Julio Núñez - Academia.edu (original) (raw)

Papers by Julio Núñez

Research paper thumbnail of Macroinvertebrados asociados a Eichhornia crassipes (Pontederiaceae) en la Ciénaga La Pachita (Cesar, Colombia)

Información tecnológica, Jun 1, 2023

En el presente estudio se evalúa la calidad del agua en la Ciénaga La Pachita (Cesar, Colombia) a... more En el presente estudio se evalúa la calidad del agua en la Ciénaga La Pachita (Cesar, Colombia) a través de análisis de macroinvertebrados acuáticos asociados a la macrofita Eichhornia crassipes (Pontederiaceae), Buchón de Agua. Se examinan variables físico-químicas en diferentes periodos hidrológicos, se estiman los índices de diversidad alfa y beta y se determinan los índices de calidad del agua BMWP/Col y ASPT. Como resultado se colectan 1550 macroinvertebrados pertenecientes a 5 clases, 11 órdenes y 21 familias. La diversidad alfa y beta muestran una diversidad media y la clase Insecta es dominante. El orden Coleoptera es el más diverso y el orden Diptera es el más abundante, siendo la familia Chironomidae la más dominante. Un importante porcentaje de las familias registradas se correlacionaron significativamente con las variables oxígeno disuelto y sólidos suspendidos. En conclusión, la Ciénaga La Pachita tiene una mediana diversidad de macroinvertebrados acuáticos asociados al sistema radicular de E. crassipes. Palabras clave: índices de diversidad alfa y beta; ciénaga; macroinvertebrados acuáticos; variables físicoquímicas; macrofitas

Research paper thumbnail of Invasive Versus Conservative Strategy in Frail Patients With NSTEMI: The MOSCA-FRAIL Clinical Trial Study Design

Revista espanola de cardiologia (English ed.), Jan 7, 2018

Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial... more Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI. This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the...

Research paper thumbnail of Cell-free DNA and Microvascular Damage in ST-segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Revista espanola de cardiologia (English ed.), Jan 11, 2018

Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperact... more Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion. We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3). ST-segment resolution was achieved in 51 (44%) patients and TIMI 3 flow in 97 (84%). Patients without STR and TIMI 3 flow had a smaller peripheral-coronary cfDNA gradient (P = .02 and P = .04 respectively). A small cfDNA gradient (< 1.82 ng/mL) was associated with a higher rate of no STR (65% vs 30%; P = .001) and lack of TIMI 3 flow (2...

Research paper thumbnail of Coronary Serum Obtained After Myocardial Infarction Induces Angiogenesis and Microvascular Obstruction Repair. Role of Hypoxia-inducible Factor-1A

Revista espanola de cardiologia (English ed.), Jan 24, 2017

Microvascular obstruction (MVO) exerts deleterious effects following acute myocardial infarction ... more Microvascular obstruction (MVO) exerts deleterious effects following acute myocardial infarction (AMI). We investigated coronary angiogenesis induced by coronary serum and the role of hypoxia-inducible factor-1A (HIF-1A) in MVO repair. Myocardial infarction was induced in swine by transitory 90-minute coronary occlusion. The pigs were divided into a control group and 4 AMI groups: no reperfusion, 1minute, 1 week and 1 month after reperfusion. Microvascular obstruction and microvessel density were quantified. The proangiogenic effect of coronary serum drawn from coronary sinus on endothelial cells was evaluated using an in vitro tubulogenesis assay. Circulating and myocardial HIF-1A levels and the effect of in vitro blockade of HIF-1A was assessed. Compared with control myocardium, microvessel density decreased at 90-minute ischemia, and MVO first occurred at 1minute after reperfusion. Both peaked at 1 week and almost completely resolved at 1 month. Coronary serum exerted a neoangiog...

Research paper thumbnail of Neutrophil Gelatinase-Associated Lipocalin for Acute Kidney Injury During Acute Heart Failure Hospitalizations: The AKINESIS Study

Journal of the American College of Cardiology, Sep 27, 2016

Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adve... more Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown. This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents. This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events. We enrolled 927 subjects (mean age, 68...

Research paper thumbnail of Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: Rationale and Study Design of a Prospective Randomized Controlled Trial

Clinical cardiology, Jan 2, 2016

Heart failure with preserved ejection fraction (HFpEF) has become the most prevalent form of hear... more Heart failure with preserved ejection fraction (HFpEF) has become the most prevalent form of heart failure in developed countries. Regrettably, there is no evidence-based effective therapy for HFpEF. We seek to evaluate whether inspiratory muscle training, functional electrical stimulation, or a combination of both can improve exercise capacity as well as left ventricular diastolic function, biomarker profile, quality of life (QoL), and prognosis in patients with HFpEF. A total of 60 stable symptomatic patients with HFpEF (New York Heart Association class II-III/IV) will be randomized (1:1:1:1) to receive a 12-week program of inspiratory muscle training, functional electrical stimulation, a combination of both, or standard care alone. The primary endpoint of the study is change in peak exercise oxygen uptake; secondary endpoints are changes in QoL, echocardiogram parameters, and prognostic biomarkers. As of March 21, 2016, thirty patients have been enrolled. Searching for novel ther...

Research paper thumbnail of Intracoronary Infusion of Thioflavin-S to Study Microvascular Obstruction in a Model of Myocardial Infarction

Revista Española de Cardiología (English Edition), 2015

Research paper thumbnail of Study of Post-Infarction Coronary Perfusion Using Quantitative Analysis of Myocardial Echocardiography With Intravenous Injection of Contrast

Revista Española de Cardiología (English Edition), 2005

Introduction and objectives. After a myocardial infarction, damage to the microcirculation indica... more Introduction and objectives. After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion. Patients and method. We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis <50%). Myocardial perfusion in segments in the infarct-related area was quantified (normalized scale 0-1) with MCE-ic (bolus of Levovist, real-time imaging, perfusion considered normal if >0.75) and MCE-iv (perfusion of SonoVue, singleimage capture in 1 out of each 6 cycles with trigger set at end-systole, perfusion considered normal if >0.9). Perfusion was considered abnormal if 2 or more segments showed altered perfusion. Results. Quantification with MCE-iv took 5±1 minutes. No side effects were observed. MCE-ic was normal in 141 segments (80%) out of 176 segments included in the infarcted area, whereas 35 segments (20%) showed abnormal perfusion. MCE-ic was normal in 31 patients (74%) and was altered in 11 cases (26%). Normal perfusion with MCE-iv had a sensitivity of 91%, a specificity of 84%, and a kappa index of 0.67 for predicting normal perfusion with MCE-ic (r=0.86; P<.0001 between the 2 techniques). Conclusions. In comparison with MCE-ic, quantitative analysis of single images captured during intravenous perfusion of contrast is an easy, rapid and valid method for analyzing postinfarction coronary perfusion.

Research paper thumbnail of Prognostic Implications of Tissue Doppler Imaging-Derived E/Ea Ratio in Acute Heart Failure Patients

Echocardiography, 2014

Background: Tissue Doppler-derived transmitral to mitral annular early diastolic velocity ratio (... more Background: Tissue Doppler-derived transmitral to mitral annular early diastolic velocity ratio (E/Ea), as a noninvasive estimation of left ventricular (LV) filling pressures, is a strong prognosticator in various cardiac scenarios including chronic heart failure; nevertheless, its utility for risk stratification in the whole spectrum of acute heart failure (AHF) patients remains elusive. Thus, the aim of this study was to determine the association between E/Ea ratio and 1-year mortality in nonselected patients with AHF. Methods: The study included 417 consecutive patients admitted for AHF. Twenty-two patients were excluded due to nonaccurate Ea measurements, leaving the final sample to be 395 patients. E-wave, septal, and lateral Ea velocities were measured following initial stabilization and according to current recommendations. The association of mean E/Ea ratio with all-cause mortality was assessed using Cox regression analysis. Results: At a median follow-up of 306 days (interquartile range, 118-564), 89 deaths (22.5%) were registered. Mean age and E/Ea ratio were 72 AE 11.5 and 20 AE 3. Proportion of LV ejection fraction ≥50% was 47%. In multivariate analysis, after adjusting for well-known prognostic factors, including natriuretic peptides, E/Ea ratio was linearly associated with an increase risk of all-cause mortality (HR 1.04, 95% CI 1.03-1.05; P < 0.001, per increase in one unit of E/Ea). The threshold of risk was identified above 20. No significant interactions among the most important subgroups were found. Conclusion: In AHF patients, tissue Doppler imaging derived E/Ea ratio is independently associated with an increased risk of all-cause mortality.

Research paper thumbnail of Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: A multicenter stress cardiac magnetic resonance registry | Valor pronóstico de la isquemia miocárdica y la necrosis en pacientes con la función ventricular izquierda deprimida: un registro multicéntrico c...

Introduccio´n y objetivos: No se conoce el valor pronó stico incremental que aporta la isquemia m... more Introduccio´n y objetivos: No se conoce el valor pronó stico incremental que aporta la isquemia miocá rdica inducible respecto a la necrosis determinada por resonancia magné tica cardiaca de estré s en pacientes con funció n ventricular izquierda deprimida. Se determina el valor pronó stico de la necrosis y la isquemia en pacientes con funció n ventricular izquierda deprimida remitidos a exploració n por resonancia magné tica de estré s con perfusió n de dipiridamol. Me´todos: En un registro multicé ntrico basado en el uso de resonancia magné tica de estré s, se determinó la presencia (! 2 segmentos) de realce tardío de contraste y defectos de perfusió n y su asociació n con eventos mayores (muerte cardiaca e infarto no mortal). Resultados: De un total de 391 pacientes, se identificó defecto de perfusió n o realce tardío en 224 (57%) y 237 (61%). Durante el seguimiento (mediana, 96 semanas), se produjeron 47 eventos mayores (12%): 25 muertes cardiacas y 22 infartos de miocardio. Los pacientes con eventos mayores presentaron mayor extensió n de los defectos de perfusió n (6 frente a 3 segmentos; p < 0,001), pero no del realce tardío (5 frente a 3 segmentos; p = 0,1). La tasa de eventos mayores fue significativamente superior en presencia de defectos de perfusió n (el 17 frente al 5%; p = 0,0005), pero no cuando había realce tardío (el 14 frente al 9%; p = 0,1). Se clasificó a los pacientes en los cuatro grupos siguientes: ausencia de defecto de perfusió n y ausencia de realce tardío (n = 124), presencia de realce tardío y ausencia de defecto de perfusió n (n = 43), presencia de realce tardío y presencia de defecto de perfusió n (n = 195), y ausencia de realce tardío y presencia de defecto de perfusió n (n = 29). Las tasas de eventos fueron del 5, el 7, el 16 y el 24% respectivamente (p de tendencia = 0,003). En un modelo de regresió n multivariable, solamente el defecto de perfusió n predijo los eventos clínicos (hazard ratio = 2,86; intervalo de confianza del 95%, 1,37-5,95; p = 0,002), pero el realce tardío no (hazard ratio = 1,70; intervalo de confianza del 95%, 0,90-3,22; p = 0,105). Conclusiones: En los pacientes con la funció n ventricular izquierda deprimida, la isquemia inducible es el má s potente predictor de futuros eventos mayores.

Research paper thumbnail of Estudio de la perfusión coronaria postinfarto mediante análisis cuantitativo de la ecocardiografía miocárdica con inyección de contraste por vía intravenosa

Revista Española de Cardiología, 2005

Introduction and objectives. After a myocardial infarction, damage to the microcirculation indica... more Introduction and objectives. After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion. Patients and method. We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis < 50%). Myocardial perfusion in segments in the infarct-related area was quantified (normalized scale 0-1) with MCE-ic (bolus of Levovist, real-time imaging, perfusion considered normal if > 0.75) and MCE-iv (perfusion of SonoVue, singleimage capture in 1 out of each 6 cycles with trigger set at end-systole, perfusion considered normal if > 0.9). Perfusion was considered abnormal if 2 or more segments showed altered perfusion. Results. Quantification with MCE-iv took 5 ± 1 minutes. No side effects were observed. MCE-ic was normal in 141 segments (80%) out of 176 segments included in the infarcted area, whereas 35 segments (20%) showed abnormal perfusion. MCE-ic was normal in 31 patients (74%) and was altered in 11 cases (26%). Normal perfusion with MCE-iv had a sensitivity of 91%, a specificity of 84% and a kappa index of 0.67 for predicting normal perfusion with MCE-ic (r = 0.86; P<.0001 between the two techniques). Conclusions. In comparison with MCE-ic, quantitative analysis of single images captured during intravenous perfusion of contrast is an easy, rapid and valid method for analyzing postinfarction coronary perfusion.

Research paper thumbnail of The Sum of ST-Segment Elevation Is the Best Predictor of Microvascular Obstruction in Patients Treated Successfully by Primary Percutaneous Coronary Intervention. Cardiovascular Magnetic Resonance Study

Revista Española de Cardiología (English Edition), 2010

Resonancia magnética cardiovascular. Obstrucción microvascular. Resolución del segmento ST. Suma ... more Resonancia magnética cardiovascular. Obstrucción microvascular. Resolución del segmento ST. Suma de la elevación del segmento ST. Infarto de miocardio con elevación del segmento ST.

Research paper thumbnail of Perfusión miocárdica alterada tras un infarto en pacientes con flujo TIMI 3 mantenido. ¿Sólo un fenómeno agudo?

Revista Española de Cardiología, 2007

Especialidades cardiología para cardiologos. ...

Research paper thumbnail of Prognostic Value of White Blood Cell Count in Acute Myocardial Infarction: Long-Term Mortality

Revista Española de Cardiología (English Edition), 2005

Introduction and objectives. Although traditionally an elevated white blood cell count (WBC), an ... more Introduction and objectives. Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method. The study included 1118 consecutive patients who were admitted with the diagnosis of AMI: 569 non-STEMI and 549 STEMI. The WBC was measured in the 24 hours following admission. Patients were divided into 3 groups: WBC1 (count, <10×10 3 cells/mL), WBC2 (count, 10-14.9×10 3 cells/mL), and WBC3 (count, ≥15×10 3 cells/mL). All-cause mortality was recorded during a median follow-up period of 10±2 months. The relationship between WBC and mortality was assessed by Cox regression analysis for both types of AMI. Results. Long-term mortality during follow-up was 18.5% in non-STEMI patients and 19.9% in STEMI patients. In non-STEMI patients, the adjusted hazard ratios for those in the WBC3 and WBC2 groups compared with those in the WBC1 group were 2.07 (1.08-3.94; P=.027) and 1.61 (1.03-2.51; P=.036), respectively. The corresponding figures in STEMI patients were 2.07 (1.13-3.76; P=.017) and 2.22 (1.35-3.63; P=.002), respectively. Conclusions. WBC on admission was an independent predictor of long-term mortality in both non-STEMI and STEMI patients.

Research paper thumbnail of Valor pronóstico del recuento leucocitario en el infarto agudo de miocardio: mortalidad a largo plazo

Revista Española de Cardiología, 2005

Este trabajo ha sido financiado mediante una beca RECAVA-FIS.

Research paper thumbnail of Papel del índice de Charlson en el pronóstico a 30 días y 1 año tras un infarto agudo de miocardio

Revista Española de Cardiología, 2004

and objectives. The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used ... more and objectives. The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for allcause mortality and recurrent AMI 30 days and 1 year after the index event. Patients and method. We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST eleva-tion=508 and non-ST elevation=527). The composite endpoint was determined after 30 days (13.9%) and 1 year (26.3%) of follow-up. The CCI was calculated on admission, and other variables with prognostic value were also recorded. CCI was stratified in 4 categories: 1: CCI=0 (control), 2: CCI=1, 3: CCI=2,4: CCI≥3. Cox proportional risks analysis was used for the multivariate analysis, and the C-statistic was calculated to assess the discriminative power of the models. Results. Hazard ratios (95% CI) estimated for each category of CCI were: 2=1.69 (1.10-2.59), 3=1.78 (1.08-2.92) and 4=1.57 (0.87-2.83) at 30 days; 2=1.62 (1.18-2.23), 3=2.00 (1.39-2.89) and 4=2.24 (1.50-3.36) at 1 year. Comparisons with the C-statistic between the nested multivariate models (with and without CCI) yielded values of 0.765 vs 0.750 after 30 days, and 0.751 vs 0.735 after 1 year. Conclusions. Our data indicate that CCI is an independent predictor of mortality or recurrent AMI 30 days and 1 year after the index AMI.

Research paper thumbnail of Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: a multicenter stress cardiac magnetic resonance registry

Revista española de cardiología (English ed.), 2014

The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress... more The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly...

Research paper thumbnail of Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes

Revista Española de Cardiología, 2011

Research paper thumbnail of Indicaciones actuales de revascularización

Revista Española de Cardiología Suplementos, 2012

Manejo del paciente con cardiopatía isquémica crónica y comorbilidades asociadas

Research paper thumbnail of Implicaciones pronósticas de la hiperglucemia de estrés en el infarto agudo de miocardio con elevación del ST. Estudio observacional prospectivo

Revista Española de Cardiología, 2011

Introduction and objectives: In patients with acute myocardial infarction, elevation of plasma gl... more Introduction and objectives: In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with STsegment elevation (STEMI). Methods: We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic. Results: Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140 mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose !140 mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P = .001), complicative bundle branch block (5% vs. 2%, P = .005), new atrioventricular block (9% vs. 5%, P = .05) and in-hospital mortality (15% vs. 5%, P < .001). Multivariate analysis showed that those with glycemia !140 mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P = .008) irrespective of diabetes mellitus status (P-value for interaction = 0.487 and 0.653, respectively). Conclusions: Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients.

Research paper thumbnail of Macroinvertebrados asociados a Eichhornia crassipes (Pontederiaceae) en la Ciénaga La Pachita (Cesar, Colombia)

Información tecnológica, Jun 1, 2023

En el presente estudio se evalúa la calidad del agua en la Ciénaga La Pachita (Cesar, Colombia) a... more En el presente estudio se evalúa la calidad del agua en la Ciénaga La Pachita (Cesar, Colombia) a través de análisis de macroinvertebrados acuáticos asociados a la macrofita Eichhornia crassipes (Pontederiaceae), Buchón de Agua. Se examinan variables físico-químicas en diferentes periodos hidrológicos, se estiman los índices de diversidad alfa y beta y se determinan los índices de calidad del agua BMWP/Col y ASPT. Como resultado se colectan 1550 macroinvertebrados pertenecientes a 5 clases, 11 órdenes y 21 familias. La diversidad alfa y beta muestran una diversidad media y la clase Insecta es dominante. El orden Coleoptera es el más diverso y el orden Diptera es el más abundante, siendo la familia Chironomidae la más dominante. Un importante porcentaje de las familias registradas se correlacionaron significativamente con las variables oxígeno disuelto y sólidos suspendidos. En conclusión, la Ciénaga La Pachita tiene una mediana diversidad de macroinvertebrados acuáticos asociados al sistema radicular de E. crassipes. Palabras clave: índices de diversidad alfa y beta; ciénaga; macroinvertebrados acuáticos; variables físicoquímicas; macrofitas

Research paper thumbnail of Invasive Versus Conservative Strategy in Frail Patients With NSTEMI: The MOSCA-FRAIL Clinical Trial Study Design

Revista espanola de cardiologia (English ed.), Jan 7, 2018

Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial... more Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI. This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the...

Research paper thumbnail of Cell-free DNA and Microvascular Damage in ST-segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Revista espanola de cardiologia (English ed.), Jan 11, 2018

Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperact... more Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion. We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3). ST-segment resolution was achieved in 51 (44%) patients and TIMI 3 flow in 97 (84%). Patients without STR and TIMI 3 flow had a smaller peripheral-coronary cfDNA gradient (P = .02 and P = .04 respectively). A small cfDNA gradient (< 1.82 ng/mL) was associated with a higher rate of no STR (65% vs 30%; P = .001) and lack of TIMI 3 flow (2...

Research paper thumbnail of Coronary Serum Obtained After Myocardial Infarction Induces Angiogenesis and Microvascular Obstruction Repair. Role of Hypoxia-inducible Factor-1A

Revista espanola de cardiologia (English ed.), Jan 24, 2017

Microvascular obstruction (MVO) exerts deleterious effects following acute myocardial infarction ... more Microvascular obstruction (MVO) exerts deleterious effects following acute myocardial infarction (AMI). We investigated coronary angiogenesis induced by coronary serum and the role of hypoxia-inducible factor-1A (HIF-1A) in MVO repair. Myocardial infarction was induced in swine by transitory 90-minute coronary occlusion. The pigs were divided into a control group and 4 AMI groups: no reperfusion, 1minute, 1 week and 1 month after reperfusion. Microvascular obstruction and microvessel density were quantified. The proangiogenic effect of coronary serum drawn from coronary sinus on endothelial cells was evaluated using an in vitro tubulogenesis assay. Circulating and myocardial HIF-1A levels and the effect of in vitro blockade of HIF-1A was assessed. Compared with control myocardium, microvessel density decreased at 90-minute ischemia, and MVO first occurred at 1minute after reperfusion. Both peaked at 1 week and almost completely resolved at 1 month. Coronary serum exerted a neoangiog...

Research paper thumbnail of Neutrophil Gelatinase-Associated Lipocalin for Acute Kidney Injury During Acute Heart Failure Hospitalizations: The AKINESIS Study

Journal of the American College of Cardiology, Sep 27, 2016

Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adve... more Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown. This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents. This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events. We enrolled 927 subjects (mean age, 68...

Research paper thumbnail of Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: Rationale and Study Design of a Prospective Randomized Controlled Trial

Clinical cardiology, Jan 2, 2016

Heart failure with preserved ejection fraction (HFpEF) has become the most prevalent form of hear... more Heart failure with preserved ejection fraction (HFpEF) has become the most prevalent form of heart failure in developed countries. Regrettably, there is no evidence-based effective therapy for HFpEF. We seek to evaluate whether inspiratory muscle training, functional electrical stimulation, or a combination of both can improve exercise capacity as well as left ventricular diastolic function, biomarker profile, quality of life (QoL), and prognosis in patients with HFpEF. A total of 60 stable symptomatic patients with HFpEF (New York Heart Association class II-III/IV) will be randomized (1:1:1:1) to receive a 12-week program of inspiratory muscle training, functional electrical stimulation, a combination of both, or standard care alone. The primary endpoint of the study is change in peak exercise oxygen uptake; secondary endpoints are changes in QoL, echocardiogram parameters, and prognostic biomarkers. As of March 21, 2016, thirty patients have been enrolled. Searching for novel ther...

Research paper thumbnail of Intracoronary Infusion of Thioflavin-S to Study Microvascular Obstruction in a Model of Myocardial Infarction

Revista Española de Cardiología (English Edition), 2015

Research paper thumbnail of Study of Post-Infarction Coronary Perfusion Using Quantitative Analysis of Myocardial Echocardiography With Intravenous Injection of Contrast

Revista Española de Cardiología (English Edition), 2005

Introduction and objectives. After a myocardial infarction, damage to the microcirculation indica... more Introduction and objectives. After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion. Patients and method. We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis <50%). Myocardial perfusion in segments in the infarct-related area was quantified (normalized scale 0-1) with MCE-ic (bolus of Levovist, real-time imaging, perfusion considered normal if >0.75) and MCE-iv (perfusion of SonoVue, singleimage capture in 1 out of each 6 cycles with trigger set at end-systole, perfusion considered normal if >0.9). Perfusion was considered abnormal if 2 or more segments showed altered perfusion. Results. Quantification with MCE-iv took 5±1 minutes. No side effects were observed. MCE-ic was normal in 141 segments (80%) out of 176 segments included in the infarcted area, whereas 35 segments (20%) showed abnormal perfusion. MCE-ic was normal in 31 patients (74%) and was altered in 11 cases (26%). Normal perfusion with MCE-iv had a sensitivity of 91%, a specificity of 84%, and a kappa index of 0.67 for predicting normal perfusion with MCE-ic (r=0.86; P<.0001 between the 2 techniques). Conclusions. In comparison with MCE-ic, quantitative analysis of single images captured during intravenous perfusion of contrast is an easy, rapid and valid method for analyzing postinfarction coronary perfusion.

Research paper thumbnail of Prognostic Implications of Tissue Doppler Imaging-Derived E/Ea Ratio in Acute Heart Failure Patients

Echocardiography, 2014

Background: Tissue Doppler-derived transmitral to mitral annular early diastolic velocity ratio (... more Background: Tissue Doppler-derived transmitral to mitral annular early diastolic velocity ratio (E/Ea), as a noninvasive estimation of left ventricular (LV) filling pressures, is a strong prognosticator in various cardiac scenarios including chronic heart failure; nevertheless, its utility for risk stratification in the whole spectrum of acute heart failure (AHF) patients remains elusive. Thus, the aim of this study was to determine the association between E/Ea ratio and 1-year mortality in nonselected patients with AHF. Methods: The study included 417 consecutive patients admitted for AHF. Twenty-two patients were excluded due to nonaccurate Ea measurements, leaving the final sample to be 395 patients. E-wave, septal, and lateral Ea velocities were measured following initial stabilization and according to current recommendations. The association of mean E/Ea ratio with all-cause mortality was assessed using Cox regression analysis. Results: At a median follow-up of 306 days (interquartile range, 118-564), 89 deaths (22.5%) were registered. Mean age and E/Ea ratio were 72 AE 11.5 and 20 AE 3. Proportion of LV ejection fraction ≥50% was 47%. In multivariate analysis, after adjusting for well-known prognostic factors, including natriuretic peptides, E/Ea ratio was linearly associated with an increase risk of all-cause mortality (HR 1.04, 95% CI 1.03-1.05; P < 0.001, per increase in one unit of E/Ea). The threshold of risk was identified above 20. No significant interactions among the most important subgroups were found. Conclusion: In AHF patients, tissue Doppler imaging derived E/Ea ratio is independently associated with an increased risk of all-cause mortality.

Research paper thumbnail of Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: A multicenter stress cardiac magnetic resonance registry | Valor pronóstico de la isquemia miocárdica y la necrosis en pacientes con la función ventricular izquierda deprimida: un registro multicéntrico c...

Introduccio´n y objetivos: No se conoce el valor pronó stico incremental que aporta la isquemia m... more Introduccio´n y objetivos: No se conoce el valor pronó stico incremental que aporta la isquemia miocá rdica inducible respecto a la necrosis determinada por resonancia magné tica cardiaca de estré s en pacientes con funció n ventricular izquierda deprimida. Se determina el valor pronó stico de la necrosis y la isquemia en pacientes con funció n ventricular izquierda deprimida remitidos a exploració n por resonancia magné tica de estré s con perfusió n de dipiridamol. Me´todos: En un registro multicé ntrico basado en el uso de resonancia magné tica de estré s, se determinó la presencia (! 2 segmentos) de realce tardío de contraste y defectos de perfusió n y su asociació n con eventos mayores (muerte cardiaca e infarto no mortal). Resultados: De un total de 391 pacientes, se identificó defecto de perfusió n o realce tardío en 224 (57%) y 237 (61%). Durante el seguimiento (mediana, 96 semanas), se produjeron 47 eventos mayores (12%): 25 muertes cardiacas y 22 infartos de miocardio. Los pacientes con eventos mayores presentaron mayor extensió n de los defectos de perfusió n (6 frente a 3 segmentos; p < 0,001), pero no del realce tardío (5 frente a 3 segmentos; p = 0,1). La tasa de eventos mayores fue significativamente superior en presencia de defectos de perfusió n (el 17 frente al 5%; p = 0,0005), pero no cuando había realce tardío (el 14 frente al 9%; p = 0,1). Se clasificó a los pacientes en los cuatro grupos siguientes: ausencia de defecto de perfusió n y ausencia de realce tardío (n = 124), presencia de realce tardío y ausencia de defecto de perfusió n (n = 43), presencia de realce tardío y presencia de defecto de perfusió n (n = 195), y ausencia de realce tardío y presencia de defecto de perfusió n (n = 29). Las tasas de eventos fueron del 5, el 7, el 16 y el 24% respectivamente (p de tendencia = 0,003). En un modelo de regresió n multivariable, solamente el defecto de perfusió n predijo los eventos clínicos (hazard ratio = 2,86; intervalo de confianza del 95%, 1,37-5,95; p = 0,002), pero el realce tardío no (hazard ratio = 1,70; intervalo de confianza del 95%, 0,90-3,22; p = 0,105). Conclusiones: En los pacientes con la funció n ventricular izquierda deprimida, la isquemia inducible es el má s potente predictor de futuros eventos mayores.

Research paper thumbnail of Estudio de la perfusión coronaria postinfarto mediante análisis cuantitativo de la ecocardiografía miocárdica con inyección de contraste por vía intravenosa

Revista Española de Cardiología, 2005

Introduction and objectives. After a myocardial infarction, damage to the microcirculation indica... more Introduction and objectives. After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion. Patients and method. We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis < 50%). Myocardial perfusion in segments in the infarct-related area was quantified (normalized scale 0-1) with MCE-ic (bolus of Levovist, real-time imaging, perfusion considered normal if > 0.75) and MCE-iv (perfusion of SonoVue, singleimage capture in 1 out of each 6 cycles with trigger set at end-systole, perfusion considered normal if > 0.9). Perfusion was considered abnormal if 2 or more segments showed altered perfusion. Results. Quantification with MCE-iv took 5 ± 1 minutes. No side effects were observed. MCE-ic was normal in 141 segments (80%) out of 176 segments included in the infarcted area, whereas 35 segments (20%) showed abnormal perfusion. MCE-ic was normal in 31 patients (74%) and was altered in 11 cases (26%). Normal perfusion with MCE-iv had a sensitivity of 91%, a specificity of 84% and a kappa index of 0.67 for predicting normal perfusion with MCE-ic (r = 0.86; P<.0001 between the two techniques). Conclusions. In comparison with MCE-ic, quantitative analysis of single images captured during intravenous perfusion of contrast is an easy, rapid and valid method for analyzing postinfarction coronary perfusion.

Research paper thumbnail of The Sum of ST-Segment Elevation Is the Best Predictor of Microvascular Obstruction in Patients Treated Successfully by Primary Percutaneous Coronary Intervention. Cardiovascular Magnetic Resonance Study

Revista Española de Cardiología (English Edition), 2010

Resonancia magnética cardiovascular. Obstrucción microvascular. Resolución del segmento ST. Suma ... more Resonancia magnética cardiovascular. Obstrucción microvascular. Resolución del segmento ST. Suma de la elevación del segmento ST. Infarto de miocardio con elevación del segmento ST.

Research paper thumbnail of Perfusión miocárdica alterada tras un infarto en pacientes con flujo TIMI 3 mantenido. ¿Sólo un fenómeno agudo?

Revista Española de Cardiología, 2007

Especialidades cardiología para cardiologos. ...

Research paper thumbnail of Prognostic Value of White Blood Cell Count in Acute Myocardial Infarction: Long-Term Mortality

Revista Española de Cardiología (English Edition), 2005

Introduction and objectives. Although traditionally an elevated white blood cell count (WBC), an ... more Introduction and objectives. Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method. The study included 1118 consecutive patients who were admitted with the diagnosis of AMI: 569 non-STEMI and 549 STEMI. The WBC was measured in the 24 hours following admission. Patients were divided into 3 groups: WBC1 (count, <10×10 3 cells/mL), WBC2 (count, 10-14.9×10 3 cells/mL), and WBC3 (count, ≥15×10 3 cells/mL). All-cause mortality was recorded during a median follow-up period of 10±2 months. The relationship between WBC and mortality was assessed by Cox regression analysis for both types of AMI. Results. Long-term mortality during follow-up was 18.5% in non-STEMI patients and 19.9% in STEMI patients. In non-STEMI patients, the adjusted hazard ratios for those in the WBC3 and WBC2 groups compared with those in the WBC1 group were 2.07 (1.08-3.94; P=.027) and 1.61 (1.03-2.51; P=.036), respectively. The corresponding figures in STEMI patients were 2.07 (1.13-3.76; P=.017) and 2.22 (1.35-3.63; P=.002), respectively. Conclusions. WBC on admission was an independent predictor of long-term mortality in both non-STEMI and STEMI patients.

Research paper thumbnail of Valor pronóstico del recuento leucocitario en el infarto agudo de miocardio: mortalidad a largo plazo

Revista Española de Cardiología, 2005

Este trabajo ha sido financiado mediante una beca RECAVA-FIS.

Research paper thumbnail of Papel del índice de Charlson en el pronóstico a 30 días y 1 año tras un infarto agudo de miocardio

Revista Española de Cardiología, 2004

and objectives. The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used ... more and objectives. The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for allcause mortality and recurrent AMI 30 days and 1 year after the index event. Patients and method. We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST eleva-tion=508 and non-ST elevation=527). The composite endpoint was determined after 30 days (13.9%) and 1 year (26.3%) of follow-up. The CCI was calculated on admission, and other variables with prognostic value were also recorded. CCI was stratified in 4 categories: 1: CCI=0 (control), 2: CCI=1, 3: CCI=2,4: CCI≥3. Cox proportional risks analysis was used for the multivariate analysis, and the C-statistic was calculated to assess the discriminative power of the models. Results. Hazard ratios (95% CI) estimated for each category of CCI were: 2=1.69 (1.10-2.59), 3=1.78 (1.08-2.92) and 4=1.57 (0.87-2.83) at 30 days; 2=1.62 (1.18-2.23), 3=2.00 (1.39-2.89) and 4=2.24 (1.50-3.36) at 1 year. Comparisons with the C-statistic between the nested multivariate models (with and without CCI) yielded values of 0.765 vs 0.750 after 30 days, and 0.751 vs 0.735 after 1 year. Conclusions. Our data indicate that CCI is an independent predictor of mortality or recurrent AMI 30 days and 1 year after the index AMI.

Research paper thumbnail of Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: a multicenter stress cardiac magnetic resonance registry

Revista española de cardiología (English ed.), 2014

The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress... more The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly...

Research paper thumbnail of Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes

Revista Española de Cardiología, 2011

Research paper thumbnail of Indicaciones actuales de revascularización

Revista Española de Cardiología Suplementos, 2012

Manejo del paciente con cardiopatía isquémica crónica y comorbilidades asociadas

Research paper thumbnail of Implicaciones pronósticas de la hiperglucemia de estrés en el infarto agudo de miocardio con elevación del ST. Estudio observacional prospectivo

Revista Española de Cardiología, 2011

Introduction and objectives: In patients with acute myocardial infarction, elevation of plasma gl... more Introduction and objectives: In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with STsegment elevation (STEMI). Methods: We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic. Results: Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140 mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose !140 mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P = .001), complicative bundle branch block (5% vs. 2%, P = .005), new atrioventricular block (9% vs. 5%, P = .05) and in-hospital mortality (15% vs. 5%, P < .001). Multivariate analysis showed that those with glycemia !140 mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P = .008) irrespective of diabetes mellitus status (P-value for interaction = 0.487 and 0.653, respectively). Conclusions: Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients.