46 results on '"Margarida, Pujol-López"'
Search Results
2. Left Bundle Branch Block
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Roderick Tung, Lluís Mont, Gaurav A. Upadhyay, José María Tolosana, and Margarida Pujol-López
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medicine.medical_specialty ,business.industry ,Left bundle branch block ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Cardiomyopathy ,medicine.disease ,Patient diagnosis ,Physiology (medical) ,Heart failure ,Internal medicine ,Left bundle branch ,medicine ,Cardiology ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Conduction disease - Abstract
Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis. Recruiting the left bundle branch with conduction system pacing depends on the complex interaction between anatomy, site of pathophysiology, and delivery tools.
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- 2021
3. Cardiac Resynchronization Therapy Response Is Equalized in Men and Women by Electrical Optimization
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Emilce Trucco, José María Tolosana, Roger Borràs, Francisco Alarcón, Rodolfo San Antonio, Ivo Roca-Luque, Elena Arbelo, Eduard Guasch, Rafael Jiménez-Arjona, María Ángeles Castel, Niraj Varma, Paz Garre, Marta Sitges, Margarida Pujol-López, Ada Doltra, and Lluís Mont
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Degree (temperature) ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,PR interval ,business - Abstract
Objectives This study hypothesized that the shorter intrinsic PR interval observed in women allows a greater degree of fusion with intrinsic conduction, achieving a shorter QRS interval du...
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- 2021
4. Conduction system pacing potential alternative for biventricular pacing in heart failure
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Margarida Pujol-López and Robert van den Heuvel
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- 2022
5. Septal flash correction with His-Purkinje pacing predicts echocardiographic response in resynchronization therapy
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Margarida Pujol‐López, Rafael Jiménez Arjona, Eduard Guasch, Adelina Doltra, Roger Borràs, Ivo Roca Luque, María Ángeles Castel, Paz Garre, Elisenda Ferró, Mireia Niebla, Esther Carro, Elena Arbelo, Marta Sitges, José M. Tolosana, and Lluís Mont
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Heart Failure ,Heart Ventricles ,Cardiac Pacing, Artificial ,Stroke Volume ,General Medicine ,Ventricular Function, Left ,Cardiac Resynchronization Therapy ,Ventricular Dysfunction, Left ,Treatment Outcome ,Echocardiography ,Physiology (medical) ,Humans ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Grant of the Catalan Society of Cardiology, 2019; Research Grant Josep Font 2019, Hospital Clínic de Barcelona His-Purkinje conduction system pacing (HPCSP) has been proposed as an alternative to cardiac resynchronization therapy (CRT); however, no predictors of echocardiographic response have been described. Septal flash (SF) is a marker of intraventricular dyssynchrony. Methods The study aimed to analyze whether HPCSP corrects SF in patients with CRT indication, and if correction of SF predicts echocardiographic response. Prospective observational study (n=30). Left ventricular ejection fraction (LVEF) was measured with echocardiography at baseline and at 6-month follow-up. Echocardiographic response was defined as increase in 5 points LVEF. ECG Imaging was performed in 2 patients to validate ventricular activation shortening and to study the basal and HPCSP activation pattern. Results HPCSP shortened QRS duration by 48±21ms and SF was significantly decreased (baseline 3.6±2.2mm vs HPCSP 1.5±1.5mm p1.5mm had 81% sensitivity and 80% specificity to predict echocardiographic response (area under curve 0.86, p=0.019). Conclusion HPCSP improves intraventricular dyssynchrony and results in 64% echocardiographic responders at 6-month follow-up. Dyssynchrony improvement with SF correction may predict echocardiographic response at 6-month follow-up (Fig.2.).
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- 2022
6. Pulsed Doppler A-wave as an aid in patient selection for atrioventricular synchrony through a leadless ventricular pacemaker
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Margarida Pujol-López, Cora Garcia-Ribas, Adelina Doltra, Eduard Guasch, Sara Vazquez-Calvo, Mireia Niebla, Rebeca Domingo, Ivo Roca-Luque, José M. Tolosana, and Lluís Mont
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
7. Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing?
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Juan Betuel Ivey-Miranda, Pedro L. Cepas-Guillén, M. Farrero, Margarida Pujol-López, Félix Pérez-Villa, Marta Sitges, Rut Andrea, Asunción Moreno, María Ángeles Castel, Eduardo Flores-Umanzor, Andrea Fernandez-Valledor, Ana Isabel Garcia, and Guillen Caldentey
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Male ,medicine.medical_specialty ,Posaconazole ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Aspergil·losi ,Population ,Neutropenia ,Heart transplantation ,Transplante cardíaco ,Postoperative Complications ,Risk Factors ,Amphotericin B ,Internal medicine ,Trasplantament cardíac ,medicine ,Humans ,Aspergillosis ,education ,Aged ,Retrospective Studies ,General Environmental Science ,Voriconazole ,Invasive Pulmonary Aspergillosis ,education.field_of_study ,medicine.diagnostic_test ,Immunosupressió ,business.industry ,Aspergillus fumigatus ,Dilated cardiomyopathy ,Middle Aged ,medicine.disease ,Transplant Recipients ,Transplantation ,Survival Rate ,Aspergilose pulmonar invasiva ,Aspergillus ,Bronchoalveolar lavage ,Spain ,lcsh:RC666-701 ,Heart Transplantation ,General Earth and Planetary Sciences ,business ,Complication ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Immunosuppression ,Imunossupressão ,medicine.drug ,Follow-Up Studies - Abstract
Introduction: Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). Objectives: To establish the characteristics of IPA infection in HT recipients and their outcomes in our center. Methods: Among 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. Results: All cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. Conclusions: IPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival. Resumo: Introdução: A infeção continua a ser uma complicação major nos recipientes para transplante cardíaco (TC), causando cerca de 20% de mortes no primeiro ano após o transplante. Nestes doentes, o Aspergillus species pode levar a várias apresentações clínicas incluindo a aspergilose pulmonar invasiva (API), com uma mortalidade elevada (53% a 78%). Objetivos: Estabelecer as características da infeção por API nos recipientes para TC e os respetivos resultados no nosso serviço. Métodos: Dos 328 transplantes cardíacos realizados no nosso centro entre 1998 e 2016, identificámos cinco casos de API. Foram examinados os registos dos doentes e foram identificadas variáveis clínicas. Resultados: Em todos os casos os doentes eram do sexo masculino com idade média de 62 anos. A indicação mais comum para TC foi a miocardiopatia não isquémica dilatada. O principal sintoma foi tosse produtiva. A avaliação radiológica baseou-se na radiografia e na TAC torácicas. A alteração radiológica mais comum foi a densidade nodular múltipla em ambas as técnicas. A broncoscopia foi realizada em todos os doentes e o Aspergillus fumigatus foi isolado em quatro casos de cultura BAL. O tratamento incluiu anfotericina em quatro doentes com alteração subsequente para voriconazol em três doentes e posaconazol num doente, tendo o tratamento durado uma média de 12 meses. A neutropenia foi encontrada num doente apenas, a insuficiência renal foi observada em dois doentes e a infeção por CMV ocorreu em três doentes. Todos os doentes sobreviveram após seguimento de 18 meses. Conclusão: A API representa uma complicação potencialmente mortal após o TC. Um diagnóstico precoce e a iniciação de um tratamento rapidamente agressivo constituem a pedra angular para uma melhor sobrevivência. Keywords: Heart transplantation, Invasive pulmonary aspergillosis, Immunosuppression, Palavras-chave: Transplante cardíaco, Aspergilose pulmonar invasiva, Imunossupressão
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- 2021
8. Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block
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Margarida Pujol‐López, Rafael Jiménez Arjona, Eduard Guasch, Roger Borràs, Adelina Doltra, Sara Vázquez‐Calvo, Ivo Roca‐Luque, Paz Garre, Elisenda Ferró, Mireia Niebla, Esther Carro, Jose L. Puente, Laura Uribe, Eric Invers, Maria Ángeles Castel, Elena Arbelo, Marta Sitges, Lluís Mont, and José M. Tolosana
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Cardiac Resynchronization Therapy ,Heart Failure ,Bundle of His ,Treatment Outcome ,Cardiac Conduction System Disease ,Cardiac Pacing, Artificial ,Ventricular Dysfunction ,Humans ,Stroke Volume ,General Medicine ,Cardiology and Cardiovascular Medicine ,Atrioventricular Block ,Ventricular Function, Left - Abstract
It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT.Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up.HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02).HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
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- 2022
9. Left Bundle Branch Pacing
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Eduard Guasch, Lluís Mont, Rafael Jiménez-Arjona, Rodolfo San Antonio, José María Tolosana, and Margarida Pujol-López
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0301 basic medicine ,medicine.medical_specialty ,Case Report: Clinical Case Series ,medicine.medical_treatment ,Cardiac resynchronization therapy ,cardiac resynchronization therapy ,030105 genetics & heredity ,Cardiac pacemaker ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Left bundle branch ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Mini-Focus Issue: Electrophysiology ,Left bundle branch block ,business.industry ,systolic heart failure ,medicine.disease ,Bundle ,RC666-701 ,Cardiology ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,cardiac pacemaker - Abstract
His bundle pacing was developed while seeking a physiological alternative to biventricular cardiac resynchronization therapy. However, His bundle pacing may not be adequate in all patients. In this scenario, left bundle branch pacing has arisen as a new cardiac resynchronization therapy modality to correct left bundle branch block and restore ventricular synchrony. (Level of Difficulty: Intermediate.), Graphical abstract
- Published
- 2020
10. Very high pacing thresholds during long‐term follow‐up predicted by a combination of implant pacing threshold and impedance in leadless transcatheter pacemakers
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José María Tolosana, Eduard Guasch, Margarida Pujol-López, Jose Apolo, Rodolfo San Antonio, Ivo Roca-Luque, Emilce Trucco, Lluís Mont, Fredy Chipa-Ccasani, and Josep Brugada
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Adult ,Male ,Pacemaker, Artificial ,Time Factors ,Long term follow up ,030204 cardiovascular system & hematology ,Pacemaker system ,Young Adult ,03 medical and health sciences ,Electric Power Supplies ,0302 clinical medicine ,Physiology (medical) ,Electric Impedance ,Humans ,Electrical performance ,Medicine ,In patient ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,Cardiac Pacing, Artificial ,Area under the curve ,Arrhythmias, Cardiac ,Sequential combination ,Equipment Design ,Middle Aged ,Predictive value ,Treatment Outcome ,Female ,Implant ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Background Micra transcatheter pacemaker system (TPS) usually achieves low implant pacing threshold (IPT). However, IPT may increase in some patients during follow-up. Aim To apply implant parameters in predicting long-term occurrence of very high pacing threshold (VHPT) in patients with Micra-TPS. Methods A cohort of 110 consecutive patients implanted with a Micra-TPS from 2014 to 2018 was evaluated at discharge and at 1, 12, 24, 36, and 48 months follow-up. VHPT was defined as greater than 2 V/0.24 ms. VHPT predictors were identified. Results Micra-TPS was implanted successfully in 108 patients (98.2%). During a mean follow-up of 24 ± 16 months, 18 patients (16.7%) died of causes nonpacemaker-related, and 4 (3.8%) developed VHPT. Patients with VHPT had higher IPT and lower implant impedance than patients with non-VHPT: 1 ± 0.31 vs 0.55 ± 0.29 V/0.24 ms (P = .003) and 580 ± 59 vs 837 ± 232 Ω (P = .03), respectively. IPT and impedance had excellent discriminative power to predict VHPT (area under the curve: 0.85 ± 0.07 and 0.91 ± 0.05, respectively). Negative predictive value (NPV) of IPT ≤ 0.5 V/0.24 ms was 100%; positive predictive value (PPV) was 8% throughout follow-up. Implant impedance ≤ 600 Ω had NPV of 99% throughout follow-up, whereas PPV varied: 16%, 21%, 16%, and 28% at 1, 12, 24, and 36 months, respectively. Sequential combination of IPT greater than 0.5 V/0.24 ms and impedance ≤ 600 Ω improved PPV to 25%, 35%, 27%, and 44%, respectively, whereas NPV remained 99% throughout follow-up. Conclusion Despite favorable long-term electrical performance of Micra-TPS, a small percent of patients developed VHPT during follow-up. A sequential combination of IPT and impedance could allow the implanter to identify patients who will develop VHPT during long-term follow-up.
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- 2020
11. Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology
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Margarida, Pujol-López, José M, Tolosana, Gaurav A, Upadhyay, Lluís, Mont, and Roderick, Tung
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Cardiac Resynchronization Therapy ,Heart Failure ,Electrocardiography ,Heart Conduction System ,Bundle-Branch Block ,Humans - Abstract
Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis. Recruiting the left bundle branch with conduction system pacing depends on the complex interaction between anatomy, site of pathophysiology, and delivery tools.
- Published
- 2021
12. Leadless pacemakers in critically ill patients requiring prolonged cardiac pacing: A multicenter international study
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Christian Veltmann, Sylvain Ploux, Philippe Ritter, Clemens Steinwender, Raphaël P. Martins, José María Tolosana, Vincent Galand, Eloi Marijon, Edouard Simeon, Margarida Pujol-López, Romain Eschalier, Johanna Mueller-Leisse, Roxane Coelho, Hermann Blessberger, Dominique Babuty, Nicolas Clementy, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hannover Medical School [Hannover] (MHH), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), University of Barcelona, CHU Pontchaillou [Rennes], CHU Pessac, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Kepler University Hospital, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Jonchère, Laurent
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Pacemaker, Artificial ,leadless ,Critical Illness ,[SDV]Life Sciences [q-bio] ,Population ,030204 cardiovascular system & hematology ,Intracardiac injection ,temporary pacing ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Physiology (medical) ,Intensive care ,Medicine ,Humans ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,intensive care ,education.field_of_study ,business.industry ,Mortality rate ,Cardiac Pacing, Artificial ,Arrhythmias, Cardiac ,Equipment Design ,medicine.disease ,Intensive care unit ,pacemaker ,3. Good health ,Transvenous pacing ,[SDV] Life Sciences [q-bio] ,Treatment Outcome ,Bacteremia ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Background Temporary transvenous pacing in critically ill patients requiring prolonged cardiac pacing is associated with a high risk of complications. We sought to evaluate the safety and efficacy of self-contained intracardiac leadless pacemaker (LPM) implantation in this population. Methods and results Consecutive patients implanted with a Micra LPM during the hospitalization in an intensive care unit were retrospectively included. Inclusion criteria were: ≥1 supracaval central venous, or a ventilation tube, or intravenous antibiotic therapy for ongoing sepsis or bacteremia. Patients with a history of previous implantation of a pacemaker were excluded. Out of 1,016 patients implanted with an LPM, 99 met the inclusion criteria. Mean age was 75 years and Charlson comorbidity index 7. LPM implantation was successfully performed in 98% of cases, with a peri-operative complication rate of 5%, mainly cardiac injuries. In-hospital mortality rate was 6%. No late (>30 days) device-related complication occurred, especially no infection. Conclusions LPM appears as an acceptable alternative to conventional temporary transvenous pacing in selected critically ill patients requiring prolonged cardiac pacing, especially regarding the risk of infection. This article is protected by copyright. All rights reserved.
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- 2021
13. A rare cause of non-infectious sialadenitis: Iodide-induced sialadenitis associated with coronary angiography
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Pedro L. Cepas, Mónica Masotti, Margarida Pujol-López, M. Farrero, Xavier Freixa, Rosario J. Perea, Victoria Martin-Yuste, Guillem Caldentey, Eduardo Flores-Umanzor, and Matias Scuarcia
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chemistry.chemical_classification ,Coronary angiography ,medicine.medical_specialty ,business.industry ,Iodide ,Contrast Media ,Iodides ,medicine.disease ,Coronary Angiography ,Sialadenitis ,Text mining ,chemistry ,RC666-701 ,Diseases of the circulatory (Cardiovascular) system ,General Earth and Planetary Sciences ,Medicine ,Humans ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Non infectious ,General Environmental Science - Published
- 2021
14. Comorbidity and low use of new antiplatelets in acute coronary syndrome
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Margarida Pujol-López, Isabel Hernández, David Viñas, Pablo Loma-Osorio, Javier Cantalapiedra, Carlos Tomás, José C. Sánchez-Salado, Albert Ariza-Solé, Jordi Sans-Roselló, Cosme García, M. Pérez-Rodriguez, Gil Bonet, Jaime Aboal, Santiago Montero, Teresa Oliveras Vilà, Rut Andrea, Isaac Llaó, and Antonia Sambola
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Male ,Ticagrelor ,Aging ,medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,Population ,CHARLSON Comorbidity Index ,Comorbidity ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Intensive care ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,education ,Aged ,Aspirin ,education.field_of_study ,business.industry ,medicine.disease ,Clopidogrel ,Treatment Outcome ,Female ,Geriatrics and Gerontology ,business ,Prasugrel Hydrochloride ,Non-ST elevation acute coronary syndromes ,Platelet Aggregation Inhibitors ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Introduction Despite the use of the new generation P2Y12 inhibitors (Ticagrelor and Prasugrel) with aspirin is the recommended therapy in acute NSTE-ACS patients, their current use in clinical practice remains quite low and might be related, among several variables, with increased comorbidity burden. We aimed to assess the prevalence of these treatments and whether their use could be associated with comorbidity. Method A multicentric prospective registry was conducted at 8 Cardiac Intensive Care Units (October 2017-April 2018) in patients admitted with non ST elevation myocardial infarction. Antithrombotic treatment was recorded and the comorbidity risk was assessed using the Charlson Comorbidity Index. We created a multivariate model to identify the independent predictors of the use of new inhibitors of P2Y12. Results A total of 629 patients were included, median age 67 years, 23.2% women, 359 patients (57.1%) treated with clopidogrel and 40.6% with new P2Y12 inhibitors: ticagrelor (228 patients, 36.2%) and prasugrel (30 patients, 4.8%). Among the patients with very high comorbidity (Charlson Score > 6) clopidogrel was the drug of choice (82.6%), meanwhile in patients with low comorbility (Charlson Score 0-1) was the ticagrelor or prasugrel (63.6%). Independent predictors of the use of ticagrelor or prasugrel were a low Charlson Comorbidity Index, a low CRUSADE score and the absence of prior bleeding. Conclusion Antiplatelet treatment with Ticagrelor or Pasugrel was low in patients admitted with NSTE-ACS. Comorbidity calculated with Charlson Comorbidity Index was a powerful predictor of the use of new generation P2Y12 inhibitors in this population.
- Published
- 2019
15. Failure-free survival of the Riata implantable cardioverter-defibrillator lead after a very long-term follow-up
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Jose Apolo, Rodolfo San Antonio, H Fernandez, Margarida Pujol-López, Omar Trotta, Josep Brugada, Lluís Mont, Elena Arbelo, Roger Borràs, José María Tolosana, Mireia Niebla, Eduard Guasch, Fredy Chipa-Ccasani, Emilce Trucco, and Ivo Roca-Luque
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Long term follow up ,medicine.medical_treatment ,Icd lead ,Electrical Failure ,030204 cardiovascular system & hematology ,Electrical failure ,Cable externalization ,Implantable cardioverter-defibrillator ,03 medical and health sciences ,0302 clinical medicine ,Productes defectuosos ,Defects in manufactures ,Physiology (medical) ,Internal medicine ,Desfibril·ladors cardioversors implantables ,Lead failure ,Medicine ,030212 general & internal medicine ,Lead (electronics) ,Long-term follow-up ,Implantable cardioverter-defibrillators ,business.industry ,Malfunction ,Incidence (epidemiology) ,3. Good health ,Failure free survival ,Lead ,lcsh:RC666-701 ,Cardiology ,Original Article ,Plom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims: Riata® implantable cardioverter-defibrillator (ICD) leads from St. Jude Medical are prone to malfunction. This study aimed to describe the rate of this lead's malfunction in a very long-term follow-up. Methods: This single-centre observational study included 50 patients who received a Riata 7Fr dual-coil lead between 2003 and 2008. Follow-up was conducted both in person and remotely, and analysed at 8-month intervals. We evaluated the rates of cable externalization (CE), electrical failure (EF), and the interaction of these two complications. Structural lead failure was defined as radiographic CE. Oversensing of non-cardiac signal or sudden changes in impedance, sensing, or pacing thresholds constituted EF. Results: During a mean follow-up of 10.2 ± 2.9 years, 16 patients (32%) died. We observed lead malfunction in 13 patients (26%): three (23%) due to CE, six (46%) to EF and four (31%) to both complications. Of the malfunctioning leads, 77% failed after seven years of follow-up. The incidence rate (IR) of overall malfunction per 100 patients per year was 0.9 during the first seven years post-implantation, increased to 7.0 after the 7th year and more than doubled (to 16.7) after 10 years. Beyond seven years post-implantation, IR per 100 patient-years increased in both EF and CE (from 0.6 to 5.6 vs. 0.3 to 4.2, respectively). Presence of CE was associated with a 4-fold increase in the proportion of EF. Conclusion: The incidence of Riata ICD lead malfunction, both for EF and CE, increased dramatically after seven years and then more than doubled after 10 years post-implantation. Keywords: Implantable cardioverter-defibrillator, Long-term follow-up, Malfunction, Cable externalization, Electrical failure
- Published
- 2019
16. Optimized single-point left ventricular pacing leads to improved resynchronization compared with multipoint pacing
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Alejandro Liberos, Eduard Guasch, Felipe Atienza, Paz Garre, Andreu M. Climent, Francisco Alarcón, Rodolfo San Antonio, Marta Sitges, Lluís Mont, Omar Trotta, Maria S. Guillem, Margarida Pujol-López, Ivo Roca-Luque, Josep Brugada, Roger Borràs, Francisco Fernández-Avilés, José María Tolosana, Levio Quinto, Adelina Doltra, Elena Arbelo, Rafael Jiménez-Arjona, and Ana Gonzalez-Ascaso
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Multipoint pacing ,Cardiac Resynchronization Therapy ,TECNOLOGIA ELECTRONICA ,Electrocardiography ,Ventricular Dysfunction, Left ,03 medical and health sciences ,QRS complex ,Electric Power Supplies ,0302 clinical medicine ,Fusion ,Internal medicine ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Reverse remodeling ,Aged ,business.industry ,Electrocardiographic imaging ,General Medicine ,Middle Aged ,Ventricular pacing ,3. Good health ,medicine.anatomical_structure ,Battery longevity ,Optimized intervals ,Echocardiography ,Ventricle ,Cardiology ,Female ,Single point ,Cardiology and Cardiovascular Medicine ,business - Abstract
[EN] Background Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results The SPP-FOI method achieved greater QRS shortening than MPP (-56 +/- 16 vs. -42 +/- 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: -58 +/- 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 +/- 2.3 vs. 6.3 +/- 2.0 years, p = .03). Conclusions SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP., Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares, Grant/Award Number: CB16/11/00354; Instituto de Salud Carlos III, Grant/Award Numbers: DTS16/0160, PI16/00435, PI16/00703, PI17/01059, PI17/01106; Sociedad Espanola de Cardiologia, Grant/Award Numbers: 2018, SEC_ESTIM_01; Agencia deGestio d'Ajuts Universitaris i de Recerca, Grant/AwardNumber: 2017_SGR_1548; Fundacio laMarato de TV3, Grant/Award Number: 20152730; Horizon 2020 Framework Programme, Grant/Award Number: 633196 - CATCH MEproject; European Regional Development Fund, Grant/Award Number: EITHealth 19600 AFFINE
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- 2021
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17. Cardiac Resynchronization Therapy Response Is Equalized in Men and Women by Electrical Optimization: PR Matters
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Margarida, Pujol-López, José María, Tolosana, Eduard, Guasch, Emilce, Trucco, Rafael, Jiménez-Arjona, Roger, Borràs, Paz, Garre, Rodolfo, San Antonio, Ada, Doltra, Ivo, Roca-Luque, Elena, Arbelo, Francisco, Alarcón, María Ángeles, Castel, Marta, Sitges, Niraj, Varma, and Lluís, Mont
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Cardiac Resynchronization Therapy ,Heart Failure ,Male ,Heart Rate ,Humans ,Female ,Cardiac Resynchronization Therapy Devices ,Retrospective Studies - Abstract
This study hypothesized that the shorter intrinsic PR interval observed in women allows a greater degree of fusion with intrinsic conduction, achieving a shorter QRS interval duration and, thus, a better response.Women benefit more from cardiac resynchronization therapy (CRT) than men. However, the reason for this difference remains elusive.A cohort of 180 patients included in the BEST (Fusion based optimization in resynchronization therapy [ECG Optimization of CRT: Evaluation of Mid-Term Response]; NCT01439529) study were retrospectively analyzed. Patients were initially randomized to either nonoptimized CRT (NON-OPT group; n = 89) or electrocardiographically optimized CRT based on the fusion-optimized intervals (FOI) method (FOI group; n = 91). Echocardiographic response was defined as a15% decrease in left ventricular end-systolic volume at the 12-month follow-up.The basal PR interval was shorter in women as compared to men. In the NON-OPT group, CRT resulted in a shorter paced QRS interval in women than in men (134 ± 21 ms vs. 151 ± 21 ms, respectively; p = 0.003, 95% confidence interval [CI]: -27 to -5.6) and better response in women than in men: 70.4% vs. 46.4%, respectively (odds ratio: 0.37; p = 0.04; 95% CI: 0.14 to 0.97). There were no differences in paced QRS interval duration (126 ± 13 ms vs. 129 ± 17 ms; p = 0.47) or response between women and men in the FOI group (68% vs. 70.5%; odds ratio: 1.12; p = 0.82; 95% CI: 0.41 to 3.07). FOI extended the atrioventricular interval to obtain the best fusion; the atrioventricular intervals tended to require greater extension in men than in women (22 ± 33 ms vs. 8 ± 28 ms, respectively; p = 0.07).Women had a shorter PR interval, which was associated with a shorter QRS interval and better response to CRT. The difference in QRS interval duration and response between men and women did not persist when CRT was optimized using fusion with intrinsic conduction (FOI programming).
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- 2020
18. Single-Point Left Ventricular Pacing Optimized by ECG Results in Better Resynchronization than Multipoint Pacing
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Maria S. Guillem, Felipe Atienza, Francisco Alarcón, Rodolfo San Antonio, Marta Sitges, Alejandro Liberos, Luis Mont Girbau, Eduard Guasch, Omar Trotta, Ana Gonzalez-Ascaso, Roger Borràs, Rafael Jiménez-Arjona, Paz Garre, Andreu M. Climent, Margarida Pujol-López, Adelina Doltra, Ivo Roca-Luque, José María Tolosana, Josep Brugada, Elena Arbelo, Francisco Fernández-Avilés, and Levio Quinto
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Ventricular pacing ,QRS complex ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Electrocardiographic imaging ,medicine ,Cardiology ,cardiovascular diseases ,Single point ,Reverse remodeling ,business - Abstract
Background: Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods: This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results: The SPP-FOI method achieved greater QRS shortening than MPP (-56±16 vs. -42±17 ms, P
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- 2020
19. 45Improving the optimization of cardiac resynchronization therapy: Does multipoint left ventricular pacing shorten the paced-QRS duration compared to the fusion-optimized intervals method?
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Levio Quinto, Adelina Doltra, Rafael Jiménez-Arjona, Omar Trotta, F Alarcon, R San Antonio, M Sanchez, Paz Garre, José María Tolosana, Ivo Roca-Luque, Eduard Guasch, J. Brugada, Luis Mont, Margarida Pujol-López, and Elena Arbelo
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medicine.medical_specialty ,QRS complex ,business.industry ,Physiology (medical) ,medicine.medical_treatment ,Internal medicine ,Cardiac resynchronization therapy ,medicine ,Cardiology ,Ventricular pacing ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements Cardiac Pacing Scholarship from the Spanish Society of Cardiology (SEC) Background Electrocardiogram-based optimization of cardiac resynchronization therapy (CRT) using the fusion-optimized intervals (FOI) method has demonstrated to improve both acute hemodynamic response and left ventricle (LV) reverse remodeling compared to nominal programming of CRT. FOI optimizes the atrioventricular (AV) and ventriculo-ventricular (VV) intervals to achieve the shortest paced-QRS duration. The recent development of multipoint pacing (MPP) enables the activation of the LV from 2 locations, also shortening the QRS duration compared to conventional biventricular pacing. Purpose To determine if MPP reduces the paced-QRS duration compared to FOI optimization. Methods This prospective clinical study included 25 consecutive patients who successfully received a CRT with MPP pacing capability. All patients were in sinus rhythm and had an PR interval below 250 ms. The QRS duration was measured with a 12-lead digital electrocardiography (screen speed of 200 mm/s) at baseline and using 3 different configurations: MPP, FOI and a combined FOI-MPP strategy. In MPP, the intervals were (based on previous studies): 1) AV 130 ms, 2) Right ventricular (RV)-LV2 (Δ1) 5 ms, and 3) LV1-LV2 (Δ2) 5 ms. In FOI, AV and VV intervals were optimized to achieve fusion between intrinsic conduction and biventricular pacing. In FOI-MPP, the Δ2 was set at 5 ms, while AV and Δ1 intervals were optimized using the FOI method. The CRT device was programmed with the configuration that achieved a greater paced-QRS shortening. After 45 days, battery life was estimated. Results Mean age was 65 ± 10 years, 20 were men (80%) and baseline QRS duration was 177 ± 17 ms. The FOI method bested nominal MPP (QRS shortened by 58 ± 16 ms vs 43 ± 16 ms, respectively, p = 0.002). Adding MPP to the narrowest QRS by FOI did not result in further shortening (FOI: 58 ± 16 ms vs FOI-MPP: 59 ± 13 ms, p = 0.81). The final configuration was FOI method alone in most cases (n = 16, 64%) and FOI-MPP in all others (n = 9, 36%; figure). In total, 10 out of 25 patients (40%) were not candidates to MPP due to: 1) pacing thresholds exceeding 3.5 V/0.4 ms at the distal or proximal electrode (8, 32%), and 2) phrenic stimulation (2, 8%). Estimated battery longevity was longer in patients receiving FOI as compared to MPP (8.3 ± 2.1 years vs. 6.2 ± 2.2 years, p = 0.04). Conclusion In CRT, the FOI method is not improved by coupling with MPP. Up to 40% of patients are not candidates for MPP due to high thresholds or phrenic stimulation. The use of MPP in unselected patients would result in a decrease of battery longevity, without any additional benefit over FOI. Abstract Figure.
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- 2020
20. P1163Correction of septal flash excursion with his bundle pacing
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Marta Sitges, José María Tolosana, Omar Trotta, Margarida Pujol-López, Eduard Guasch, F Alarcon, Elena Arbelo, Paz Garre, Levio Quinto, Luis Mont, Adelina Doltra, R Jimenez Arjona, R San Antonio, and Ivo Roca-Luque
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medicine.medical_specialty ,business.industry ,Left bundle branch block ,Two dimensional echocardiography ,Excursion ,medicine.disease ,Atrioventricular node ,Bundle of His ,Flash (photography) ,medicine.anatomical_structure ,Physiology (medical) ,Internal medicine ,Bundle ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block - Abstract
Funding Acknowledgements Grant from the Catalan Society of Cardiology Background His bundle pacing (HBP) directly stimulates the conduction system and could therefore correct asynchrony and evolve as a more physiological pacing approach. Septal flash (SF) is a fast contraction and relaxation of the septum occurring during the isovolumetric contraction period. It is a specific marker of cardiac dyssynchrony. Purpose Evaluate whether HBP corrects SF in patients with an indication for CRT or RV pacing. Methods A cohort of 20 consecutive patients undergoing HBP at our center was analyzed. HBP indications were: Group A (n = 3): left bundle branch block (LBBB) and left ventricular (LV) dysfunction (LV ejection fraction [LVEF] Patients in groups B and C had a RV backup lead implanted, in line with current recommendations. The presence of SF was analyzed in 2D-echocardiography at 15 days post-implant. SF excursion was quantified using M-mode in parasternal short and long axis views as the highest amplitude of the early inward motion. Baseline SF excursion was determined during intrinsic rhythm (group A) or RV pacing (groups B and C). For each patient, the pair of measurements (baseline, HBP) in the axis with the highest baseline SF was selected. Results Mean LVEFs were 21 ± 8%, 32 ± 6%, and 41 ± 18% for groups A, B and C, respectively. HBP shortened QRS duration by 42 ± 15 ms and 45 ± 23 ms in groups A (Baseline QRS - HBP QRS) and B + C (RV pacing QRS - HBP QRS), respectively. At baseline, all patients except 1 had SF (Fig. 1A). The mean SF excursion was 4.3 ± 1.9 mm, with SF excursion being larger in group A than in the RV-paced groups (6.3 ± 1.5 mm vs. 3.9 ± 1.8 mm for groups A and B + C, respectively, p = 0.04). HBP abolished SF in 3 patients (15%) and, on average, decreased SF excursion by 2.3 mm (95% CI 1.3-3.2), irrespective of pacing indication (Fig. 1B). The degree of SF excursion reduction after HBP significantly correlated with QRS shortening (r = 0.53, p = 0.024) (Fig 1C). Conclusions In conclusion, we show that HBP results in acute correction or decrease of SF, thereby improving LBBB- or RV-induced mechanical dyssynchrony. Abstract Figure. Septal Flash and His pacing
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- 2020
21. Brugada syndrome, Brugada phenocopy, or simply arrythmia induced by cocaine intoxication?
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Pedro L, Cepas-Guillén, Margarida, Pujol-López, Rodolfo, San Antonio, Elena, Arbelo, Emilio, Salgado, and Josep, Brugada
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Electrocardiography ,Cocaine ,Humans ,Arrhythmias, Cardiac ,Brugada Syndrome - Published
- 2020
22. Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon-expandable and self-expanding valves
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Ander Regueiro, Gerard Roura, Rafael Romaguera, Angel Cequier, Victoria Martin-Yuste, Manel Sabaté, Margarida Pujol-López, José L. Ferreiro-Gutiérrez, Marco Hernández-Enríquez, Montserrat Gracida, Rut Andrea, Xavier Freixa, Salvatore Brugaletta, Josep Gómez-Lara, and Joan Antoni Gómez-Hospital
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Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,030204 cardiovascular system & hematology ,Prosthesis Design ,Risk Assessment ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Hospital Mortality ,030212 general & internal medicine ,Major complication ,reproductive and urinary physiology ,Aged ,Retrospective Studies ,Aged, 80 and over ,Platelet Count ,business.industry ,Mortality rate ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Thrombocytopenia ,Treatment Outcome ,Balloon expandable stent ,Increased risk ,Spain ,Heart Valve Prosthesis ,embryonic structures ,Cardiology ,Population study ,Female ,Cardiology and Cardiovascular Medicine ,business ,Major bleeding - Abstract
Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to higher mortality and major complications. No comparison between balloon-expandable (BEV) and self-expanding valves (SEV) regarding drop platelet count (DPC) has been reported to date. The objectives of this study were to analyze the differences in DPC between BEVs or SEVs and their prognostic implications in clinical outcomes.We retrospectively analyzed patients undergoing TAVI. Platelet counts after TAVI were collected. Two groups were created: DPC ≤ 30% and DPC 30%. VARC-2 criteria were used to define outcomes.Study population was composed of 195 patients (age 77.5 ± 6.7, 57.4% males). All of them but one experienced DPC (mean DPC 31.9 ± 15.3%). DPC was significantly higher among the patients treated with BEV compared to those treated with SEV (36.3 ± 15.1% vs 27.7 ± 14.4, P 0.001). After multivariate analysis, the use of BEV was independently associated with a higher rate of DPC 30% (67.4% vs 36.0%; OR 3.4; 95% CI, 1.42-8.16). At 30 days, the DPC 30% was associated with a higher rate of life-threatening/major bleeding, major vascular complications, in-hospital sepsis and mortality. At one year, there were no statistically significant differences in the mortality rate between groups (6.35% vs 10.0%, HR 1.54; 95% CI, 0.56-4.25).In this study, the use of BEV was associated with a higher risk of DPC after TAVI. A DPC rate 30% was associated with an increased risk of major complications at 30 days.
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- 2018
23. miRNA Update: A Review Focus on Clinical Implications of miRNA in Vascular Remodeling
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Manel Sabaté, Manel Garabito, Salvatore Brugaletta, Margarida Pujol-López, Ana Paula Dantas, and Luis Ortega-Paz
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Pathology ,medicine.medical_specialty ,vascular remodeling ,Biology ,01 natural sciences ,03 medical and health sciences ,restenosis ,0302 clinical medicine ,Restenosis ,Smooth muscle ,microRNA ,Gene expression ,medicine ,0101 mathematics ,Cell phenotype ,Messenger RNA ,lcsh:R5-920 ,Cell growth ,010102 general mathematics ,percutaneous coronary intervention ,MicroRNA ,General Medicine ,medicine.disease ,re-endothelialization ,030220 oncology & carcinogenesis ,Cancer research ,lcsh:Medicine (General) ,Function (biology) - Abstract
MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression at the post-transcriptional level. Through specific base pairing with their targets messenger RNAs (mRNA), miRNA can modify cell phenotype and function. Several miRNAs are aberrantly expressed in diseased arteries and may influence different features of vascular remodeling, including neointimal formation and diminished re-endothelialization. This review will discuss the clinical implications of miRNAs in the field of vascular remodeling and their potential role as diagnostic and therapeutic tools. miRNA modulation offers a promising strategy for therapeutic intervention to inhibit smooth muscle cell proliferation and enhance endothelial regeneration after percutaneous coronary intervention (PCI) in order to reduce restenosis and late thrombosis.
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- 2017
24. Programming Pacemakers to Reduce and Terminate Atrial Fibrillation
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Margarida Pujol-López, José María Tolosana, Lluís Mont, and Rodolfo San Antonio
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Pacemaker, Artificial ,Reduced risk ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,Bradycardia ,medicine ,Humans ,In patient ,Heart Atria ,cardiovascular diseases ,030212 general & internal medicine ,PR interval ,business.industry ,Cardiac Pacing, Artificial ,Atrial fibrillation ,Ventricular pacing ,medicine.disease ,Treatment Outcome ,Therapy, Computer-Assisted ,cardiovascular system ,Antitachycardia Pacing ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
The goal of this paper is to review present knowledge regarding preventive and antitachycardia pacing algorithms, aimed to reduce atrial fibrillation (AF) burden in patients when pacing is indicated. Reactive antitachycardia pacing (ATP), the new generation of ATP, is significantly associated with a reduced risk of AF. In patients with indication for pacing and history of AF, pacemakers endowed with atrial preventive pacing and atrial ATP combined with managed ventricular pacing proved superior to standard dual-chamber pacing. Managed ventricular pacing is an algorithm that minimizes unnecessary right ventricular pacing. Progression to persistent AF is prevented by ventricular pacing minimization in patients with normal PR interval. The synergistic effect of pacemakers that combine atrial preventive pacing with reactive ATP and with algorithms that minimize ventricular pacing can reduce AF incidence and decrease the combined endpoint of permanent AF, hospital admissions, and mortality.
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- 2019
25. Abstract 600: Anti-Angiogenic Effects of Circulating Exosomes From Patients With Acute Coronary Syndrome: Potential Role of miR-199a and miR-125a
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Luis Ortega-Paz, Ana Paula Dantas, Iolanda Lazaro, Manel Sabaté, Salvatore Brugaletta, Ahmed Amin, Joaquim Bobi, and Margarida Pujol-López
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Acute coronary syndrome ,Physiology ,business.industry ,Anti angiogenic ,medicine.disease ,Microvesicles ,Human health ,microRNA ,Cancer research ,Biomarker (medicine) ,Medicine ,Mir 199a ,Cardiology and Cardiovascular Medicine ,business ,Mir 125a - Abstract
Circulating exosomes have a great impact in human health as a biomarker or as messengers in intercellular signaling. In this study we aimed to determine how miRNA profile in circulating exosomes interfere with angiogenic phenotype of endothelial cell (EC) during acute event of coronary syndrome. Exosomes were purified from serum of patients with non-ST segment elevation myocardial infarction in the acute phase (NSTEMI, n=34) during percutaneous coronary intervention. Healthy donors (n=23) were included as control. Purified exosomes were quantified and characterized by nanoparticle tracking analysis (Nanosight). Healthy EC (HUVEC) were treated for 48h with labeled exosomes (5x10 5 particles/1x10 6 cells) and tested for their angiogenic potential (migration and tube formation) and mRNA expression. Exosome miRNA profile was determined by miRNA array. Exosomes levels were markedly increased in NSTEMI (1.3x10 9 particle/ml) vs control (7.5x10 8 particle/ml; p=0.02). HUVEC treatment with healthy exosomes improve migration and tube formation compared to untreated HUVEC. Nevertheless, exosomes from NSTEMI patients, in the acute phase lack their pro-angiogenic potential (Fig A). Network analysis of exosome miRNA and HUVEC mRNA expression revealed a correlation of increased miR-199a and miR-125a expression with decrease of components involved in EC sprout and stabilization (Fig B). Circulating exosomes have an important role in the control of angiogenesis. However, in the acute phase of NSTEMI intercellular communication via exosome is modified and exert an inhibitory effect on angiogenesis. These results could contribute to the progression and outcomes of the disease.
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- 2019
26. Management of anticoagulation in patients undergoing leadless pacemaker implantation
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Lluís Mont, Mireia Niebla, Markus Linhart, José María Tolosana, Francisco Alarcón, Josep Brugada, Rodolfo San Antonio, Omar Trotta, Fredy Chipa-Ccasani, Emilce Trucco, Margarida Pujol-López, Elena Arbelo, Eduard Guasch, Ivo Roca-Luque, and Jose Apolo
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Male ,medicine.medical_specialty ,Pacemaker, Artificial ,Medication Therapy Management ,Hemorrhage ,030204 cardiovascular system & hematology ,Pacemaker implantation ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Thromboembolism ,Atrial Fibrillation ,Catheterization, Peripheral ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Dosing ,Vein ,Blood Coagulation ,business.industry ,Incidence (epidemiology) ,Anticoagulants ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,medicine.anatomical_structure ,Outcome and Process Assessment, Health Care ,Female ,Risk Adjustment ,Tamponade ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The Micra transcatheter pacing system (Micra TPS) is often implanted in patients with atrial fibrillation and thus with increased thromboembolic risk. It is unknown whether the use of anticoagulants, associated with the use of a large venous introducer, implies an increased risk of bleeding in this group of patients. Objective The purpose of this study was to assess the incidence of bleeding and thromboembolic complications after Micra TPS implantation with and without therapeutic anticoagulation. Methods This single-center observational study included 107 consecutive patients receiving the Micra TPS from 2014 to 2018. At procedure completion, a figure-of-eight suture was placed at the femoral puncture site after sheath withdrawal and was maintained for 24 hours. In patients receiving enoxaparin or new oral anticoagulants, treatment was discontinued 12 or 24 hours before the procedure, respectively, and was reinitiated 4–6 hours postprocedure. In those receiving vitamin K antagonists (VKAs), dosing was not discontinued and the procedure was performed if the international normalized ratio was less than 3. Results Sixty-four patients (60%) did not receive anticoagulants. Of the 43 (40%) who did, 29 (67%) received VKAs, 8 (19%) received new oral anticoagulants, and 6 (14%) received enoxaparin. Two patients presented hemorrhagic or thromboembolic complications during short-term follow-up: 1 woman receiving VKAs presented hemorrhagic pericardial effusion without tamponade and 1 woman not receiving anticoagulants presented thrombosis of the ipsilateral saphenous vein. Conclusion Bleeding and thromboembolic complications after receiving Micra TPSs are infrequent. The use of anticoagulant therapy, regardless of the type, does not increase the complications associated with the procedure.
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- 2019
27. Severe Cardiac Complications of Shabu Use: An Emerging Drug in Europe
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Xavier Bosch, Margarida Pujol-López, Mercè Roqué, and Luis Ortega-Paz
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Adult ,Male ,Drug ,Pediatrics ,medicine.medical_specialty ,Heart Diseases ,Philippines ,media_common.quotation_subject ,030204 cardiovascular system & hematology ,Methamphetamine ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,Survival rate ,media_common ,Cardiotoxicity ,business.industry ,Incidence ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,Survival Rate ,Central Nervous System Stimulants ,Female ,business ,medicine.drug - Published
- 2017
28. Complicaciones cardiacas graves por shabu: una droga emergente en Europa
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Luis Ortega-Paz, Mercè Roqué, Xavier Bosch, and Margarida Pujol-López
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2017
29. Electrocardiographic optimization techniques in resynchronization therapy
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Rodolfo San Antonio, Elena Arbelo, Eduard Guasch, José María Tolosana, Jagmeet P. Singh, Edwin Kevin Heist, Margarida Pujol-López, Lluís Mont, and Emilce Trucco
- Subjects
medicine.medical_specialty ,Haemodynamic response ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,Cardiac Resynchronization Therapy ,QRS complex ,Electrocardiography ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Treatment Failure ,Intracardiac Electrogram ,Heart Failure ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Stroke Volume ,medicine.disease ,Treatment Outcome ,Echocardiography ,Heart failure ,cardiovascular system ,Cardiology ,Implant ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,Algorithms ,circulatory and respiratory physiology - Abstract
Cardiac resynchronization therapy (CRT) is a cornerstone of therapy for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a wide QRS complex. However, not all patients respond to CRT: 30% of CRT implanted patients are currently considered clinical non-responders and up to 40% do not achieve LV reverse remodelling. In order to achieve the best CRT response, appropriate patient selection, device implantation, and programming are important factors. Optimization of CRT pacing intervals may improve results, increasing the number of responders, and the magnitude of the response. Echocardiography is considered the reference method for atrioventricular and interventricular (VV) intervals optimization but it is time-consuming, complex and it has a large interobserver and intraobserver variability. Previous studies have linked QRS shortening to clinical response, echocardiographic improvement and favourable prognosis. In this review, we describe the electrocardiographic optimization methods available: 12-lead electrocardiogram; fusion-optimized intervals (FOI); intracardiac electrogram-based algorithms; and electrocardiographic imaging. Fusion-optimized intervals is an electrocardiographic method of optimizing CRT based on QRS duration that combines fusion with intrinsic conduction. The FOI method is feasible and fast, further reduces QRS duration, can be performed during implant, improves acute haemodynamic response, and achieves greater LV remodelling compared with nominal programming of CRT.
- Published
- 2018
30. The plus and pure left bundle branch pacing
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Lluís Mont, José María Tolosana, and Margarida Pujol-López
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Bundle of His ,business.industry ,Bundle-Branch Block ,Cardiac Pacing, Artificial ,Ventricular Septum ,Anatomy ,Bundle branches ,Electrocardiography ,Text mining ,Physiology (medical) ,Left bundle branch ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
31. Subcutaneous implantable cardioverter-defibrillator infection affecting deep tissues: is it always mandatory to remove the device?
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Rodolfo San Antonio, Lluís Mont, José María Tolosana, Margarida Pujol-López, and Eduard Guasch
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Treatment outcome ,MEDLINE ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Death, Sudden, Cardiac ,Treatment Outcome ,Physiology (medical) ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Device Removal - Published
- 2020
32. Percutaneous coronary intervention due to chronic total occlusion in the left main coronary artery after bypass grafting: A feasible option in selected cases
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Victoria Martin-Yuste, Marco Hernández, Guillem Caldentey, Manel Sabaté, Margarida Pujol-López, Gustavo Jiménez-Brítez, Rodolfo San Antonio, Sara Vazquez, Eduardo Flores-Umanzor, and Pedro L. Cepas-Guillén
- Subjects
Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_treatment ,Ischemia ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,Asymptomatic ,Angina ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Coronary Artery Bypass ,General Environmental Science ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Coronary Vessels ,Cardiac surgery ,surgical procedures, operative ,lcsh:RC666-701 ,Conventional PCI ,Cardiology ,General Earth and Planetary Sciences ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is an infrequent finding. Revascularization is recommended in the presence of demonstrated viability or ischemia. Coronary artery bypass grafting (CABG) has long been considered the preferred option. Patients with previous CABG due to LMCA disease with occlusion of one graft and progression of the LMCA to CTO constitute a special population, as just one ischemic artery remains. For these patients, there is no other option for revascularization other than cardiac surgery (requiring resternotomy) or percutaneous coronary intervention (PCI) of the LMCA. Methods and Results: Out of 620 patients with CTO diagnosed in our center, we identified five with previous CABG due to LMCA disease for a retrospective case series. They had occlusion of one graft and progression of the LMCA to CTO. All five underwent PCI. Each patient received a functional classification for angina, myocardial ischemic tests, and a follow-up coronary angiogram during a median follow-up of 63 months. Coronary angiogram showed CTO of the semi-protected LMCA lesions with two CABGs previously performed in all patients, one occluded and the other patent. Three patients had occluded saphenous vein grafts to the circumflex coronary artery, and the rest had left internal mammary artery-left anterior descending artery CABG failure. Ischemia and viability were demonstrated. Surgery was ruled out due to high surgical risk. PCI due to CTO of the LMCA with drug-eluting stents was performed. In a five-year follow-up period, four patients remained asymptomatic and event free. One post-PCI death occurred from non-cardiovascular cause. Conclusions: PCI due to CTO of the LMCA following CABG can be successful and safe and can provide sustained clinical improvements in selected cases. Resumo: Introdução: A oclusão crónica total (OCT) do tronco comum (TC) coronário é um achado pouco frequente. A revascularização é recomendada na presença de viabilidade ou de isquemia comprovada. A coronary artery bypass grafting (CABG) tem sido durante muito tempo a opção preferencial. Os doentes com CABG prévia devida a doença do TC com oclusão de um enxerto e progressão para oclusão crónica total do tronco comum constituem uma população especial, uma vez que fica apenas uma artéria com isquemia. Para esses doentes não existe outra opção de revascularização além da cirurgia cardíaca – com necessidade de reesternotomia – ou a intervenção coronária percutânea do tronco comum. Métodos e resultados: Dos 620 doentes com oclusões coronárias totais diagnosticadas no nosso centro, identificamos como séries de casos retrospetivos, cinco com CABG prévia devida a doença do TC, que tinham uma oclusão de um enxerto e progressão da doença do TC para oclusão crónica total. Os cinco foram submetidos a intervenção coornária percutânea (ICP). Cada doente recebeu a classificação funcional de angina, de testes de isquemia do miocárdio e o seguimento com angiografía coronária durante o tempo médio de 63 meses de seguimento. O angiograma coronário mostrou oclusão coronária total das lesões semiprotegidas do TC com duas pontagens previamente feitas em todos os doentes, uma ocluída e a outra permeável. Três doentes tinham enxertos de veia safena para a artéria coronária circunflexa (Safena-CX) ocluídos e os restantes tinham insuficiência da pontagem com mamária interna esquerda para a artéria coronária descendente anterior (MIE-DA). Foi demonstrada isquemia ou viabilidade. A opção cirúrgica foi recusada devido ao elevado risco cirúrgico. Foi feita a ICP da oclusão coronária total do TC com stents revestidos de fármaco. Em cinco anos de seguimento, quatro doentes permaneceram assintomáticos e livres de eventos. Ocorreu uma morte após ICP devido a causa não cardiovascular. Conclusões: A ICP de oclusão crónica total do TC após CABG pode ser bem-sucedida, segura, e pode fornecer melhorias clínicas mantidas em casos selecionados. Keywords: Chronic total occlusion, Left main coronary artery, Coronary artery bypass grafting, Palavras-chave: Oclusão crónica total, Tronco comum coronário, Cirurgia coronária
- Published
- 2018
33. What is This Image? 2018: Image 2 Result : Early infective endocarditis with aorto-left atrial fistula: Unmasking the underlying disease with positron emission tomography
- Author
-
F. Lomeña, Barbara Vidal, E. Quintana, Margarida Pujol-López, Eduardo Flores-Umanzor, R San Antonio, and Xavier Bosch
- Subjects
medicine.medical_specialty ,Fistula ,Heart Diseases ,Aortic Diseases ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Heart Atria ,Vascular Fistula ,medicine.diagnostic_test ,Endocarditis ,business.industry ,Middle Aged ,medicine.disease ,Underlying disease ,Positron emission tomography ,Infective endocarditis ,Positron-Emission Tomography ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Published
- 2018
34. Syncope: Arrhythmic onset of a metastasis
- Author
-
Sara Vazquez, Bárbara Carbonell, Margarida Pujol-López, Rodolfo San Antonio, Rosario J. Perea, and Rut Andrea
- Subjects
Tachycardia ,medicine.medical_specialty ,biology ,business.industry ,Syncope (genus) ,MEDLINE ,General Medicine ,biology.organism_classification ,medicine.disease ,Metastasis ,Text mining ,Internal medicine ,Cardiology ,medicine ,medicine.symptom ,business - Published
- 2019
35. Cardiac Magnetic Resonance as an Alternative to Endomyocardial Biopsy to Predict Recoverability of Left Ventricular Function in Methamphetamine- Associated Cardiomyopathy
- Author
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Rosario J. Perea, Luis Ortega-Paz, Xavier Bosch, Margarida Pujol-López, and Eduardo Flores-Umanzor
- Subjects
medicine.medical_specialty ,Ventricular function ,medicine.diagnostic_test ,business.industry ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Methamphetamine ,medicine.disease ,030218 nuclear medicine & medical imaging ,Endomyocardial biopsy ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,Internal medicine ,Biopsy ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,Cardiac magnetic resonance ,business ,Medical therapy ,medicine.drug - Abstract
We read with interest the article published by Schurer et al. [(1)][1] in which they evaluated the relationship between the prognosis of methamphetamine-associated cardiomyopathy (MACM) and methamphetamine (MA) consumption. They suggest that the cessation of MA abuse together with medical therapy
- Published
- 2017
36. Central extracorporeal membrane oxygenation as a bridge to decision in a patient with a ventricular septal rupture complicating a myocardial infarction
- Author
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M. Farrero, Rut Andrea, Margarida Pujol-López, Victoria Martin, and Eduardo Flores-Umanzor
- Subjects
Heart transplantation ,Surgical repair ,medicine.medical_specialty ,business.industry ,Cardiogenic shock ,medicine.medical_treatment ,Percutaneous coronary intervention ,Diffuse alveolar hemorrhage ,030204 cardiovascular system & hematology ,medicine.disease ,Ventricular Septal Rupture ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,RC666-701 ,medicine ,Extracorporeal membrane oxygenation ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
In the era of primary percutaneous coronary intervention, mechanical complications after acute myocardial infarction are extremely rare, with an incidence of less than 0.5%. Rupture of the ventricular septum is the least frequent occurrence. Despite early surgical repair, mortality still remains high. Patients who are at high risk of perioperative death include those with cardiogenic shock and multiorgan dysfunction. In this group, a mechanical circulatory support such as an Extracorporeal Membrane Oxygenation circuit could be used as bridge to surgical repair is feasible or heart transplantation, as it provides hemodynamic stability and the potential to correct multiorgan dysfunction. We reported a case pf ECMO device implantation as a bridge to heart transplantation in a patient with post infarction ventricular septal rupture. Unfortunately, while on the waiting list for heart transplantation with maximum priority the patient had massive diffuse alveolar hemorrhage secondary to the anticoagulation required by the equipment and died. Resumen: En la era de la intervención coronaria percutánea primaria, las complicaciones mecánicas tras un infarto de miocardio agudo son extremadamente infrecuentes, con una incidencia de menos del 0,5%. La ruptura del septum ventricular es el caso menos frecuente. A pesar de la reparación quirúrgica, la mortalidad sigue siendo elevada. Los pacientes con alto riesgo de muerte perioperativa incluyen a aquellos con shock cardiógeno y síndrome de disfunción multiorgánica. En este grupo, podría utilizarse soporte circulatorio mecánico, tal como el circuito de oxigenación por membrana extracorpórea, como puente hacia la reparación quirúrgica o trasplante cardiaco, ya que aporta estabilidad dinámica y la posibilidad de corregir el síndrome de disfunción multiorgánica. Se reporta un caso de implantación de dispositivo de membrana extracorpórea, como puente al trasplante cardiaco, en un paciente con ruptura del septum ventricular tras infarto. Lamentablemente, a pesar de estar en lista de espera con prioridad máxima, sufrió una hemorragia alveolar difusa masiva, secundaria a la anticoagulación requerida por el equipo, y falleció. Keywords: Ventricular septal rupture, Extracorporeal membrane oxygenation circuit, Acute myocardial infarction, Palabras clave: Ruptura del septum ventricular, Circuito de oxigenación por membrana extracorpórea, Infarto de miocardio agudo
- Published
- 2018
37. Myocardial injury in a Shabu user: late gadolinium multiphocal enhancement
- Author
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Luis Ortega-Paz, Rosario J. Perea, Xavier Bosch, and Margarida Pujol-López
- Subjects
Adult ,Male ,medicine.diagnostic_test ,business.industry ,Illicit Drugs ,Gadolinium ,chemistry.chemical_element ,Contrast Media ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,Methamphetamine ,Myocarditis ,chemistry ,Medicine ,Humans ,business ,Nuclear medicine - Published
- 2016
38. Eosinophilic granulomatosis with polyangitis (Churg-Strauss) and severe pericardial effusion
- Author
-
Sergio Prieto-González, Susanna Prat-Gonzalez, José Hernández-Rodríguez, and Margarida Pujol-López
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Churg-Strauss Syndrome ,Middle Aged ,medicine.disease ,Pericardial effusion ,Magnetic Resonance Imaging ,Pericardial Effusion ,Radiography ,Echocardiography ,Eosinophilic ,Medicine ,Humans ,Female ,business ,Churg strauss - Published
- 2016
39. A rare cause of severe mitral stenosis and reversible pulmonary hypertension
- Author
-
Eduard Guasch, Manel Azqueta, Margarida Pujol-López, Rodolfo San Antonio, and Eduardo Flores-Umanzor
- Subjects
Male ,medicine.medical_specialty ,Delayed Diagnosis ,Hypertension, Pulmonary ,Physical examination ,030204 cardiovascular system & hematology ,Diagnosis, Differential ,Heart Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Mitral Valve Stenosis ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Myxoma ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Stenosis ,Echocardiography ,cardiovascular system ,Etiology ,Cardiology ,Left Atrial Myxoma ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Myxoma is a rare cause of severe mitral stenosis. We describe a challenging case of severe mitral stenosis and reversible pulmonary hypertension produced by a giant left atrial myxoma. The greatest risk is a diagnostic delay due to focus on discarding a pulmonary etiology of dyspnea. Physical examination and early echocardiographic assessment are the keys to avoid overlooking this uncommon pathology.
- Published
- 2017
40. ST-segment elevation mimicking myocardial infarction after hydrochloric acid ingestion: Acute caustic myocarditis
- Author
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Rosario J. Perea, Manel Sabaté, Rodolfo San Antonio, and Margarida Pujol López
- Subjects
Male ,medicine.medical_specialty ,Myocarditis ,Hydrochloric acid ,030204 cardiovascular system & hematology ,Coronary Angiography ,Diagnosis, Differential ,Electrocardiography ,Stomach Rupture ,03 medical and health sciences ,chemistry.chemical_compound ,Fatal Outcome ,0302 clinical medicine ,Predictive Value of Tests ,Pneumoperitoneum ,Internal medicine ,medicine ,Humans ,Pericardium ,ST segment ,Ingestion ,Upper gastrointestinal ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,Aged ,business.industry ,030208 emergency & critical care medicine ,equipment and supplies ,medicine.disease ,Suicide ,medicine.anatomical_structure ,chemistry ,cardiovascular system ,Cardiology ,ST Elevation Myocardial Infarction ,Hydrochloric Acid ,Caustic (optics) ,Cardiology and Cardiovascular Medicine ,business - Abstract
ST-segment elevation after hydrochloric acid ingestion has barely been described in the literature, without identification of its causal mechanism. We hypothesize that acute caustic myocarditis, by direct contact between necrotic upper gastrointestinal tract and pericardium may induce the ECG findings.
- Published
- 2017
41. Therapeutic hypothermia after out-of-hospital cardiac arrest - Should we keep platelets in mind?
- Author
-
Rodolfo San Antonio, Eduardo Flores-Umanzor, Margarida Pujol-López, and Guillem Caldentey
- Subjects
medicine.medical_specialty ,business.industry ,Context (language use) ,Disease ,cardiac arrest ,Hypothermia ,medicine.disease ,Thrombosis ,Out of hospital cardiac arrest ,antiplatelet therapy ,Antithrombotic treatment ,Internal medicine ,RC666-701 ,Cardiology ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Platelet ,medicine.symptom ,business ,Ischemic heart ,hypothermia ,thrombosis - Abstract
Therapeutic hypothermia has been associated with an increase in thrombotic events, but this point has not been fully clarified. Most patients undergoing therapeutic hypothermia in a cardiac ICU receive antithrombotic treatment, usually in the context of ischemic heart disease. But, what should we do if our patient does not need antithrombotic treatment for any reason? After this case, doubts arise on the need to use an anti-thrombotic treatment on all patients subjected to therapeutic hypothermia in the context of aborted cardiac arrest
- Published
- 2017
42. THROMBOCYTOPENIA AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A COMPARISON BETWEEN BALLOON-EXPANDABLE AND SELF-EXPANDING PROSTHESIS
- Author
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Marco Hernández-Enríquez, Rafael Romaguera, Angel Cequier, Margarida Pujol-López, Ander Regueiro, Manel Sabaté, Joan Antoni Gómez-Hospital, and Rut Andrea
- Subjects
medicine.medical_specialty ,Balloon expandable stent ,Transcatheter aortic ,Valve replacement ,Clinical events ,business.industry ,hemic and lymphatic diseases ,medicine.medical_treatment ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Prosthesis ,Surgery - Abstract
Thrombocytopenia after transcatheter aortic valve replacement (TAVR) is frequent and has been associated with clinical events. There are only limited data concerning differences in thrombocytopenia after implantation of balloon-expandable (BEV) and self-expanding (SEV) valves. The aim of the study
- Published
- 2018
43. An unusual cause of thoracic pain: Cardiac perforation associated with a pacemaker
- Author
-
Margarida Pujol-López, Eduardo Flores-Umanzor, Rodolfo San Antonio, and Rosario J. Perea
- Subjects
medicine.medical_specialty ,business.industry ,Anesthesia ,Cardiac Perforation ,Medicine ,business ,Surgery - Published
- 2017
44. Un caso inusual de dolor torácico: perforación cardiaca asociada a marcapasos
- Author
-
Rodolfo San Antonio, Eduardo Flores-Umanzor, Rosario J. Perea, and Margarida Pujol-López
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,General Medicine ,business - Published
- 2017
45. Granulomatosis eosinofílica con poliangitis (Churg-Strauss) y derrame pericárdico grave
- Author
-
José Hernández-Rodríguez, Sergio Prieto-González, Susanna Prat-Gonzalez, and Margarida Pujol-López
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,General Medicine ,business ,Dermatology - Published
- 2017
46. Lesión miocárdica en consumidor de shabú: patrón multifocal de realce tardío de gadolinio
- Author
-
Margarida Pujol-López, Rosario J. Perea, Luis Ortega-Paz, and Xavier Bosch
- Subjects
business.industry ,Medicine ,General Medicine ,Nuclear medicine ,business - Published
- 2016
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