Jesús Castillo - Academia.edu (original) (raw)

Papers by Jesús Castillo

International Journal of Clinical Practice, 2018

European Heart Journal, 2017

Risk prediction for sudden cardiac death and ICD treatments 815 (11.7 million inhabitants) betwee... more Risk prediction for sudden cardiac death and ICD treatments 815 (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of pre-hospital SCD and used these variables to build a SCD prediction score which we validated internally and externally. Results: In the overall STEMI population, (n=8112; median age 60 years, 78% males), SCD occurred in 452 patients (5.6%). By multivariate analysis, younger age, absence of obesity, absence of diabetes, shortness of breath, and a short delay between pain onset and call to EMS were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold with a score between 20 and 29, and more than 18-fold with a score ≥30, compared to those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared to 1.6% in patients with a score ≤9 (P for trend<0.001). Sensitivity and specificity varied between 96.9% and 10.5% for scores 10 and above, and 18.0% and 97.6% for scores 30 and above, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively). Conclusion: Anticipating the occurrence of SCD at the acute phase of STEMI is feasible, and it should be added to the survival chain as a new link immediately before SCD (Figure). Near-term can accordingly be developed as a novel approach to reduce the burden of SCD

REC: CardioClinics, 2019

Abstract Introduction and objectives Oral anticoagulation therapy is prescribed to most patients ... more Abstract Introduction and objectives Oral anticoagulation therapy is prescribed to most patients with atrial fibrillation. The main limitation of anticoagulant treatment is the occurrence of bleeding episodes. We sought to assess the type of hemorrhages and mortality in patients anticoagulated for nonvalvular atrial fibrillation. Methods Observational retrospective study analyzing 2 081 138 hospitalization reports from 2014 corresponding to 151 hospitals of the Spanish National Health System. Patients were selected with the diagnosis of hemorrhage, nonvalvular atrial fibrillation, and oral anticoagulation. Results A total of 5783 hospitalizations were analyzed. Most hemorrhages were digestive (43.6%), followed by cerebral (30.6%). Among the digestive, only 27% were high. Mean age was 79.8 years, 57.1% were males, the mean hospital stay was 7.7 days. Complexity assessed by the mean diagnostic related group was 2.39 (versus 1.83 of the total hospitalizations). In-hospital mortality was 15.2% versus 10.8% of the hospitalization for hemorrhages and 3.9% of the total hospitalizations (P Conclusions Hemorrhages in patients anticoagulated for nonvalvular atrial fibrillation have a high sociosanitary impact. The most frequent hemorrhages were digestive, only a fourth part of them was high. A third of hemorrhages were cerebral. In-hospital mortality in this population was high.

Circulation. Arrhythmia and electrophysiology, 2017

The optimal dosage of cryotherapy during cryoballoon ablation of pulmonary veins is still unclear... more The optimal dosage of cryotherapy during cryoballoon ablation of pulmonary veins is still unclear. This trial tested the noninferiority of a novel, individualized, cryotherapy-dosing strategy for each vein. This prospective, randomized, multicenter, noninferiority study included 140 patients with paroxysmal atrial fibrillation, which was refractory to antiarrhythmic drugs. Patients were randomly assigned to a conventional strategy of 180-second cryoballoon applications per vein with a bonus freeze (control group, n=70) or to a shorter-time application protocol, with 1 application that lasted the time required for electric block time to effect plus 60- and a 120-second freeze bonus (study group, n=70). Patients were followed with a long-term monitoring system of 30 days. At 1-year follow-up, no difference was observed in terms of free atrial fibrillation-recurrence rates: 79.4% in control versus 78.3% in study group (Δ=1.15%; 90% confidence interval, -10.33% to 12.63%; P=0.869). Time...

Extremadura Arqueologica, 1991

Archivo Espanol De Arqueologia, 1990

Presentaremos aqui el resultado de una campana de excavaciones llevada a cabo por el procedimient... more Presentaremos aqui el resultado de una campana de excavaciones llevada a cabo por el procedimientos de urgencia en la finca "Torre Albarragena" (Valencia de Alcantara, Caceres). Durante la misma se pusieron al descubierto parte del sector residencial de un asentamiento rural romano, algunas de cuyas habitaciones se hallaron pavimentadas con mosaicos de tematica geometrica y naturalista; destacando un tema de pompa triunfal baquica. El conjunto se inscribe cronologicamente a finales del s. III y principios del s. IV

Actas Del Xxi Congreso Nacional De Arqueologia Vol 3 1995 Isbn 84 7753 673 2 Pags 1099 1108, 1995

Actas Del Xxi Congreso Nacional De Arqueologia Vol 3 1995 Isbn 84 7753 673 2 Pags 1057 1066, 1995

Pacing and Clinical Electrophysiology, 2015

Background: We sought to assess the efficacy of high-energy shocks to restore rhythm and predicto... more Background: We sought to assess the efficacy of high-energy shocks to restore rhythm and predictors of success in patients with sustained ventricular arrhythmias and implantable cardioverter defibrillator (ICD). Methods and results: Data from 162 patients included in the UMBRELLA study that experienced one or more episodes of ventricular tachycardia (VT) for which ICD shocks of at least 30 Joules were delivered (appropriate high-energy shocks) were analyzed. In total, 456 ventricular arrhythmia episodes were registered. Forty four episodes (9.6%) from 39 patients (24%) had at least one ineffective high-energy shock delivered. Hypertrophic cardiomyopathy was more frequent among patients with unsuccessful shocks (10.3% vs 2.4%). Patients with ineffective shocks had higher proportion of sustained monomorphic ventricular arrhythmias (86.4%; the other 13.6% were sustained polymorphic and ventricular fibrillation [VF]) compared with patients with all their shocks effective (62.9%, P = 0.02). No statistical differences were found between groups in time from detection to the high-energy shock delivery, in tachycardia cycle length, or in antitachycardia pacing, but patients with ineffective high-energy shocks had higher proportion of previously ineffective low-energy shock (9.1% vs 0.5%, P = 0.01). Conclusion: We found a substantial rate of ineffective high-energy shocks for the treatment of VT or VF in patients with ICD. High-energy shock efficacy seems to be reduced by hypertrophic cardiomyopathy and by the administration of previous low-energy shocks.

Journal of Cardiovascular Pharmacology and Therapeutics, 2015

Introduction: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic eve... more Introduction: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events. Many patients with AF receive chronic anticoagulation, either with vitamin K antagonists (VKAs) or with non-VKA oral anticoagulants (NOACs). We sought to analyze variables associated with prescription of NOAC. Methods: Patients with AF under anticoagulation treatment were prospectively recruited in this observational registry. The sample comprised 1290 patients under chronic anticoagulation for AF, 994 received VKA (77.1%) and 296 NOAC (22.9%). Univariate and multivariate analyses were performed to identify variables associated with use of NOAC. Results: Mean age was 73.8 ± 9.4 years, and 42.5% of the patients were women. The CHA2DS2-VASc score was 0 in 4.9% of the population, 1 in 24.1%, and ≥2 in 71% (median = 4, interquartile range = 2). Variables associated with NOAC treatment were major bleeding (odds ratio [OR] = 3.36; confidence interval [CI] 95%: 1.73-6.51; P < .001), hem...

Clinical Cardiology, 2015

Background: Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis ... more Background: Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis reveals poor quality of anticoagulation control. We sought to assess the prevalence of poor anticoagulant control in patients under VKA treatment in the prevention of stroke for atrial fibrillation (AF). Hypothesis: Control of anticoagulation with VKA is inadequate in a high percentage of patients with AF. Methods: Patients with AF under VKA treatment were prospectively recruited in this observational registry. The sample comprised 948 patients. The estimated time spent in the therapeutic range (TTR) was calculated, and variables related with a TTR >65% were analyzed. Results: Mean age was 73.8 ± 9.4 years, and 42.5% of the patients were women. Mean TTR was 63.77% ± 23.80% for the direct method and 60.27% ± 24.48% for the Rosendaal method. Prevalence of poor anticoagulation control was 54%. Variables associated with good anticoagulation control were university studies (odds ratio [OR]: 1.99, 95% confidence interval [CI]: 1.08-3.64), chronic hepatic disease (OR: 8.15, 95% CI: 1.57-42.24), low comorbidity expressed as Charlson index (OR: 0.87, 95% CI: 0.76-0.99), no previous cardiac disease (OR: 0.64, 95% CI: 0.41-0.98), lower risk of bleeding assessed as hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly age, and use of drugs or alcohol (HAS-BLED; OR: 0.81, 95% CI: 0.69-0.95), and lower heart rate (OR: 0.99, 95% CI: 0.98-0.99). Conclusions: Patients who receive VKA to prevent stroke for AF spend less than half the time within therapeutic range.

Revista Española de Cardiología, 2008

Revista Española de Cardiología, 2011

Electrocardiography (ECG) is the most widely used method for diagnosing left ventricular hypertro... more Electrocardiography (ECG) is the most widely used method for diagnosing left ventricular hypertrophy (LVH) in hypertensive patients. We assessed the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) determination compared with ECG for detecting LVH in 336 consecutive hypertensive patients with preserved systolic function. We found a significant correlation between NT-proBNP levels and left ventricular mass adjusted for body surface area (r = .41; P < .001). The area under the receiver operating characteristic curve was 0.75 (95% CI, 0.7-0.8). A cutoff of 74.2 pg/mL had a greater sensitivity than ECG (76.6% vs 25.5%; P < .001) and a higher negative predictive value (87.8% vs 76.6%; P < .001) in the identification of LVH. NT-proBNP determination may be a useful tool for LVH screening in hypertensive patients.