Luis Almenar - Academia.edu (original) (raw)

Papers by Luis Almenar

Revista Española de Cardiología, 1998

Revista Española de Cardiología (English Edition), 2005

This paper describes the general situation regarding heart transplantation in Spain and the resul... more This paper describes the general situation regarding heart transplantation in Spain and the results obtained using the technique, incorporating data for the year 2004. In 2004, 294 heart transplants were carried out, which brings the total number of procedures performed since 1984 to 4680. Clinically, the typical heart transplant recipient in Spain is male, aged around 50 years, has blood group A, has non-revascularizable coronary artery disease, and is in NYHA functional class IV/IV. The percentage of emergency heart transplantations was 35%, which is higher than in the previous year (29%), and higher than the mean for the preceding 5 years (22%). The early mortality rate was 10%, which is lower that the mean for the preceding 5 years (13%). After combining the results for 2004 with those of previous years, the probability of survival at 1, 5 and 10 years was 80%, 70% and 60%, respectively. When the survival rates for different time periods were analyzed, a significant improvement could be seen in the last 5 years, with recent survival rates being 85% and 72% at 1 and 5 years, respectively. The most frequent cause of death in the first month was acute graft failure; in the first year, infection and rejection; and, over the long term, tumors and a combination of graft vasculopathy and sudden death. A comparative analysis of survival rates showed that long-term results in Spain are slightly better than those published in the world literature. Moreover, survival has tended to improve gradually in recent years.

Revista Española de Cardiología Suplementos, 2012

Cirugía Cardiovascular, 2007

In the year 2012, 3 scientific sections-heart failure and transplant, congenital heart disease, a... more In the year 2012, 3 scientific sections-heart failure and transplant, congenital heart disease, and clinical cardiology-are presented together in the same article. The most relevant development in the area of heart failure and transplantation is the 2012 publication of the European guidelines for heart failure. These describe new possibilities for some drugs (eplerenone and ivabradine); expand the criteria for resynchronization, ventricular assist, and peritoneal dialysis; and cover possibilities of percutaneous repair of the mitral valve (MitraClip W). The survival of children with hypoplastic left heart syndrome in congenital heart diseases has improved significantly. Instructions for percutaneous techniques and devices have been revised and modified for the treatment of atrial septal defects, ostium secundum, and ventricular septal defects. Hybrid procedures for addressing structural congenital heart defects have become more widespread. In the area of clinical cardiology studies have demonstrated that percutaneous prosthesis implantation has lower mortality than surgical implantation. Use of the CHA 2 DS 2-VASc criteria and of new anticoagulants (dabigatran, rivaroxaban and apixaban) is also recommended. In addition, the development of new sequencing techniques has enabled the analysis of multiple genes.

Revista Española de Cardiología, 2000

Page 1. 97 1095 Las prioridades de la prevención de las enfermedades cardiovasculares deben centr... more Page 1. 97 1095 Las prioridades de la prevención de las enfermedades cardiovasculares deben centrarse en grupos específicos, encabezados por los pacientes con enfermedad ya esta-blecida y por los individuos de alto ...

American Journal of Transplantation, 2009

Amyloidosis (Am), a systemic disease, has poor prognosis because of organ damage produced by prot... more Amyloidosis (Am), a systemic disease, has poor prognosis because of organ damage produced by protein deposition in the extracellular space. Although heart transplantation (HTx) is possible, donor availability concerns and high mortality make this approach controversial. The Spanish Registry for Heart Transplantation includes 25 Am patients (54 ± 9 years): 13 with AL type, 2 with AA and 10 with TTR mutation. Fifteen patients (60%) died during follow-up (4.9 ± 1.3 years): 9 AL-Am patients, both AA-Am patients and 4 with TTR-Am. HTx survival for Am patients was similar to patients without Am at 1 month but significantly worse at 5 years: 46% versus 78% (p < 0.02). Of 10 AL-Am patients undergoing successful HTx, 4 died of systemic Am. Stem cell transplantation was performed in 3 (1 died of acute rejection). Five of 10 patients with TTR-Am underwent liver transplant; 4 remained alive at the last follow-up. Findings include poor outcome for AL-Am patients despite HTx and better survival for TTR-Am patients if HTx is associated with liver transplantation. Given the shortage of donors and poor outcome for Am patients, we would recommend that HTx be reserved for patients without or with mild systemic Am and be supplemented by additional therapies as indicated.

Journal of Personalized Medicine

The non-invasive diagnosis of acute cellular rejection (ACR) is a major challenge. We performed a... more The non-invasive diagnosis of acute cellular rejection (ACR) is a major challenge. We performed a molecular study analyzing the predictive capacity of serum RanGTPase AP1 (RANGAP1) for diagnosing ACR during the first year after heart transplantation (HT). We included the serum samples of 75 consecutive HT patients, extracted after clinical stability, to determine the RANGAP1 levels through ELISA. In addition, various clinical, analytical, and echocardiographic variables, as well as endomyocardial biopsy results, were collected. RANGAP1 levels were higher in patients who developed ACR (median 63.15 ng/mL; (inter-quartile range (IQR), 36.61–105.69) vs. 35.33 ng/mL (IQR, 19.18–64.59); p = 0.02). Receiver operating characteristic (ROC) curve analysis confirmed that RANGAP1 differentiated between patients with and without ACR (area under curve (AUC), 0.70; p = 0.02), and a RANGAP1 level exceeding the cut-off point (≥90 ng/mL) was identified as a risk factor for the development of ACR (OR...

Journal of Personalized Medicine, 2021

Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and redu... more Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and reduces SERCA2a levels, essential for intracellular calcium homeostasis. We consider in this study whether the molecules involved in these processes can differentiate those patients with advanced HF and the need for mechanical circulatory support (MCS) as a bridge to recovery or urgent heart transplantation from those who are clinically stable and who are transplanted in an elective code. Material and method: Blood samples from 29 patients with advanced HF were analysed by ELISA, and the plasma levels of Importin5, Nucleoporin153 kDa, RanGTPase-Activating Protein 1 and sarcoplasmic reticulum Ca2+ ATPase were compared between patients requiring MCS and those patients without a MCS need prior to heart transplantation. Results: SERCA2a showed significantly lower levels in patients who had MCS compared to those who did not require it (0.501 ± 0.530 ng/mL vs. 1.123 ± 0.661 ng/mL; p = 0.01). A SER...

Revista Española de Cardiología, 2018

Introducción y objetivos: El tacrolimus de liberació n prolongada (TLP) permite una dosificació n... more Introducción y objetivos: El tacrolimus de liberació n prolongada (TLP) permite una dosificació n ú nica diaria, lo que simplifica el ré gimen inmunosupresor. El presente estudio describe la eficacia y la seguridad del uso de TLP de novo y precoz para el trasplante cardiaco. Me´todos: Se realizó un estudio observacional, retrospectivo y multicé ntrico para comparar el uso de novo de TLP (grupo de TLP; n = 94), tacrolimus de liberació n está ndar (grupo de TLE; n = 42) y la conversió n precoz (CP) de TLP a TLE (grupo de CP; n = 44). El TLP se usó entre 2007 y 2012. Se analizaron la tasa de incidencia de rechazo agudo, infecció n e infecció n por citomegalovirus al primer añ o tras el trasplante, así como pará metros de seguridad. Resultados: Entre los grupos no hubo diferencias significativas en la dosis diaria y las concentraciones sé ricas de tacrolimus durante el primer añ o tras el trasplante. La incidencia de rechazo fue de 1,05 (IC95%, 0,51-1,54), 1,39 (IC95%, 1,00-1,78) y 1,11 (IC95%, 0,58-1,65) eventos/pacientes-añ os en los grupos de TLE, TLP y CP respectivamente (p = 0,48). La incidencia de infecció n fue de 0,75 (IC95%, 0,60-0,86), 0,62 (IC95%, 0,52-0,71) y 0,55 (IC95%, 0,40-0,68) en los grupos de TLE, TLP y CP respectivamente (p = 0,46). Se produjo infecció n por citomegalovirus en el 23,8, el 20,2 y el 18,2% respectivamente (p = 0,86). No hubo diferencias significativas entre los grupos en los pará metros de seguridad o la funció n del injerto. Falleció 1 paciente del grupo de TLE y 2 del grupo de TLP. Conclusiones: Parece que el uso de novo de TLP o la CP de TLP a TLE tienen similares eficacia y seguridad que el TLE en el trasplante cardiaco.

European journal of heart failure, Jan 6, 2018

The LION-HEART study was a multicentre, double-blind, randomised, parallel-group, placebo-control... more The LION-HEART study was a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial evaluating the efficacy and safety of intravenous administration of intermittent doses of levosimendan in outpatients with advanced chronic heart failure. Sixty-nine patients from 12 centres were randomly assigned at a 2:1 ratio to levosimendan or placebo groups, receiving treatment by a 6-hour intravenous infusion (0.2 μg/kg/min without bolus) every 2 weeks for 12 weeks. The primary endpoint was the effect on serum concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) throughout the treatment period in comparison with placebo. Secondary endpoints included evaluation of safety, clinical events and health-related quality of life (HRQoL). The area under the curve (AUC, pg.day/mL) of the levels of NT-proBNP over time for patients who received levosimendan was significantly lower than for the placebo group (344 × 10 [95% Confidence Interval (CI) 283 × 10 -404 × 10...

Revista Española de Cardiología (English Edition), 2016

Introduction and objectives: The present article reports the characteristics and results of heart... more Introduction and objectives: The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. Methods: We describe the main features of recipients, donors, surgical procedures, and results of all heart transplants performed in Spain until December 31, 2015. Results: A total of 299 cardiac transplants were performed in 2015, with the whole series comprising 7588 procedures. The main transplant features in 2015 were similar to those observed in recent years. A remarkably high percentage of transplants were performed under emergency conditions and there was widespread use of circulatory assist devices, particularly continuous-flow left ventricular assist devices prior to transplant (16% of all transplants). Survival has significantly improved in the last decade compared with previous time periods. Conclusions: During the last few years, between 250 and 300 heart transplants have consistently been performed each year in Spain. Despite a more complex clinical context, survival has increased in recent years.

Revista Española de Cardiología (English Edition), 2015

Introduction and objectives: We present the characteristics and outcomes of heart transplantation... more Introduction and objectives: We present the characteristics and outcomes of heart transplantation in Spain since it was first performed in 1984. Methods: A descriptive analysis of the characteristics of recipients, donors, the surgical procedure, and the outcomes of heart transplantations performed in Spain until 31 December 2014. Results: In 2014, 266 procedures were performed, making a time series of 7289 transplantations. The temporal analysis confirmed a significant worsening of the clinical profile of recipients (higher percentage of older patients, patients with severe renal failure, insulin-dependent diabetes, previous cardiac surgery, and previous mechanical ventilation), of donors (higher percentage of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations, reaching 41.4% in 2014, and ischemia time > 240 min). Mechanical assist devices were used less than in 2013; in 2014 they were used in 18.8% of all transplant recipients. Survival at 1, 5, 10, and 15 years was 76%, 65%, 52%, and 38%, respectively, and has remained stable since 1995. Conclusions: Cardiac transplantation activity in Spain has remained stable in recent years, at around 250 procedures per year. Despite a clear deterioration in donor and recipient characteristics and surgical times, the mortality outcomes have remained comparable to those of previous periods in our environment. The growing use of circulatory assist devices before transplantation is also confirmed.

Transplantation Proceedings, 2010

Proliferation signal inhibitors (PSI; sirolimus, everolimus) are being increasingly used in heart... more Proliferation signal inhibitors (PSI; sirolimus, everolimus) are being increasingly used in heart transplantation. We performed an observational, retrospective, multicenter study in 9 Spanish centers seeking to describe the clinical context in which a PSI was used among maintenance heart recipients and its evolution over time. We collected a cohort of 548 patients in whom a PSI was prescribed from October 2001 to March 2009. The group was divided into 3 time periods. The use of PSI steeply increased in the 2005-2006 period, remaining stable thereafter. There were no significant differences over time with regard to age, gender, or time from transplantation to the introduction of the PSI. Everolimus usage overtook sirolimus from 2005 on; currently, &amp;gt;90% of the subjects with PSI indications are prescribed everolimus. Compared with earlier periods, patients in the more recent period (October 2006-March 2009) showed less vascular graft disease and better basal renal function, irrespective of the primary indication for the PSI prescription. Also, skin cancer overtook solid cancer as the main type of neoplasm in patients for whom malignancy was the primary indication for the use of the PSI. The actuarial incidence of PSI withdrawal owing to adverse effects did not change significantly over time.

Revista Española de Cardiología, 2013

Introduccio´n y objetivos: Este artículo presenta las características y los resultados del traspl... more Introduccio´n y objetivos: Este artículo presenta las características y los resultados del trasplante cardiaco en Españ a desde que empezó su actividad en mayo de 1984. Me´todos: Se realiza un aná lisis descriptivo de las características de receptores, donantes, procedimiento quirú rgico y resultados de los trasplantes cardiacos realizados en Españ a hasta el 31 de diciembre de 2012. Resultados: Durante 2012 se han realizado 247 procedimientos, con lo que en la serie histó rica constan 6.775 trasplantes. En los ú ltimos añ os, se observa un empeoramiento del perfil clínico tanto de los receptores (el 34% mayores de 60 añ os, el 22% con insuficiencia renal grave, el 17% con diabetes mellitus insulinodependiente, el 29% con cirugía cardiaca previa y el 16% con ventilació n mecá nica), como de los donantes (el 38% mayores de 45 añ os y el 26% con discordancia de peso > 20%) y del procedimiento (el 29% con tiempo de isquemia > 4 h y el 36% en procedimientos urgentes). La supervivencia a 1, 5, 10 y 15 añ os ha sido del 78, el 67, el 53 y el 38% respectivamente. Estas cifras permanecen estables desde 1995. Conclusiones: La actividad del trasplante cardiaco en Españ a permanece estable en los ú ltimos añ os, con alrededor de 250 procedimientos al añ o. A pesar del claro empeoramiento en las características de donantes, receptores y tiempos quirú rgicos, se mantienen unos resultados en mortalidad comparables a los de nuestro entorno.

Revista Española de Cardiología (English Edition), 2014

Introduction and objectives: The present article reports the characteristics and outcome of heart... more Introduction and objectives: The present article reports the characteristics and outcome of heart transplantation in Spain since it was first performed in May 1984. Methods: We provide a descriptive analysis of the characteristics of the recipients, the donors, the surgical procedure, and results of the heart transplantations performed in Spain until 31 December 2013. Results: During 2013, a total of 248 transplantation procedures were carried out, bringing the time series to a total of 7023 transplantations. The temporal analysis confirms a significant deterioration in the clinical profile of the recipients (higher percentage of older patients, severe renal failure, insulindependent diabetes mellitus, previous heart surgery, mechanical ventilation), of the donors (higher proportion of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations which, in 2013, reached 49%, and with ischemia times > 240 min). There was a marked increase in the use of circulatory assist devices prior to transplantation which, in 2013, were employed in 25.2% of all the patients. The survivals at 1, 5, 10, and 15 years were 76%, 65%, 52%, and 37%, respectively, and have remained stable since 1995. Conclusions: Heart transplantation activity in Spain remains stable in recent years, with around 250 procedures a year. Despite the clear deterioration in the clinical characteristics of the donors and recipients, and lengthening of the operative times, the results in terms of mortality continue to be comparable to those reported in our neighboring countries, and a growing use of circulatory assist devices prior to transplantation is confirmed.

The Journal of Heart and Lung Transplantation, 2015

BACKGROUND. The lengthy waiting time for heart transplantation is associated with high mortality.... more BACKGROUND. The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. METHODS. We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors. RESULTS. There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001). CONCLUSIONS. There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.

Revista Española de Cardiología, 2014

Revista Española de Cardiología, 2006

Introducción y objetivos. Actualmente, el impacto de la diabetes mellitus en los pacientes con tr... more Introducción y objetivos. Actualmente, el impacto de la diabetes mellitus en los pacientes con trasplante cardiaco es controvertido y su efecto sobre la mortalidad y otras complicaciones, como las infecciones y los rechazos, no está completamente aclarado. El objetivo de este estudio es analizar estos efectos en nuestra población de pacientes trasplantados. Métodos. Se ha estudiado a una población de 365 pacientes consecutivos con trasplante cardiaco desde noviembre de 1987 hasta mayo de 2003, dividiéndolos en 3 grupos en función de la presencia de diabetes pretrasplante (grupo 1), diabetes de novo (grupo 2) y no diabéticos (grupo 3). Se analizaron variables tanto basales como de complicaciones evolutivas, y los resultados se compararon mediante test t de Student, test χ 2 y método de Kaplan-Meier para la supervivencia. Resultados. No apreciamos diferencias entre grupos en la supervivencia al año (p = 0,24) ni a 5 años (p = 0,32). Los pacientes de los grupos con diabetes mellitus pretrasplante y de novo tenían mayor edad (54,6 frente a 54,9 frente a 50,6 años; p = 0,04), mayor prevalencia de hipertensión arterial (el 48, el 36 y el 23%; p = 0,001) y mayor porcentaje de tratamiento con tacrolimus (el 10, el 12 y el 4%; p = 0,04) y esteroides (el 92, el 86 y el 70%; p = 0,001). Evolutivamente, estos 2 grupos presentan mayor incidencia de rechazo (el 64, el 70 y el 45%; p = 0,001). Conclusiones. La diabetes previa al trasplante o de novo no tuvo impacto negativo sobre la supervivencia de nuestros pacientes trasplantados. Su presencia se asocia al tratamiento con esteroides y tacrolimus. En estos pacientes sería deseable realizar un ajuste individualizado de la inmunodepresión.

Revista Española de Cardiología (English Edition), 2010