Felipe Fernández-Vázquez - Academia.edu (original) (raw)

Papers by Felipe Fernández-Vázquez

European Heart Journal, Oct 1, 2021

Eurointervention, Mar 1, 2022

AME surgical video database, Feb 1, 2017

Revista Española de Cardiología Suplementos, 2019

Resumen El paciente con fibrilacion auricular y enfermedad coronaria combina a menudo altos riesg... more Resumen El paciente con fibrilacion auricular y enfermedad coronaria combina a menudo altos riesgos isquemico y hemorragico. En el contexto de la anticoagulacion oral, el clopidogrel es el inhibidor del P2Y12 con mejor perfil de seguridad y, aunque recomendado para los pacientes con sindrome coronario agudo, el pretratamiento antes de un procedimiento invasivo continua siendo objeto de debate. Para los pacientes electivos que van a someterse a una intervencion coronaria, no se recomienda la terapia puente con heparina periprocedimiento, dado que esta estrategia se ha relacionado con una mayor incidencia de eventos adversos. El acceso radial deberia ser de eleccion en la mayoria de los casos, siempre que la situacion hemodinamica y la anatomia coronaria lo permitan. Aunque la evidencia es aun escasa, se recomienda administrar dosis bajas de heparina no fraccionada durante el procedimiento. Informacion sobre el suplemento: este articulo forma parte del suplemento titulado «Actualizacion en el tratamiento de los pacientes con fibrilacion auricular sometidos a intervencion coronaria», que ha sido patrocinado por Boehringer Ingelheim.

European heart journal. Acute cardiovascular care, May 1, 2022

The International Journal of Cardiovascular Imaging, 2020

Regadenoson Stress Echocardiography (RSE) can detect myocardial ischemia, and its diagnostic accu... more Regadenoson Stress Echocardiography (RSE) can detect myocardial ischemia, and its diagnostic accuracy should be evaluated. We sought to investigate the agreement between RSE and gated-SPECT myocardial perfusion imaging (MPI) and appraise its diagnostic accuracy.Consecutive patients (n = 202) referred for non-invasive evaluation of myocardial ischemia, with (38.6%) or without a previous coronary artery disease (CAD) diagnosis, were enrolled. Both tests were performed simultaneously. Invasive coronary angiography (CA) is considered the gold standard. The mean age was 70.9 (9.8) years, and 59.9% were male. The prevalence of cardiovascular risk factors (arterial hypertension [81.7%], diabetes mellitus [37.6%], hypercholesterolemia [71.8%], and smoking [18.8%]) was high. Forty-four patients (21.8%) had a non-interpretable electrocardiogram, 15 (34.1%) of them were a result of ventricular paced-rhythm, while 29 (65.9%) were a result of advanced left ventricular branch block. The overall agreement between both diagnostic techniques was good: Gwet's AC1 0.66 (CI95% 0.55 to 0.76), and it was higher in patients without a previous CAD diagnosis: 0.76 (CI95% 0.65 to 0.87). In the biased sample (those who underwent CA), RSE and nuclear study sensitivity was 0.50 and 0.78 and specificity was 0.75 and 0.75, respectively. We noted a dramatic reduction in sensitivity for RSE after debiasing (debiased sensitivity of 0.16), and the negative predictive value was similar to the biased and debiased samples. RSE is in strong agreement with gated-SPECT MPI. However, its low sensitivity and negative predictive value preclude its use as a bedside test to detect myocardial ischemia.

Annals of Translational Medicine, 2020

Background: Limited information has been reported regarding the impact of percutaneous mitral val... more Background: Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods: We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction (LVEF), functional mitral regurgitation (FMR) grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results: Ninety-three patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-month follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0±17.8 vs. 2.7±13.5, P=0.002), sustained VT or ventricular fibrillation (0.9±2.5 vs. 0.5±2.9, P=0.012) and ICD antitachycardia therapies (2.5±12.0 vs. 0.9±5.0, P=0.033) were observed. Conclusions: PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.

Journal of the American College of Cardiology, 2020

Background: Nonagenarians patients (>90 years) are more and more frequent in our daily clinical p... more Background: Nonagenarians patients (>90 years) are more and more frequent in our daily clinical practice given the increase in life expectancy. Although percutaneous coronary intervention (PCI) is a well-established therapy for myocardial infarction with ST-segment elevation (STEMI); in very older patients, and specifically nonagenarians, this therapy is rejected in a high percentage by doctors and family members as it is considered a very invasive treatment. Our aims are to evaluate the clinical characteristics, the medical management and the prognosis of nonagenarians with STEMI. Methods: Retrospective observational study where all nonagenarians admitted to STEMI in two tertiary hospitals between 2006 and 2018 were evaluated. There were no exclusion criteria. Demographic, clinical and procedural data were collected. In-hospital and 1-year mortality was evaluated among those received PCI versus those managed with medical treatment. Results: 167 patients were included (mean age 91.9 years; 60% women). The number of patients increased over the years (from 2 cases in 2006, to 20 cases in 2018). Emerging catheterization was performed in 60% (n = 100) of our cohort. PCI treatment was performed in 83% of those (n = 83). Bare metal stent use was preponderant (76%). Successful revascularization of the responsible vessel was achieved in 91% of the patients. In general, hospital mortality was 22%, increased to 32% at 6 months and up to 41% at 1-year follow-up. In-hospital and 1-year mortality was lower in the PCI group than in the medical treatment group (12% versus 32%, p<0.01 and 28% versus 54%, p<0.01, respectively). Conclusion: Nonagenarians patients admitted by STEMI have progressively increased in our daily clinical practice. PCI may be an adequate therapeutic strategy in this high-risk cohort.

Journal of the American College of Cardiology, 2011

The purpose of this study was to test the ability of insulin-like growth factor (IGF)-1/hepatocyt... more The purpose of this study was to test the ability of insulin-like growth factor (IGF)-1/hepatocyte growth factor (HGF) to activate resident endogenous porcine cardiac stem/progenitor cells (epCSCs) and to promote myocardial repair through a clinically applicable intracoronary injection protocol in a pig model of myocardial infarction (MI) relevant to human disease. Background In rodents, cardiac stem/progenitor cell (CSC) transplantation as well as in situ activation through intramyocardial injection of specific growth factors has been shown to result in myocardial regeneration after acute myocardial infarction (AMI). Methods Acute MI was induced in pigs by a 60-min percutaneous transluminal coronary angiography left anterior descending artery occlusion. The IGF-1 and HGF were co-administered through the infarct-related artery in a single dose (ranging from 0.5 to 2 g HGF and 2 to 8 g IGF-1) 30 min after coronary reperfusion. Pigs were sacrificed 21 days later for dose-response relationship evaluation by immunohistopathology or 2 months later for cardiac function evaluation by cardiac magnetic resonance imaging. Results The IGF-1/HGF activated c-kit positive-CD45 negative epCSCs and increased their myogenic differentiation in vitro. The IGF-1/HGF, in a dose-dependent manner, improved cardiomyocyte survival, and reduced fibrosis and cardiomyocyte reactive hypertrophy. It significantly increased c-kit positive-CD45 negative epCSC number and fostered the generation of new myocardium (myocytes and microvasculature) in infarcted and peri-infarct/border regions at 21 and 60 days after AMI. The IGF-1/HGF reduced infarct size and improved left ventricular function at 2 months after AMI. Conclusions In an animal model of AMI relevant to the human disease, intracoronary administration of IGF-1/HGF is a practical and effective strategy to reduce pathological cardiac remodeling, induce myocardial regeneration, and improve ventricular function.

European Heart Journal, Aug 1, 2018

The impact of intervention in mitral regurgitation 511 impairment (P<0.01) in patients with an EC... more The impact of intervention in mitral regurgitation 511 impairment (P<0.01) in patients with an ECV≥28%. There was a trend towards longer admission times after mitral valve surgery in patients with an ECV≥28% (P=0.08). During a median follow-up of 1015 days (IQR 574-980) 13 events occurred. Kaplan-Meier analysis demonstrated an increased risk of events in patients with an ECV≥28% (log-rank P=0.021, Figure). ROC AUC for event-free survival was 0.83 for ECV and 0.68 for NT-pro-BNP. Cox-regression confirmed significant increased events in patients with an ECV≥28% independently of NTpro-BNP with an adjusted HR of 1.3 (95% CI 1.05-1.61; P=0.015). Conclusions: A significant proportion of patients with class I trigger for mitral valve surgery has increased ECV suggesting structural myocardial damage with uncertain reversibility. CMR quantified cardiac size and function confirms an association of eccentric remodeling with expansion of extracellular volume. ECV expansion conveys an increased risk, independently of NT-pro-BNP. Further research is warranted to define a possible role of ECV to optimize timing of surgery for severe mitral regurgitation in order to reduce hospital admission times and long-term morbidity and mortality.

Catheterization and Cardiovascular Interventions, 2014

IJC Heart & Vasculature, Dec 1, 2018

MitraClip is an established therapy for patients with mitral regurgitation (MR) that are consider... more MitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip. Methods: Prospective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE. Results: During a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20-17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03-11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66-8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507-0.848]) in this subgroup. Conclusions: BE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients.

Eurointervention, Feb 1, 2020

Cardiovascular Revascularization Medicine, 2020

Background: Functional mitral regurgitation (FMR) is a common finding among patients with heart f... more Background: Functional mitral regurgitation (FMR) is a common finding among patients with heart failure (HF) and it is related to adverse events. Outcomes in patients undergoing transcatheter mitral valve repair (TMVR) are still a matter of debate. We performed a meta-analysis to assess mid-and long-term outcomes of patients with FMR treated with MitraClip® compared to medical management. Methods: We conducted an electronic database search of all published data PubMed Central, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar databases. The primary end-point was all-cause mortality. The secondary end-points were hospitalizations for HF, need for heart transplantation or left ventricular assist device, unplanned mitral valve surgery, myocardial infarction and stroke. Results: Five studies (n = 1513 patients) were included in the analysis. The summary estimate including all the available studies showed a statistically significant reduction in all-cause mortality favoring MitraClip® (HR 0.56, CI 95% [0.38-0.84]) and HF hospitalizations (HR 0.65; CI 95% [0.46-0.92]). A significant reduction in the indication for advanced HF therapies (OR 0.48; CI 95% [0.25-0.90]) or the need for unplanned mitral valve surgery (OR 0.20; CI 95% [0.07-0.57]) was also found in the group of patients that underwent TMVR. No differences in the incidence of myocardial infarction or stroke were found between both groups of treatment. No publication bias was detected. Conclusion: TMVR with MitraClip® system was related to a significant reduction in all-cause mortality, hospitalizations for HF and the need for HF transplant, left ventricular assist device or unplanned surgery beyond 1-year follow up.

European Heart Journal, Aug 1, 2017

Background: Primary percutaneous coronary intervention (PCI) improved prognosis of patients with ... more Background: Primary percutaneous coronary intervention (PCI) improved prognosis of patients with acute ST-elevation myocardial infarction (STEMI). However, studies have shown sex-based disparities in outcomes after primary PCI. Purpose: This study sought to investigate the influence of gender on short and long-term mortality in unselected STEMI patients treated with primary PCI. Methods: Data of all consecutive STEMI patients admitted for primary PCI between 8/2009 and 12/2012, enrolled in a prospective registry of a high volume tertiary centre, were analyzed. In-hospital bleeding was assessed using Bleeding Academic Research Consortium (BARC) criteria. The primary outcomes were 30-day, 1-year, and 4-year all cause mortality. Results: Of the 3034 consecutive STEMI patients underwent emergency coronary angiography, 2715 were treated with primary PCI, of whom 807 (29.7%) were female. In comparison to men, women were significantly older, with higher prevalence of diabetes, hypertension and hypercholesterolemia. Women also showed higher incidence of Killip class II-IV, renal insufficiency and anaemia at admission, and higher rates of in-hospital BARC type ≥2 bleeding (11.9% vs. 3.9%, p<0.001). Compared with man, women had significantly higher rates of 30-day (9.4% vs. 5.2%; p<0.001), 1-year (16.0% vs. 9.8%; p<0.001) and 4-year (21.6% vs. 15.7%; p<0.001) all-cause mortality. Kaplan-Meier curves for 4-year survival are shown in Figure. However, after adjusting baseline differences using multivariate analysis, female sex was not an independent predictor of mortality at 30-days (HR 1.08, 95% CI 0.74-1.56; p=0.692) as well as at 1-year (HR 1.05, 95% CI 0.80-1.38; p=0.704) and at 4-years (HR 0.87, 95% CI 0.70-1.08; p=0.214) follow up. Kaplan-Meier curves for 4-year survival Conclusion: This study found that women treated with primary PCI had higher risk profile, more co-morbidity and were at increased risk of bleeding as compared to men. However, female gender was not an independent predictor of short and long-term mortality.

REC: interventional cardiology (English Edition)

REC: interventional cardiology, 2022

Journal of the American College of Cardiology, 2021

European Journal of Preventive Cardiology, 2021

Funding Acknowledgements Type of funding sources: None. Introduction Nonagenarians have a high r... more Funding Acknowledgements Type of funding sources: None. Introduction Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up. Purpose The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction. Methods A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded. Results 680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had ...