Sergio V. Perrone - Academia.edu (original) (raw)

Papers by Sergio V. Perrone

Revista de la Federación Argentina de Cardiología, Oct 22, 2021

Grupo GEIC y Sociedades Latinoamericanas de Cardiología Iª Directiva Latinoamericana para la IC d... more Grupo GEIC y Sociedades Latinoamericanas de Cardiología Iª Directiva Latinoamericana para la IC descompensada VI. Evaluación y tratamiento de poblaciones especiales A. Pacientes con enfermedad arterial coronaria (EAC) sospecha/confirmada (Tablas 19 y 20) Definir la etiología de la IC congestiva resulta en significativas implicaciones pronósticas y terapéuticas.

COVID-19: relationship between angiotensin-converting enzyme 2, cardiovascular system and host im... more COVID-19: relationship between angiotensin-converting enzyme 2, cardiovascular system and host immune response Coronavirus disease 2019 (COVID-19) causes severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2), and can be particularly detrimental to patients with underlying cardiovascular disease (CVD), and is a cause of morbidity and mortality. significant worldwide. The virus infects host cells through angiotensin-converting enzyme

$Research paper thumbnail of Impact of left ventricular ejection fraction phenotypes on healthcare resource utilization in hospitalized heart failure: a secondary analysis of <scp>REPORT‐HF</scp>$

European Journal of Heart Failure, Apr 12, 2023

Clinical Cardiology, Jul 1, 1996

Background: Vascular endothelium reacts to various patho‐physiologic stimuli by releasing several... more Background: Vascular endothelium reacts to various patho‐physiologic stimuli by releasing several autocoids and cyto‐kines that can be used along with the coagulation and fibrinolytic markers for the diagnosis of hemostatic alterations. Several newer markers for vascular distress, such as tissue plasminogen activator (TPA), tissue plasminogen activator inhibitor‐ I (PAI‐1), TPA/PAI‐1 complex, and the newly reported inhibitor of the coagulation process, namely, tissue factor pathway inhibitor (TFPI), have been implicated in the pathogenesis of pulmonary hypertension.Methods: To investigate the behavior of endothelial cells at basal and time‐dependent venous stasis‐induced changes, various markers were measured in patients with primary and secondary pulmonary hypertension and compared with healthy human volunteers (controls) without any family history of thromboembolism or history of hypertensive disorders. The right atrial pressure (RAP) and pulmonary arterial pressure were measured and the hemostatic parameters were correlated to determine the relevance of these parameters with the alterations in the present indices.Results: A fibrinolytic deficit exists in patients with pulmonary hypertension, indicated by the prolongation of the euglobulin clot lysis time at basal conditions and after the venous occlusion test. This defect was mainly due to increased production of PAI‐1 by endothelium (patients 59.8 ± 22.3 AU/ml; controls 30.3 ± 14.5 AU/ml; p = 0.005). We also report for the first time that a decrease in tissue factor pathway inhibitor antigen was also observed in these patients when RAP was >9 mmHg [controls 95.6 ± 61.6 ng/ml; patients with RAP >9 mmHg 47.2 ± 19.2 ng/ml (p = 0.044); patients with RAP <9 mmHg 96.6 ± 32.4 ng/ml (p = 0.002 compared with patients with RAP > 9 mmHg)], indicating endothelial cell and hemostatic disturbances.Conclusions: We conclude that the euglobulin clot lysis time was prolonged in patients with pulmonary hypertension compared with controls. The impairment of the fibrinolytic system was due to an elevated concentration of PAI‐1. In RAP > 9 mmHg, an additional prothrombotic factor is the decrease in plasma tissue factor pathway inhibitor antigen. It appears from this study that antithrombotic treatment is indicated in these patients.

European Heart Journal, Nov 1, 2020

Circulation-heart Failure, Jul 1, 2018

BACKGROUND: To describe the baseline characteristics of patients with heart failure and preserved... more BACKGROUND: To describe the baseline characteristics of patients with heart failure and preserved left ventricular ejection fraction enrolled in the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in HFpEF) comparing sacubitril/valsartan to valsartan in reducing morbidity and mortality. METHODS AND RESULTS: We report key demographic, clinical, and laboratory findings, and baseline therapies, of 4822 patients randomized in PARAGON-HF, grouped by factors that influence criteria for study inclusion. We further compared baseline characteristics of patients enrolled in PARAGON-HF with those patients enrolled in other recent trials of heart failure with preserved ejection fraction (HFpEF). Among patients enrolled from various regions (16% Asia-Pacific, 37% Central Europe, 7% Latin America, 12% North America, 28% Western Europe), the mean age of patients enrolled in PARAGON-HF was 72.7±8.4 years, 52% of patients were female, and mean left ventricular ejection fraction was 57.5%, similar to other trials of HFpEF. Most patients were in New York Heart Association class II, and 38% had ≥1 hospitalizations for heart failure within the previous 9 months. Diabetes mellitus (43%) and chronic kidney disease (47%) were more prevalent than in previous trials of HFpEF. Many patients were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (85%), β-blockers (80%), calcium channel blockers (36%), and mineralocorticoid receptor antagonists (24%). As specified in the protocol, virtually all patients were on diuretics, had elevated plasma concentrations of N-terminal pro-B-type natriuretic peptide (median, 911 pg/mL; interquartile range, 464-1610), and structural heart disease. CONCLUSIONS: PARAGON-HF represents a contemporary group of patients with HFpEF with similar age and sex distribution compared with prior HFpEF trials but higher prevalence of comorbidities. These findings provide insights into the impact of inclusion criteria on, and regional variation in, HFpEF patient characteristics.

Journal of the American College of Cardiology, Mar 1, 2023

Drugs in Context

Funding declaration: There was no funding associated with the preparation of this article.

Insuficiencia cardíaca, Sep 1, 2021

New England Journal of Medicine, 2020

BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization f... more BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure in patients regardless of the presence or absence of diabetes. More evidence is needed regarding the effects of these drugs in patients across the broad spectrum of heart failure, including those with a markedly reduced ejection fraction. METHODS In this double-blind trial, we randomly assigned 3730 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of cardiovascular death or hospitalization for worsening heart failure. RESULTS During a median of 16 months, a primary outcome event occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio for cardiovascular death or hospitalization for heart failure, 0.75; 95% confidence interval [CI], 0.65 to 0.86; P<0.001). The effect of empagliflozin on the primary outcome was consistent in patients regardless of the presence or absence of diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.70; 95% CI, 0.58 to 0.85; P<0.001). The annual rate of decline in the estimated glomerular filtration rate was slower in the empagliflozin group than in the placebo group (-0.55 vs.-2.28 ml per minute per 1.73 m 2 of body-surface area per year, P<0.001), and empagliflozin-treated patients had a lower risk of serious renal outcomes. Uncomplicated genital tract infection was reported more frequently with empagliflozin. CONCLUSIONS Among patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes. (Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Reduced ClinicalTrials.gov number, NCT03057977.

$Research paper thumbnail of Evaluation of the effects of sodium–glucose co‐transporter 2 inhibition with empagliflozin on morbidity and mortality in patients with chronic heart failure and a preserved ejection fraction: rationale for and design of the EMPEROR‐Preserved Trial$

European Journal of Heart Failure, 2019

BackgroundThe principal biological processes that characterize heart failure with a preserved eje... more BackgroundThe principal biological processes that characterize heart failure with a preserved ejection fraction (HFpEF) are systemic inflammation, epicardial adipose tissue accumulation, coronary microcirculatory rarefaction, myocardial fibrosis and vascular stiffness; the resulting impairment of left ventricular and aortic distensibility (especially when accompanied by impaired glomerular function and sodium retention) causes increases in cardiac filling pressures and exertional dyspnoea despite the relative preservation of left ventricular ejection fraction. Independently of their actions on blood glucose, sodium–glucose co‐transporter 2 (SGLT2) inhibitors exert a broad range of biological effects (including actions to inhibit cardiac inflammation and fibrosis, antagonize sodium retention and improve glomerular function) that can ameliorate the pathophysiological derangements in HFpEF. Such SGLT2 inhibitors exert favourable effects in experimental models of HFpEF and have been fou...

Global Heart, 2016

Introduction: Autonomic nervous dysfunctions are closely related to the occurrence, development a... more Introduction: Autonomic nervous dysfunctions are closely related to the occurrence, development and prognosis of acute myocardial infarction (AMI). Heart rate recovery after exercise (HRR)is a common clinical evaluated index of autonomic nervous function, which reflects autonomic balance under treadmill exercise. Our preliminary study showed that plasma levels of catestatin (CST) were increased gradually, and inversely associated with norepinephrine during the early phase of AMI, which indicated that CST might play an important role in regulation of autonomic nervous system after AMI. However there are few studies about the relationship between HRR and CST after AMI. Objectives: To investigate the relationship between HRR and CST in patients with acute ST segment elevation myocardial infarction (STEMI) treated with primary PCI. Methods: A total of 80 STEMI patients with blood sample were retrospectively investigated. All the patients were conducted cardiopulmonary exercise testing(CPET)within 30 days after STEMI, and heart rate recovery at 1 minute and 2 minute (HRR 1 ,HRR 2) were calculated. Levels of plasma CST in patients with blood samples before primary PCI were detected by ELISA, and the correlation between CST and HRR were investigated. Results: Mean plasma concentration of CST in those patients before PCI was 4.30AE0.61 ng/ml. The plasma levels of CST were positively associated with HRR 1 (r¼0.234,p¼0.037) and HRR 2 (r¼0.238, p¼0.033). Multiple linear regression analysis demonstrated CST was independently positively correlated to HRR 1 and HRR 2. Conclusion: Lower Catestain level is an independently predicting factor of autonomic nervous dysfunction in STEMI.

Revista De La Sociedad De Obstetricia Y Ginecologia De Buenos Aires, 1987

The Journal of Heart and Lung Transplantation, 2016

The presence of irreversible pulmonary hypertension and/ or anthropometric significant difference... more The presence of irreversible pulmonary hypertension and/ or anthropometric significant differences between donor and recipient (> 20%) are one of the main constraints in the selection of suitable donors to enable the completion of a successful orthotopic heart transplant. The use of pretransplant ventricular assistance or the selection of heavier donors, and the heterotopic heart transplantation (HHTx) had been considered in different transplant programs to try to overcome this drawback and also as a bridge to recovery. We present here our experience in HHTx. Methods: In an attempt to address this issue we evaluate our experience in 11 HHTx performed at our institution between 2001 and 2013, in 10 patients [8 Males (73 %), 3 Females (27 %); Age 42.5 ± 15 years (18/65)]; one patient (Pts) received a second HHTx at 15 month post first HTxC. Pre transplant diagnosis were: idiopathic dilated cardiomyopathy 7 Pts (63.6%), necrotic dilated cardiomyopathy 1 Pts (9.1%), Chagas cardiomyopathy 1 Pts (9.1%), hypothyroid cardiomyopathy 1 Pts (9.1%) and graft vascular disease 1 Pts (9.1%). Three of the recipients were in national emergency waiting list at the time of transplantation, 2 in urgency and 6 in elective lists. The donor / recipient selection criteria was done taking in account significant high pulmonary vascular resistances and / or anthropometric mismatch, and/or sex mismatch. In all Pts the donor pulmonary artery was anastomosed to the recipient right atrium without the use of any prosthetic material to spare the donor right ventricle and assisting recipient's left ventricle using the recipient right ventricle to support the pulmonary circulation. Proper synchronization between the two hearts was performed using pacemakers. Ischemic times varied between 76 and 245 minutes (mean 184.1 ± 57.8). Standard immunosuppression scheme was used. Results: The actuarial survival including hospital mortality was 67% at one year and 56% at 5 years. The average follow-up of patients was 4.46 years, and longer survival reached is 13.6 years. All patients who survive more than 3 month returned to normal life. Conclusion: Several attempts to perform HHTx in our country failed using the conventional surgical technic. In our experience, applying the technic described by Yacoub and Khaghani, we consider that is feasible for a selected group of patients with acceptable medium term results.

EA Bocchi y col. Recomendaciones para el uso de everolimus

Comité de Insuficiencia Cardíaca de la Federación Argentina de Cardiología, Jun 24, 2020

European Journal of Heart Failure

Acute heart failure can be a life-threatening medical condition. Delaying administration of intra... more Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.