58.5 7.8 years: 40 healthy subjects, 80 with cardiovascular risk factors, and 40 patients with AMI. In a subgroup of 60 subjects, the first 10, 30, and 20 of each group, respectively, FMD was evaluated twice, after upper arm occlusion and forearm occlusion to induce hyperemia. In the initial substudy, the FMD after upper arm occlusion was 7.6 2.4% in healthy subjects, 5.1 2.2% in men with risk factors (p < 0.0001), and 3.5 2.2% in AMI patients (p < 0.041, with respect to the risk-factor group). FMD after forearm occlusion was 4.6 1.5%, 2.3 2.1% (p < 0.006), and 2.2 1.9%, respectively, with no significant statistical differences between the risk-factor and AMI groups. Only upper arm occlusion was performed in...