Xavier Borras | Universitat Autònoma de Barcelona (original) (raw)
Papers by Xavier Borras
European heart journal, Jan 21, 2017
We aimed to determine whether treatment with sildenafil improves outcomes of patients with persis... more We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their compo...
Journal of cardiac surgery, Jan 9, 2017
Tricuspid valve replacement has been associated with high mortality and poor long-term outcomes. ... more Tricuspid valve replacement has been associated with high mortality and poor long-term outcomes. We report the preoperative risk factors associated with short and long-term outcomes following tricuspid valve replacement with mechanical prostheses. In 62 patients who underwent mechanical tricuspid valve replacement, clinical, laboratory, and echocardiographic findings were analyzed using both univariate and multivariate analyses to describe operative and long-term mortality. In our population (mean age 59 ± 9.7 years, 82.3% female), most common causes of tricuspid valve disease were rheumatic fever (69.4%) and functional regurgitation (19.4%). Operative and long-term mortality were 17.7 and 33.9%, respectively. Age, diabetes mellitus, and coronary artery disease were independently associated with increased long-term mortality. New York Heart Association (NYHA) class and right heart failure symptoms significantly improved during follow-up. In this series of mechanical tricuspid valve ...
Revista Espanola De Cardiologia, Feb 15, 2008
Clinical cardiology encompasses all forms of heart disease and their more general characteristics... more Clinical cardiology encompasses all forms of heart disease and their more general characteristics, and its sphere of activity includes practical aspects of prevention, diagnosis, and inpatient and outpatient treatment as applied to patients on an everyday basis. Since certain areas of cardiology have become highly specialized, this review of new developments reported in the past year has attempted to bring together all those advances that are not the subject of research in some particular specialization within cardiology and that have such a wide range of application that they should be familiar to all clinical cardiologists, irrespective of their daily responsibilities. For the purposes of this review, articles were classified according to their origin as either English-language, European, or domestic publications. The review concludes with a summary of registry data collected in the last two years by the Clinical and Outpatient Cardiology Section of the Spanish Society of Cardiology.
Medicina clínica, Jan 5, 2003
Handheld echocardiography may be a powerful diagnostic tool in the emergency room. However, its u... more Handheld echocardiography may be a powerful diagnostic tool in the emergency room. However, its usefulness in this environment when it is performed by medical personnel with a basic training in echocardiography remains to be clarified. A cardiologist with expertise in echocardiography and a cardiology fellow with basic training evaluated 33 patients admitted in emergency using a handheld device. The echocardiogram led to a change in the diagnosis and treatment in 27% and 46% of patients, respectively, allowing an early discharge in 49% of cases. The agreement between the two observers was acceptable. Portable echocardiography is a useful tool in emergency rooms and may be reliably performed by medical personnel with basic training in echocardiography.
Revista Española de Cardiología, 2000
Assessment of the Internal Mammary Artery Graft Patency: Usefulness of Echo-Enhancer Agents to Id... more Assessment of the Internal Mammary Artery Graft Patency: Usefulness of Echo-Enhancer Agents to Identify the Flow Signal by Color Doppler Echocardiography Objectives. a) To study the capacity of the technique of high-frequency color Doppler to detect flow signal of left internal mammary artery grafts; b) to assess the usefulness of an echo-enhancer agent to facilitate the detection of the signal, and c) to evaluate the patency of the graft according to its pulsed Doppler velocity profile pattern. Methods. 39 consecutive patients were studied. A Hewlett-Packard 5500 echocardiograph was used, with a high-frequency probe (S12) applied at the high left parasternal border. When a graft signal was not elicited after a predetermined 5-minute check period, an intravenous dose of 4 g of Levovist ® (Schering España) at 400 mg/ml was administrated. According to previous studies, a pulsed Doppler flow profile with a predominantly diastolic pattern was considered a normal graft patency, while a systolic one was deemed as abnormal. Results. Graft flow was identified by color Doppler in 33/39 patients (85%). The additional use of an echo-enhancer in 6 patients with no detected signal increased this proportion to 38/39 (97%). Normal flow patterns were seen in 34/38 (89%). Among the four patients with abnormal pattern, 1 case of early myocardial infarction was observed, while angiographic studies showed distal occlusion of the graft in 1 or the presence of competitive flow in 2 patients. Conclusions. The high-frequency color Doppler technique allows the detection of a flow signal from internal mammary artery grafts in most patients. The administration of an echo-enhancer agent is useful in those with non detectable signals. An abnormal pulsed Doppler velocity pattern indicates graft malfunction.
Revista española de cardiología (English ed.), 2012
In patients with heart failure, left ventricular ejection fraction ≤35% and sinus rhythm without ... more In patients with heart failure, left ventricular ejection fraction ≤35% and sinus rhythm without conditions such as atrial fibrillation, thrombus or history of thromboembolic events, the use of anticoagulation is controversial. Our objective was to evaluate the anticoagulation strategy in these patients, variables associated with its use, and its effects on various cardiovascular events. Of the patients included in the REDINSCOR registry with left ventricular ejection fraction ≤35% and sinus rhythm without other anticoagulation indications (including patients with heart failure from 19 Spanish centres), we compared those who received this treatment with the remaining patients. Between 2007 and 2010, 2263 patients were included, of whom 902 had left ventricular ejection fraction ≤35% and sinus rhythm. Of these, 237 (26%) were receiving anticoagulation therapy. Variables associated with this treatment were a lower left ventricular ejection fraction, ischemic etiology, advanced functio...
Revista Española de Cardiología, 2012
Introducción y objetivos: La mortalidad por cardiopatía isqué mica aguda se ha reducido, pero los... more Introducción y objetivos: La mortalidad por cardiopatía isqué mica aguda se ha reducido, pero los pacientes cró nicos persisten sintomá ticos en una proporció n importante. Se pretende conocer las características clínicas y la terapé utica del paciente con angina estable y el impacto de esta enfermedad en la calidad de vida. Me´todos: Estudio observacional, multicé ntrico y de corte transversal, sobre 2.039 pacientes con angina estable en control ambulatorio. Ademá s de variables clínicas, el investigador recogió su valoració n subjetiva sobre la gravedad de la angina y la limitació n causada por ella. Los pacientes contestaron sobre percepció n de gravedad y calidad de vida con cuestionarios específicos. Resultados: Se analizó a 2.024 pacientes. El 73% eran varones (media de edad, 68 AE 10 añ os). El 50,3% estaba asintomá tico (menos de una crisis de angina por semana en las ú ltimas 4 semanas), el 39,2% había tenido entre una y tres crisis por semana, y el 10,5% declaró má s de tres crisis por semana. El 66% había sido revascularizado, y de ellos el 59% volvía a tener angina. Los pacientes puntuaron la gravedad de la enfermedad má s que los mé dicos (4,5 AE 2,5 frente a 4,3 AE 2,3; p = 0,002). Las percepciones del mé dico y del paciente sobre la repercusió n de la angina tuvieron poca concordancia (índice kappa < 0,3), pues los pacientes consideraron que su enfermedad era má s grave, má s invalidante y con mayor disminució n de la calidad de vida. Conclusiones: Persiste una elevada proporció n de pacientes sintomá ticos y con reducció n de la calidad de vida. La percepció n del paciente sobre la enfermedad es peor que la del mé dico.
Revista Española de Cardiología, 2011
![Research paper thumbnail of [Cardiopulmonary stress testing in children who have had congenital heart disease surgery. Physical exercise recommendations during school hours]](https://attachments.academia-assets.com/101384755/thumbnails/1.jpg)
](Revista española de cardiología, 2011
To analyze and discover if stress testing with exhaled gases in children who have had congenital ... more To analyze and discover if stress testing with exhaled gases in children who have had congenital heart surgery is useful so we could make physical exercise recommendations according to heart disease, type of surgery performed, present hemodynamic state and level of exercise practiced. Prospective study of 108 children, who performed stress testing with exhaled gases, electrocardiogram monitoring and blood pressure. A questionnaire was used to obtain variables concerning heart disease, surgery, present functional condition and level of exercise practiced. Exercise recommendations were given after stress testing, and after a year 35 patients answered a questionnaire. There were significant differences between lesion severity and heart rate at rest and during effort, systolic pressure at rest and during effort, oxygen uptake, oxygen pulse, carbon dioxide production and test duration. A relationship was observed between level of weekly exercise and greater oxygen uptake and test duratio...
Revista Española de Cardiología (English Edition), 2008
Heart failure is a prevalent condition that is associated with high morbidity and mortality and t... more Heart failure is a prevalent condition that is associated with high morbidity and mortality and that places a substantial demand on healthcare resources. As the condition often affects older individuals with comorbidities, its treatment requires the implementation of an integrated model of care that can be applied in primary care, in hospitals, and in the patient's home. The use of heart failure units has improved quality of life in these patients and has reduced hospital admissions. However, in Spain integrated care has not yet been widely implemented. Clinical and preclinical research on heart failure is complex and, consequently, it is essential for investigators to work together in research networks. As a result, 16 Spanish centers have organized themselves into a heart failure research network (REDINSCOR). This network is considering the establishment of a national heart failure registry and is involved in seven research projects, whose subjects range from molecular biology and cell physiology to diagnosis, treatment, and the development of integrated healthcare models.
Revista Española de Cardiología, 2001
La revascularizacion coronaria de la arteria descendente anterior con la arteria mamaria interna ... more La revascularizacion coronaria de la arteria descendente anterior con la arteria mamaria interna izquierda (AMI) es una tecnica de uso habitual. La situacion del injerto, adyacente a la pared toracica, permite su estudio mediante ecocardiografia Doppler transtoracica1,2. La imagen que presentamos corresponde a un varon de 55 anos, que manifesto disfuncion ventricular izquierda a las 48 h de haber sido intervenido de revascularizacion coronaria, precisando la colocacion del balon de contrapulsacion (BCP) para su estabilizacion hemodinamica. El aumento del flujo diastolico coronario es uno de los mecanismos de accion beneficiosa del BCP, junto con la reduccion de la poscarga3-5. Mediante un equipo de ecocardiografia Doppler (Hewlett-Packard Sonos 5500, Andover, Mass), equipado con una sonda de alta frecuencia (12 MHz), se obtuvo senal de flujo en el injerto de la AMI mediante Doppler pulsado (DP). En la figura 1 se presenta el registro simultaneo de la curva de presion en la arteria radial (P), el electrocardiograma (ECG) y la senal espectral DP, con el BCP sincronizado 3:1. El registro espectral de velocidades evidencia un claro predominio del flujo diastolico (d) sobre el sistolico (s), indicativo de la permeabilidad del injerto1. Con el inflado del BCP existe un aumento de la presion arterial (flecha) y un incremento del 35% de la integral de la curva de velocidades maximas en diastole, equivalente a la variacion del volumen sanguineo total a traves del injerto. Dicha informacion fue de utilidad para ajustar el inicio y la duracion del inflado del BCP con el fin de obtener el maximo flujo en el injerto coronario. BIBLIOGRAFIA
Cirugía Cardiovascular, 2013
(SECTCV) presenta su primer informe con el registro de la actividad de la cirugía reparadora de l... more (SECTCV) presenta su primer informe con el registro de la actividad de la cirugía reparadora de las válvulas mitral, aórtica y tricúspide realizadas en España los años 2009 a 2011. Métodos: Los datos se obtienen mediante participación voluntaria y fueron analizados para su publicación en las reuniones del grupo de trabajo celebradas en los meses de junio y octubre de 2012 en Sevilla, coincidiendo con los congresos nacionales de la SECTCV y la Sociedad Española de Cardiología. Se reportan datos comparativos de la cirugía valvular. Resultados: Se ofrecen datos de 33 centros que representan aproximadamente el 80% de la actividad quirúrgica del país. Se observa un incremento progresivo en el número de total de intervenciones valvulares y de reparaciones durante los 3 años, realizándose 8.878 (1.581 reparaciones), 9.530 (1.709) y 9.711(1.888) en 2009, 2010 y 2011, respectivamente. El porcentaje de cirugía de reparación/cirugía de recambio en 2011 fue del 3% para la válvula aórtica, del 33% para la válvula mitral y del 91% para la válvula tricúspide. Conclusiones: El primer Registro Nacional de Cirugía Reparadora Valvular representa la consolidación de actividades del grupo de trabajo. La elevada participación de centros hace fiables sus datos y nos permite por primera vez realizar una valoración del estado actual de la cirugía reparadora en el país. Estos datos sirven de referencia para compararse con los de otros países.
Revista Española de Cardiología, 2014
Revista Española de Cardiología (English Edition), 2014
Revista Española de Cardiología (English Edition), 2013
These guidelines 2 are an updated version of the previous 2007 document. They are very relevant f... more These guidelines 2 are an updated version of the previous 2007 document. They are very relevant for several reasons, including: a) the significant increase in patients older than 75 years with severe valvular heart disease who may benefit from different therapeutic options; b) the development of diagnostic methods and a better understanding of the natural history of the disease; c) discrepancies Article history:
Journal of the American Society of Echocardiography, 1988
Journal of the American College of Cardiology, 2000
The goal of this study was to investigate the presence of myocardial cell damage in patients with... more The goal of this study was to investigate the presence of myocardial cell damage in patients with systemic hypertension and its relationship with left ventricular hypertrophy (LVH). BACKGROUND Although initially compensatory, LVH adversely affects myocellular integrity and contributes to congestive heart failure in hypertensive patients. Noninvasive detection of myocardial damage can be of value. METHODS We performed imaging studies with 111 In-labeled monoclonal antimyosin antibodies to identify myocardial damage in 39 patients with systemic hypertension and variable degrees of LVH. Three groups were considered: 16 asymptomatic patients with normal echocardiographic left ventricular mass (LVM) (group I); 14 asymptomatic patients with LVH (group II) and 9 patients with symptomatic hypertensive heart disease and advanced LVH (group III). The severity of myocardial damage was represented as heart-to-lung (target-tobackground) antibody uptake ratio (normal: Ͻ1.55). RESULTS Mean LVM index was 105 Ϯ 14 g/m 2 in group I, 124 Ϯ 24 in group II and 174 Ϯ 29 in group III. Heart-to-lung ratios of antimyosin uptake were: 1.45 Ϯ 0.14 in group I, 4 of the 16 (25%) patients showing an abnormal scan; 1.50 Ϯ 0.07 in group II with abnormal scans in 2 of the 14 (16%) patients and 1.77 Ϯ 0.16 (p Ͻ 0.001) in group III, all 9 patients presenting with abnormal antimyosin scans. On multivariate regression analysis LVM index was the main variable that independently correlated with the degree of myocardial uptake of antimyosin (r ϭ 0.815; p ϭ 0.001). CONCLUSIONS This study provides the first in vivo evidence of myocyte damage in patients with hypertension. The severity of myocardial damage can be related to the magnitude of LVH.
Journal of Human Hypertension, 2000
The insertion/deletion polymorphism (I/D) of the angiotensin-converting enzyme (ACE) gene has bee... more The insertion/deletion polymorphism (I/D) of the angiotensin-converting enzyme (ACE) gene has been associated in some studies with a higher prevalence of left ventricular hypertrophy (LVH), but few of them were performed on pharmacologically treated hypertensive patients. The present study was undertaken to determine whether ACE genotype determination could help in the identification of pharmacologically treated hypertensive patients at a higher risk of LVH. Ninety-six consecutive men with essential hypertension were selected for the study. Left ventricular mass (LVM) was assessed by echocardiography and indexed by body surface area and 82 patients were considered suitable for the study. Three groups of patients were defined on the basis of their I/D ACE genotype: DD (n ؍ 39), ID (n ؍ 33) and II (n ؍ 10). There were no statistically significant differences between the three groups regarding to the severity of
The American Journal of Cardiology, 1991
European heart journal, Jan 21, 2017
We aimed to determine whether treatment with sildenafil improves outcomes of patients with persis... more We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their compo...
Journal of cardiac surgery, Jan 9, 2017
Tricuspid valve replacement has been associated with high mortality and poor long-term outcomes. ... more Tricuspid valve replacement has been associated with high mortality and poor long-term outcomes. We report the preoperative risk factors associated with short and long-term outcomes following tricuspid valve replacement with mechanical prostheses. In 62 patients who underwent mechanical tricuspid valve replacement, clinical, laboratory, and echocardiographic findings were analyzed using both univariate and multivariate analyses to describe operative and long-term mortality. In our population (mean age 59 ± 9.7 years, 82.3% female), most common causes of tricuspid valve disease were rheumatic fever (69.4%) and functional regurgitation (19.4%). Operative and long-term mortality were 17.7 and 33.9%, respectively. Age, diabetes mellitus, and coronary artery disease were independently associated with increased long-term mortality. New York Heart Association (NYHA) class and right heart failure symptoms significantly improved during follow-up. In this series of mechanical tricuspid valve ...
Revista Espanola De Cardiologia, Feb 15, 2008
Clinical cardiology encompasses all forms of heart disease and their more general characteristics... more Clinical cardiology encompasses all forms of heart disease and their more general characteristics, and its sphere of activity includes practical aspects of prevention, diagnosis, and inpatient and outpatient treatment as applied to patients on an everyday basis. Since certain areas of cardiology have become highly specialized, this review of new developments reported in the past year has attempted to bring together all those advances that are not the subject of research in some particular specialization within cardiology and that have such a wide range of application that they should be familiar to all clinical cardiologists, irrespective of their daily responsibilities. For the purposes of this review, articles were classified according to their origin as either English-language, European, or domestic publications. The review concludes with a summary of registry data collected in the last two years by the Clinical and Outpatient Cardiology Section of the Spanish Society of Cardiology.
Medicina clínica, Jan 5, 2003
Handheld echocardiography may be a powerful diagnostic tool in the emergency room. However, its u... more Handheld echocardiography may be a powerful diagnostic tool in the emergency room. However, its usefulness in this environment when it is performed by medical personnel with a basic training in echocardiography remains to be clarified. A cardiologist with expertise in echocardiography and a cardiology fellow with basic training evaluated 33 patients admitted in emergency using a handheld device. The echocardiogram led to a change in the diagnosis and treatment in 27% and 46% of patients, respectively, allowing an early discharge in 49% of cases. The agreement between the two observers was acceptable. Portable echocardiography is a useful tool in emergency rooms and may be reliably performed by medical personnel with basic training in echocardiography.
Revista Española de Cardiología, 2000
Assessment of the Internal Mammary Artery Graft Patency: Usefulness of Echo-Enhancer Agents to Id... more Assessment of the Internal Mammary Artery Graft Patency: Usefulness of Echo-Enhancer Agents to Identify the Flow Signal by Color Doppler Echocardiography Objectives. a) To study the capacity of the technique of high-frequency color Doppler to detect flow signal of left internal mammary artery grafts; b) to assess the usefulness of an echo-enhancer agent to facilitate the detection of the signal, and c) to evaluate the patency of the graft according to its pulsed Doppler velocity profile pattern. Methods. 39 consecutive patients were studied. A Hewlett-Packard 5500 echocardiograph was used, with a high-frequency probe (S12) applied at the high left parasternal border. When a graft signal was not elicited after a predetermined 5-minute check period, an intravenous dose of 4 g of Levovist ® (Schering España) at 400 mg/ml was administrated. According to previous studies, a pulsed Doppler flow profile with a predominantly diastolic pattern was considered a normal graft patency, while a systolic one was deemed as abnormal. Results. Graft flow was identified by color Doppler in 33/39 patients (85%). The additional use of an echo-enhancer in 6 patients with no detected signal increased this proportion to 38/39 (97%). Normal flow patterns were seen in 34/38 (89%). Among the four patients with abnormal pattern, 1 case of early myocardial infarction was observed, while angiographic studies showed distal occlusion of the graft in 1 or the presence of competitive flow in 2 patients. Conclusions. The high-frequency color Doppler technique allows the detection of a flow signal from internal mammary artery grafts in most patients. The administration of an echo-enhancer agent is useful in those with non detectable signals. An abnormal pulsed Doppler velocity pattern indicates graft malfunction.
Revista española de cardiología (English ed.), 2012
In patients with heart failure, left ventricular ejection fraction ≤35% and sinus rhythm without ... more In patients with heart failure, left ventricular ejection fraction ≤35% and sinus rhythm without conditions such as atrial fibrillation, thrombus or history of thromboembolic events, the use of anticoagulation is controversial. Our objective was to evaluate the anticoagulation strategy in these patients, variables associated with its use, and its effects on various cardiovascular events. Of the patients included in the REDINSCOR registry with left ventricular ejection fraction ≤35% and sinus rhythm without other anticoagulation indications (including patients with heart failure from 19 Spanish centres), we compared those who received this treatment with the remaining patients. Between 2007 and 2010, 2263 patients were included, of whom 902 had left ventricular ejection fraction ≤35% and sinus rhythm. Of these, 237 (26%) were receiving anticoagulation therapy. Variables associated with this treatment were a lower left ventricular ejection fraction, ischemic etiology, advanced functio...
Revista Española de Cardiología, 2012
Introducción y objetivos: La mortalidad por cardiopatía isqué mica aguda se ha reducido, pero los... more Introducción y objetivos: La mortalidad por cardiopatía isqué mica aguda se ha reducido, pero los pacientes cró nicos persisten sintomá ticos en una proporció n importante. Se pretende conocer las características clínicas y la terapé utica del paciente con angina estable y el impacto de esta enfermedad en la calidad de vida. Me´todos: Estudio observacional, multicé ntrico y de corte transversal, sobre 2.039 pacientes con angina estable en control ambulatorio. Ademá s de variables clínicas, el investigador recogió su valoració n subjetiva sobre la gravedad de la angina y la limitació n causada por ella. Los pacientes contestaron sobre percepció n de gravedad y calidad de vida con cuestionarios específicos. Resultados: Se analizó a 2.024 pacientes. El 73% eran varones (media de edad, 68 AE 10 añ os). El 50,3% estaba asintomá tico (menos de una crisis de angina por semana en las ú ltimas 4 semanas), el 39,2% había tenido entre una y tres crisis por semana, y el 10,5% declaró má s de tres crisis por semana. El 66% había sido revascularizado, y de ellos el 59% volvía a tener angina. Los pacientes puntuaron la gravedad de la enfermedad má s que los mé dicos (4,5 AE 2,5 frente a 4,3 AE 2,3; p = 0,002). Las percepciones del mé dico y del paciente sobre la repercusió n de la angina tuvieron poca concordancia (índice kappa < 0,3), pues los pacientes consideraron que su enfermedad era má s grave, má s invalidante y con mayor disminució n de la calidad de vida. Conclusiones: Persiste una elevada proporció n de pacientes sintomá ticos y con reducció n de la calidad de vida. La percepció n del paciente sobre la enfermedad es peor que la del mé dico.
Revista Española de Cardiología, 2011
Revista española de cardiología, 2011
To analyze and discover if stress testing with exhaled gases in children who have had congenital ... more To analyze and discover if stress testing with exhaled gases in children who have had congenital heart surgery is useful so we could make physical exercise recommendations according to heart disease, type of surgery performed, present hemodynamic state and level of exercise practiced. Prospective study of 108 children, who performed stress testing with exhaled gases, electrocardiogram monitoring and blood pressure. A questionnaire was used to obtain variables concerning heart disease, surgery, present functional condition and level of exercise practiced. Exercise recommendations were given after stress testing, and after a year 35 patients answered a questionnaire. There were significant differences between lesion severity and heart rate at rest and during effort, systolic pressure at rest and during effort, oxygen uptake, oxygen pulse, carbon dioxide production and test duration. A relationship was observed between level of weekly exercise and greater oxygen uptake and test duratio...
Revista Española de Cardiología (English Edition), 2008
Heart failure is a prevalent condition that is associated with high morbidity and mortality and t... more Heart failure is a prevalent condition that is associated with high morbidity and mortality and that places a substantial demand on healthcare resources. As the condition often affects older individuals with comorbidities, its treatment requires the implementation of an integrated model of care that can be applied in primary care, in hospitals, and in the patient's home. The use of heart failure units has improved quality of life in these patients and has reduced hospital admissions. However, in Spain integrated care has not yet been widely implemented. Clinical and preclinical research on heart failure is complex and, consequently, it is essential for investigators to work together in research networks. As a result, 16 Spanish centers have organized themselves into a heart failure research network (REDINSCOR). This network is considering the establishment of a national heart failure registry and is involved in seven research projects, whose subjects range from molecular biology and cell physiology to diagnosis, treatment, and the development of integrated healthcare models.
Revista Española de Cardiología, 2001
La revascularizacion coronaria de la arteria descendente anterior con la arteria mamaria interna ... more La revascularizacion coronaria de la arteria descendente anterior con la arteria mamaria interna izquierda (AMI) es una tecnica de uso habitual. La situacion del injerto, adyacente a la pared toracica, permite su estudio mediante ecocardiografia Doppler transtoracica1,2. La imagen que presentamos corresponde a un varon de 55 anos, que manifesto disfuncion ventricular izquierda a las 48 h de haber sido intervenido de revascularizacion coronaria, precisando la colocacion del balon de contrapulsacion (BCP) para su estabilizacion hemodinamica. El aumento del flujo diastolico coronario es uno de los mecanismos de accion beneficiosa del BCP, junto con la reduccion de la poscarga3-5. Mediante un equipo de ecocardiografia Doppler (Hewlett-Packard Sonos 5500, Andover, Mass), equipado con una sonda de alta frecuencia (12 MHz), se obtuvo senal de flujo en el injerto de la AMI mediante Doppler pulsado (DP). En la figura 1 se presenta el registro simultaneo de la curva de presion en la arteria radial (P), el electrocardiograma (ECG) y la senal espectral DP, con el BCP sincronizado 3:1. El registro espectral de velocidades evidencia un claro predominio del flujo diastolico (d) sobre el sistolico (s), indicativo de la permeabilidad del injerto1. Con el inflado del BCP existe un aumento de la presion arterial (flecha) y un incremento del 35% de la integral de la curva de velocidades maximas en diastole, equivalente a la variacion del volumen sanguineo total a traves del injerto. Dicha informacion fue de utilidad para ajustar el inicio y la duracion del inflado del BCP con el fin de obtener el maximo flujo en el injerto coronario. BIBLIOGRAFIA
Cirugía Cardiovascular, 2013
(SECTCV) presenta su primer informe con el registro de la actividad de la cirugía reparadora de l... more (SECTCV) presenta su primer informe con el registro de la actividad de la cirugía reparadora de las válvulas mitral, aórtica y tricúspide realizadas en España los años 2009 a 2011. Métodos: Los datos se obtienen mediante participación voluntaria y fueron analizados para su publicación en las reuniones del grupo de trabajo celebradas en los meses de junio y octubre de 2012 en Sevilla, coincidiendo con los congresos nacionales de la SECTCV y la Sociedad Española de Cardiología. Se reportan datos comparativos de la cirugía valvular. Resultados: Se ofrecen datos de 33 centros que representan aproximadamente el 80% de la actividad quirúrgica del país. Se observa un incremento progresivo en el número de total de intervenciones valvulares y de reparaciones durante los 3 años, realizándose 8.878 (1.581 reparaciones), 9.530 (1.709) y 9.711(1.888) en 2009, 2010 y 2011, respectivamente. El porcentaje de cirugía de reparación/cirugía de recambio en 2011 fue del 3% para la válvula aórtica, del 33% para la válvula mitral y del 91% para la válvula tricúspide. Conclusiones: El primer Registro Nacional de Cirugía Reparadora Valvular representa la consolidación de actividades del grupo de trabajo. La elevada participación de centros hace fiables sus datos y nos permite por primera vez realizar una valoración del estado actual de la cirugía reparadora en el país. Estos datos sirven de referencia para compararse con los de otros países.
Revista Española de Cardiología, 2014
Revista Española de Cardiología (English Edition), 2014
Revista Española de Cardiología (English Edition), 2013
These guidelines 2 are an updated version of the previous 2007 document. They are very relevant f... more These guidelines 2 are an updated version of the previous 2007 document. They are very relevant for several reasons, including: a) the significant increase in patients older than 75 years with severe valvular heart disease who may benefit from different therapeutic options; b) the development of diagnostic methods and a better understanding of the natural history of the disease; c) discrepancies Article history:
Journal of the American Society of Echocardiography, 1988
Journal of the American College of Cardiology, 2000
The goal of this study was to investigate the presence of myocardial cell damage in patients with... more The goal of this study was to investigate the presence of myocardial cell damage in patients with systemic hypertension and its relationship with left ventricular hypertrophy (LVH). BACKGROUND Although initially compensatory, LVH adversely affects myocellular integrity and contributes to congestive heart failure in hypertensive patients. Noninvasive detection of myocardial damage can be of value. METHODS We performed imaging studies with 111 In-labeled monoclonal antimyosin antibodies to identify myocardial damage in 39 patients with systemic hypertension and variable degrees of LVH. Three groups were considered: 16 asymptomatic patients with normal echocardiographic left ventricular mass (LVM) (group I); 14 asymptomatic patients with LVH (group II) and 9 patients with symptomatic hypertensive heart disease and advanced LVH (group III). The severity of myocardial damage was represented as heart-to-lung (target-tobackground) antibody uptake ratio (normal: Ͻ1.55). RESULTS Mean LVM index was 105 Ϯ 14 g/m 2 in group I, 124 Ϯ 24 in group II and 174 Ϯ 29 in group III. Heart-to-lung ratios of antimyosin uptake were: 1.45 Ϯ 0.14 in group I, 4 of the 16 (25%) patients showing an abnormal scan; 1.50 Ϯ 0.07 in group II with abnormal scans in 2 of the 14 (16%) patients and 1.77 Ϯ 0.16 (p Ͻ 0.001) in group III, all 9 patients presenting with abnormal antimyosin scans. On multivariate regression analysis LVM index was the main variable that independently correlated with the degree of myocardial uptake of antimyosin (r ϭ 0.815; p ϭ 0.001). CONCLUSIONS This study provides the first in vivo evidence of myocyte damage in patients with hypertension. The severity of myocardial damage can be related to the magnitude of LVH.
Journal of Human Hypertension, 2000
The insertion/deletion polymorphism (I/D) of the angiotensin-converting enzyme (ACE) gene has bee... more The insertion/deletion polymorphism (I/D) of the angiotensin-converting enzyme (ACE) gene has been associated in some studies with a higher prevalence of left ventricular hypertrophy (LVH), but few of them were performed on pharmacologically treated hypertensive patients. The present study was undertaken to determine whether ACE genotype determination could help in the identification of pharmacologically treated hypertensive patients at a higher risk of LVH. Ninety-six consecutive men with essential hypertension were selected for the study. Left ventricular mass (LVM) was assessed by echocardiography and indexed by body surface area and 82 patients were considered suitable for the study. Three groups of patients were defined on the basis of their I/D ACE genotype: DD (n ؍ 39), ID (n ؍ 33) and II (n ؍ 10). There were no statistically significant differences between the three groups regarding to the severity of
The American Journal of Cardiology, 1991