Artículos de revista (CUN)
Permanent URI for this collectionhttps://hdl.handle.net/10171/70263
See
121 results
Filtering
Settings
Results
- Postoperative management and nursing care after implantation of a total artificial heart: Scoping review(Elsevier, 2024) Fernández, E. (Elena); Romero, C. (C.); Bengoechea, L. (L.); Jimeno-San-Martin, L. (Leticia); Goñi-Viguria, R. (Rosana); Rabago, G. (Gregorio); Mendiluce, N. (N.); Regaira-Martínez, E. (Elena)Introduction: End-stage heart failure (HF) is a condition whose only successful long-term treatment, with a survival of more than 10 years, is heart transplantation. However, limited organ availability and the progressive increase in the number of patients with advanced HF have served as an impetus for the development of implantable mechanical assistive devices. Aim: To provide an overview of postoperative management and nursing care after the implementation of a Total Artificial Heart (TAH). Methods: A scoping review was carried out by consulting the PUBMED, CINAHL, and COCHRANE databases. From all the documents located, information was extracted on the date of publication, country of publication, type of study, and results of interest to answer the research question. In addition, the degree of recommendation was identified. Results: Twenty-three documents were included in the scoping review. Results were classified in relation to: 1) description of the CAT SynCardia®; 2) nursing care in the immediate postoperative period (management of the device and management of hematological, infectious, nephrological, nutritional complications, related to immobilization, sleep-rest disturbances, psychological disorders, and patient and family education); and 3) follow-up at home. Conclusions: The complexity of implantation of the TAH, the multiple related complications that can arise during this process, both in the immediate post-operative and late, require a standardised and multidisciplinary management. The absence of standardised protocols raises the need for future studies to measure the effectiveness of care in patients with TAH. A multidisciplinary approach is crucial. Nurses must acquire autonomy and involvement in decision-making and develop competencies to address the patient's and family's physiological and psychosocial needs.
- Effect of the Mediterranean diet in cardiovascular prevention(Elsevier, 2024) Martinez-Gonzalez, M.A. (Miguel Ángel); Hernandez-Hernandez, A. (Aitor)The Mediterranean diet is the best evidence-based model for cardiovascular prevention. In addition to 2 major randomized secondary prevention trials (Lyon Heart and CORDIOPREV) and 1 primary prevention trial (PREDIMED) that have demonstrated these benefits, there is an unprecedented body of high-quality prospective epidemiological evidence supporting these beneficial effects. The key elements of this traditional pattern are the abundant use of extra-virgin olive oil and high consumption of foods of natural plant-based origin (fruits, vegetables, nuts, and legumes) and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, with meals is an essential element of this traditional pattern. Although removing wine consumption from the Mediterranean diet has been associated with a reduction in its preventive efficacy, doubts have recently arisen about the possible adverse effect of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, will randomize 10 000 drinkers aged 50 to 75 years to abstention or moderate consumption. UNATI aims to answer these doubts with the best possible evidence.
- Presence of Activated (Phosphorylated) STAT3 in Radiation Necrosis Following Stereotactic Radiosurgery for Brain Metastases(MDPI, 2023) Serrano, D. (Diego); Aristu-Mendioroz, J.J. (José Javier); Jablonska, P.A. (Paola Anna); Leon, S. (Sergio); Calvo-Alonso, A. (Alfonso); Barranco, J. (Jennifer); Echeveste, J.I. (José I.); Galán, N. (Nuria)Brain radiation necrosis (RN) is a subacute or late adverse event following radiotherapy, involving an exacerbated inflammatory response of the brain tissue. The risk of symptomatic RN associated with stereotactic radiosurgery (SRS) as part of the treatment of brain metastases (BMs) has been a subject of recent investigation. The activation of the signal transducer and activator of transcription 3 (STAT3) was shown in reactive astrocytes (RA) associated with BMs. Given that the pathophysiological mechanisms behind RN are not fully understood, we sought to investigate the role of STAT3 among other inflammatory markers in RN development. A mouse model of RN using clinical LINAC-based SRS was designed to induce brain necrosis with the administration of 50 Gy in a single fraction to the left hemisphere using a circular collimator of 5 mm diameter. Immunohis- tochemistry and multiplex staining for CD4, CD8, CD68, GFAP, and STAT3 were performed. For validation, eleven patients with BMs treated with SRS who developed symptomatic RN and required surgery were identified to perform staining for CD68, GFAP, and STAT3. In the mouse model, the RN and perinecrotic areas showed significantly higher staining for F4/80+ and GFAP+ cells, with a high infiltration of CD4 and CD8 T-lymphocytes, when compared to the non-irradiated cerebral hemisphere. A high number of GFAP+pSTAT3+ and F4/80+pSTAT3+ cells was found in the RN areas and the rest of the irradiated hemisphere. The analysis of human brain specimens showed that astrocytes and microglia were actively phosphorylating STAT3 in the areas of RN and gliosis. Phosphorylated STAT3 is highly expressed in the microglia and RA pertaining to the areas of brain RN. Targeting STAT3 via inhibition represents a promising strategy to ameliorate symptomatic RN in BM patients undergoing SRS.
- A Fibrosis Biomarker Early Predicts Cardiotoxicity Due to Anthracycline-Based Breast Cancer Chemotherapy(MDPI, 2022) Díaz, A. (Agnes); Sepúlveda, P. (Pilar); Lupón, J. (Josep); Gavira, J.J. (Juan José); Ravassa, S. (Susana); Lopez-Picazo, J.M. (José M.); Santisteban, M. (Marta); Gonzalez, A. (Arantxa); Hernándiz, A. (Amparo); Mazo, M. (Manuel); Rabago, G. (Gregorio); Aramendia, J.M. (J.M.); Fuente, A. (Ana) de la; Garcia-Bolao, I. (Ignacio); Cediel, G. (Germán); López, B. (Begoña); Diez, J. (Javier); Santaballa, A. (Ana); Bayes-Genis, A. (Antoni)Anthracycline-based cancer chemotherapy (ACC) causes myocardial fibrosis, a lesion contributing to left ventricular dysfunction (LVD). We investigated whether the procollagen-derived type-I C-terminal-propeptide (PICP): (1) associates with subclinical LVD (sLVD) at 3-months after ACC (3m-post-ACC); (2) predicts cardiotoxicity 1-year after ACC (12m-post-ACC) in breast cancer patients (BC-patients); and (3) associates with LVD in ACC-induced heart failure patients (ACC-HF-patients). Echocardiography, serum PICP and biomarkers of cardiomyocyte damage were assessed in two independent cohorts of BC-patients: CUN (n = 87) at baseline, post-ACC, and 3m and 12m (n = 65)-post-ACC; and HULAFE (n = 70) at baseline, 3m and 12m-post-ACC. Thirty-seven ACC-HF-patients were also studied. Global longitudinal strain (GLS)-based sLVD (3m-post-ACC) and LV ejection fraction (LVEF)-based cardiotoxicity (12m-post-ACC) were defined according to guidelines. BC-patients: all biomarkers increased at 3m-post-ACC versus baseline. PICP was particularly increased in patients with sLVD (interaction-p < 0.001) and was associated with GLS (p < 0.001). PICP increase at 3m-post-ACC predicted cardiotoxicity at 12m-post-ACC (odds-ratio ≥ 2.95 per doubling PICP, p ≤ 0.025) in both BC-cohorts, adding prognostic value to the early assessment of GLS and LVEF. ACC-HF-patients: PICP was inversely associated with LVEF (p = 0.004). In ACC-treated BC-patients, an early increase in PICP is associated with early sLVD and predicts cardiotoxicity 1 year after ACC. PICP is also associated with LVD in ACC-HF-patients.
- Estado actual de la terapia de resincronización cardiaca(Elsevier BV, 2012) Canepa-Leite, J.P. (J. P.); Garcia-de-Yebenes, M. (Manuel); Calvo, N. (Naiara); Arguedas, H. (Hugo); Gavira, J.J. (Juan José); Garcia-Bolao, I. (Ignacio); Moreno-Galdós, L. (Leire)Se revisa el estado actual de la terapia de resincronización cardiaca en sus diferentes aspectos: mecanismos de acción, indicaciones actuales y técnica de implante.
- A multimodal scaffold for SDF1 delivery improves cardiac function in a rat subacute myocardial infarct model(ACS Publications, 2023) Garcia-de-Yebenes, M. (Manuel); Pérez-Estenaga, I. (Iñigo); Tumin-Chevalier, M. (Merari); Pandit, A. (Abhay); Alsharabasy, A.M. (Amir M.); Larequi-García, E. (Eduardo); Cilla, M. (Myriam); Peña, E. (Estefanía); Prosper-Cardoso, F. (Felipe); Pelacho, B. (Beatriz); Abizanda-Sarasa, G. (Gloria); Perez, M.M. (Marta M.); Gurtubay, J. (Jon)Ischemic heart disease is one of the leading causes of death worldwide. The efficient delivery of therapeutic growth factors could counteract the adverse prognosis of post-myocardial infarction (post-MI). In this study, a collagen hydrogel that is able to load and appropriately deliver pro-angiogenic stromal cell-derived factor 1 (SDF1) was physically coupled with a compact collagen membrane in order to provide the suture strength required for surgical implantation. This bilayer collagen-on-collagen scaffold (bCS) showed the suitable physicochemical properties that are needed for efficient implantation, and the scaffold was able to deliver therapeutic growth factors after MI. In vitro collagen matrix biodegradation led to a sustained SDF1 release and a lack of cytotoxicity in the relevant cell cultures. In vivo intervention in a rat subacute MI model resulted in the full integration of the scaffold into the heart after implantation and biocompatibility with the tissue, with a prevalence of anti-inflammatory and pro-angiogenic macrophages, as well as evidence of revascularization and improved cardiac function after 60 days. Moreover, the beneficial effect of the released SDF1 on heart remodeling was confirmed by a significant reduction in cardiac tissue stiffness. Our findings demonstrate that this multimodal scaffold is a desirable matrix that can be used as a drug delivery system and a scaffolding material to promote functional recovery after MI.
- Acute L waves in heart failure(Elsevier BV, 2023) Sánchez-Vega, J.D. (Juan Diego); Garcia-de-Yebenes, M. (Manuel); García-Gómez, S. (Sergio)L waves are an unusual finding in the analysis of mitral valve pulsed-wave Doppler. This wave is recorded as flow between the left atrium and left ventricle during diastole, due to elevated left ventricular (LV) filling pressures.1---3 In this situation, triphasic mitral filling can be observed, with the presence of mid-diastolic L waves
- Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation(Oxford Academic, 2015) Salterain-González, N. (Nahikari); Garcia-de-Yebenes, M. (Manuel); Calvo, N. (Naiara); Arguedas, H. (Hugo); Gavira, J.J. (Juan José); Barba, J. (Joaquín); Macias, A. (Alfonso); Esteban, A. (Alberto); Garcia-Bolao, I. (Ignacio)Aims: Left atrial appendage (LAA) is the source of thrombi in up to 90% of patients with non-valvular atrial fibrillation (AF). Catheter ablation (CA) is an effective treatment for symptomatic AF and, in selected cases, LAA occlusion devices have been introduced as an alternative to oral anticoagulants (OACs). The safety and feasibility of combining CA and percutaneous LAA closure (LAAC) are unknown. Methods and results: Patients with symptomatic drug-refractory AF, CHADS2 score of ≥1, and CHA2DS2-VASc score ≥2 were included. Catheter ablation consisted in pulmonary vein isolation with or without roof line with radiofrequency and LAA was occluded with the Watchman or Amplatzer Cardiac Plug (ACP) devices guided by angiography and transoesophageal echocardiography. A total of 35 patients were included (71% male; 70 years). Median score was 3 on both CHA2DS2-VASc and HAS-BLED, 9% had prior stroke under OAC, and 48% had bleeding complications. Successful CA and device implantation were achieved in 97% of cases. The Watchman device was used in 29 patients and ACP in 6 patients. Periprocedural complications included three cases of cardiac tamponade. At 3 months, all patients met the criteria for successful sealing of the LAA. After a mean follow-up of 13 months (3-75), 78% of patients were free of arrhythmia recurrences and OAC was withheld in 97% of patients. Conclusions: The combination of CA and percutaneous LAAC in a single procedure is technically feasible in patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to OACs, although it is associated with a significant risk of major complications.
- Myocardial T1 and T2 mapping by magnetic resonance in patients with immune checkpoint inhibitor–associated myocarditis(Elsevier BV, 2021) Wintersperger, B.J. (B. J.); Salterain-González, N. (Nahikari); Drobni, Z. (Zsofia); Calvillo-Arguelles, O. (Oscar); Calles, A. (Antonio); Fernandez-Aviles, F. (Francisco); Lyon, A.R. (Alexander R.); Garcia-de-Yebenes, M. (Manuel); Reynolds, K.L. (Kerry L.); Kovacina, B. (Bojan); Baksi, A.J. (A. John); Neilan, T.G. (T.G.); Hartmann, S.E. (Sarah E.); Gavira, J.J. (Juan José); Thavendiranathan, P. (Paaladinesh); Kwong, R.Y. (Raymond Y.); Gupta, D. (Dipti); Mahmood, S.S. (Syed S.); Zlotoff, D.A. (Daniel A.); Weinsaft, J.W. (Jonathan W.); Zafar, A. (Amna); Awadalla, M. (Magid); Ederhy, S. (Stephane); Gilman, H.K. (Hannah K.); Barac, A. (Ana); Michel, C. (Caroline); Chen, C.L. (Carol L.); Jerosch-Herold, M. (M.); Sullivan, R. (Ryan); Fradley, M.G. (Michael G.); Cabral, M. (Marcella); Yang, E.H. (Eric H.); Mahmoudi, M. (Michael); Nohria, A. (Anju); Zhang, L. (Lili); Heinzerling, L.M. (Lucie M.); González-Mansilla, A. (Ana); Kirchberger, M.C. (Michael C.); Coelho-Filho, O.R. (Otavio R.); Zatarain-Nicolás, E. (Eduardo); Thuny, F. (Franck); Afilalo, J. (Jonathan); Ganatra, S. (Sarju); Sahni, G. (Gagan); Rizvi, M.A. (Muhammad A.)BACKGROUND Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited. OBJECTIVES This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis. METHODS In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. RESULTS Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across all patients, mean z-scores for T1 and T2 values were 2.9 1.9 (p < 0.001) and 2.2 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n ¼ 67), native T1 (1,079.0 55.5 ms vs. 1,000.3 22.1 ms; p < 0.001) and T2 (56.2 4.9 ms vs. 49.8 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91 (95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p ¼ 0.004) but not T2 values were independently associated with subsequent MACE. CONCLUSIONS The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis. (J Am Coll Cardiol 2021;77:1503–16) © 2021 by the American College of Cardiology Foundation.
- Global circumferential and radial strain among patients with immune checkpoint inhibitor myocarditis(Elsevier BV, 2022) Salterain-González, N. (Nahikari); Gongora, C. (Carlos); Devereux, R. (Richard); Drobni, Z. (Zsofia); Calles, A. (Antonio); Hung, J. (Judy); Fernandez-Aviles, F. (Francisco); Lyon, A.R. (Alexander R.); Quinaglia, T. (Thiago); Garcia-de-Yebenes, M. (Manuel); Reynolds, K.L. (Kerry L.); Picard, M.H. (Michael H.); Neilan, T.G. (T.G.); Hassan, M.Z.O. (Malek Z. O.); Gavira, J.J. (Juan José); Thavendiranathan, P. (Paaladinesh); Gupta, D. (Dipti); Mahmood, S.S. (Syed S.); Zlotoff, D.A. (Daniel A.); Zafar, A. (Amna); Mandawa, A. (Anant); Awadalla, M. (Magid); Ederhy, S. (Stephane); Gilman, H.K. (Hannah K.); Sama, S. (Supraja); Barac, A. (Ana); Michel, C. (Caroline); Chen, C.L. (Carol L.); Sullivan, R. (Ryan); Fradley, M.G. (Michael G.); Cabral, M. (Marcella); Suero-Abreu, G.L. (Giselle L.); Yang, E.H. (Eric H.); Mahmoudi, M. (Michael); Nohria, A. (Anju); Zubiri, L. (Leire); Zhang, L. (Lili); Heinzerling, L.M. (Lucie M.); González-Mansilla, A. (Ana); Nikolaidou, S. (Sofia); Coelho-Filho, O.R. (Otavio R.); Zatarain-Nicolás, E. (Eduardo); Thuny, F. (Franck); Afilalo, J. (Jonathan); Ganatra, S. (Sarju); Sahni, G. (Gagan); Rizvi, M.A. (Muhammad A.)BACKGROUND Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS. OBJECTIVES This study aimed to detail the role of GCS and GRS in ICI myocarditis. METHODS In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. RESULTS Cases and controls were similar in age (66 15 years vs 63 12 years; P ¼ 0.20), sex (male: 73% vs 61%; P ¼ 0.20) and cancer type (P ¼ 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% 3.4% vs 23.5% 3.8%; P ¼ 0.14; GRS: 45.5% 6.2% vs 43.6% 8.8%; P ¼ 0.24). Overall, 56% (n ¼ 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% 4.2% vs 23.6% 3.0%; P < 0.001; GRS: 28.6% 6.7% vs 47.0% 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P ¼ 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P ¼ 0.008) below the median was associated with an increased event rate. In receiveroperating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P ¼ 0.04) and GCS over cTnT (P ¼ 0.002). CONCLUSIONS GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance. (J Am Coll Cardiol Img 2022;15:1883–1896) © 2022 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.