0000000000173122
AUTHOR
María J. Bosch
showing 29 related works from this author
Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction.
2013
Abstract Introduction and objectives A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. Methods One week after a first ST-segment elevation myocardial infarction we carried out a comp…
Prognostic usefulness of white blood cell count on admission and one-year outcome in patients with non-ST-segment elevation acute chest pain.
2006
Little is known about the prognostic value of leukocyte count on admission for patients with chest pain. In total, 1,461 patients who presented to the emergency department with non–ST-segment elevation chest pain were studied by clinical history, electrocardiography, serial troponin I determination, and leukocyte count on admission. End points were 1-year mortality and major events (mortality or infarction). Overall patient distribution by quartiles of leukocyte count showed increased mortality (6%, 7%, 6%, and 17%, p = 0.0001) and major events (13%, 13%, 15%, and 24%, p = 0.0001) in the fourth quartile. After adjustment for other risk factors, the fourth quartile cut-off value (>10,000 cel…
Valor pronóstico de la isquemia miocárdica y la necrosis en pacientes con la función ventricular izquierda deprimida: un registro multicéntrico con r…
2014
Resumen Introduccion y objetivos No se conoce el valor pronostico incremental que aporta la isquemia miocardica inducible respecto a la necrosis determinada por resonancia magnetica cardiaca de estres en pacientes con funcion ventricular izquierda deprimida. Se determina el valor pronostico de la necrosis y la isquemia en pacientes con funcion ventricular izquierda deprimida remitidos a exploracion por resonancia magnetica de estres con perfusion de dipiridamol. Metodos En un registro multicentrico basado en el uso de resonancia magnetica de estres, se determino la presencia (≥ 2 segmentos) de realce tardio de contraste y defectos de perfusion y su asociacion con eventos mayores (muerte car…
Efecto pronóstico de una estrategia terapéutica guiada por los valores del antígeno carbohidrato 125 (CHANCE-HF). Diseño del estudio
2015
Resumen Introduccion y objetivos La morbilidad y la mortalidad despues de un ingreso por insuficiencia cardiaca aguda siguen siendo extremadamente elevadas. En este contexto, se ha demostrado que las concentraciones plasmaticas del antigeno carbohidrato 125 muestran correlacion con la gravedad de la sobrecarga hidrica y el riesgo de muerte y reingreso. Los datos preliminares indican un posible papel del antigeno carbohidrato 125 como guia para el tratamiento. El objetivo de este estudio es evaluar el efecto pronostico de una estrategia de tratamiento guiada por el antigeno carbohidrato 125 comparada con el tratamiento estandar en pacientes dados de alta recientemente tras un ingreso por ins…
Contractile Reserve and Extent of Transmural Necrosis in the Setting of Myocardial Stunning: Comparison at Cardiac MR Imaging
2010
To perform a comparison of cardiac magnetic resonance (MR) imaging-derived ejection fraction (EF) during low-dose dobutamine infusion (EF(D)) with the extent of segments with transmural necrosis in more than 50% of their wall thickness (ETN) for the prediction of major adverse cardiac events (MACEs) and late systolic recovery soon after a first ST-segment elevation myocardial infarction (STEMI).Institutional ethics committee approval and written informed consent were obtained. One hundred nineteen consecutive patients with a first STEMI, a depressed left ventricular EF, and an open infarct-related artery underwent MR imaging at 1 week after infarction. EF(D) and ETN (by using a 17-segment m…
An Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndromes. From Large Trials to the Real World
2004
Introduction and objectives We report the impact on prognosis of an invasive strategy used at our center for non-ST-segment elevation acute coronary syndrome. Patients and method We analyzed 504 consecutive patients with typical chest pain, electrocardiographic changes or increased troponin I serum values, who were divided into 2 cohorts: a ) conservative group, 272 patients admitted between October 2001 and September 2002 and managed with a conservative strategy, and b ) invasive group, 232 patients admitted between October 2002 and September 2003 for whom an invasive strategy was recommended. We recorded major events (death or reinfarction) and minor events (readmission or need for post-d…
Diferencias entre sexos en la mortalidad a un mes y a un año tras un síndrome coronario agudo
2004
Fundamento y objetivo Se pretende estudiar las diferencias entre sexos en la mortalidad a corto plazo (un mes) y a largo plazo (un ano) tras un sindrome coronario agudo Pacientes y metodo Despues de la publicacion de la nueva definicion de infarto de miocardio analizamos prospectivamente a 1.324 pacientes consecutivos ingresados con el diagnostico de sindrome coronario agudo en un hospital terciario. De estos pacientes, 483 (37%) presentaban un infarto con elevacion de ST; 439 (33%), infarto sin elevacion del ST (valores de troponina I superiores a 1 ng/ml), y 402 (30%), angina inestable (troponina I inferior a 1 ng/ml) Resultados Durante un ano hubo 177 muertes (13,4%). La mortalidad fue s…
Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with …
2010
Aim Elevated brain natriuretic peptide (BNP) and tumour marker antigen carbohydrate 125 (CA125) levels have shown to be associated with higher risk for adverse outcomes in patients with acute heart failure (AHF). Nevertheless, no attempt has been made to explore the utility of combining these two biomarkers. We sought to assess whether CA125 adds prognostic value to BNP in predicting 6-month all-cause mortality in patients with AHF. Methods and results We analysed 1111 consecutive patients admitted for AHF. Antigen carbohydrate 125 (U/mL) and BNP (pg/mL) were measured at a median of 72 ± 12 h after instauration of treatment. Antigen carbohydrate 125 and BNP were dichotomized based on propos…
Prognostic Value of White Blood Cell Count in Acute Myocardial Infarction: Long-Term Mortality
2005
Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method. The study included 1118 consecutive patients who were admitted with the diagnosis of AMI: 569 non-STEMI and 549 STEMI. The WBC was measured in the 24 hours following admission. Patients were divided into…
Prognostic implications of dipyridamole cardiac MR imaging: a prospective multicenter registry
2011
Purpose: To evaluate dipyridamole cardiac magnetic resonance (MR) imaging in the prediction of major events (MEs) in patients with ischemic chest pain in a large multicenter registry. Materials and Methods: Institutional ethics committee approval and written informed consent were obtained. A total of 1722 patients who were undergoing cardiac MR imaging for chest pain were included. Wall motion abnormalities (WMAs) at rest, hyperemia perfusion defect (PD), late gadolinium enhancement (LGE), and inducible WMA were analyzed (abnormal if more than one abnormal segment was seen) with the 17-segment model. A cardiac MR categorization was created: category 1, no PD, LGE, or inducible WMA; category…
Diuretic Strategies in Acute Heart Failure and Renal Dysfunction: Conventional vs Carbohydrate Antigen 125-guided Strategy. Clinical Trial Design
2017
Abstract Introduction and objectives The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic str…
Estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST. De los grandes estudios al mundo real
2004
Introduccion y objetivos Presentamos el impacto pronostico de una estrategia invasiva (EI) en el sindrome coronario agudo sin elevacion del segmento ST en nuestra institucion. Pacientes y metodo Se ha estudiado a 504 pacientes consecutivos con dolor toracico tipico, cambios electrocardiograficos y elevacion de la troponina I divididos en 2 cohortes: a) grupo conservador, 272 pacientes ingresados entre octubre de 2001 y septiembre de 2002, manejados con una estrategia conservadora (EC); b) grupo invasivo, 232 pacientes ingresados entre octubre de 2002 y septiembre de 2003 y en los que se recomendo una EI. Se recogieron los eventos mayores (defuncion o reinfarto) y menores (reingreso o necesi…
A practical approach with outcome for the prognostic assessment of non-ST-segment elevation chest pain and normal troponin.
2007
Patients with non-ST-elevation chest pain constitute a heterogeneous population. Our aim is to compare the outcome of patients with chest pain, non-ST-segment deviation, and normal troponin, categorized using a risk score, with that of patients with ST depression or troponin increase. A total of 1,449 patients with non-ST-elevation chest pain were evaluated. A validated risk score (using pain characteristics and risk factors) was applied to patients without ST depression or troponin increase. Accordingly, 4 risk categories were defined: group 1, no troponin increase, no ST depression, and risk score3 points (n = 633); group 2, no troponin increase, no ST depression, but risk scoreor = 3 poi…
Carbohydrate antigen 125: an emerging prognostic risk factor in acute heart failure?
2007
To assess whether circulating levels of carbohydrate antigen 125 (CA125) predict subsequent 6-month all-cause mortality in patients after the index hospitalisation for acute heart failure (HF).Prospective cohort study at a single teaching centre in Spain.529 consecutive patients with acute HF admitted in a single university centre were analysed. In addition to the traditional clinical information, CA125 (U/ml) was measured during the early course of hospitalisation. The independent association between baseline CA125 and mortality was assessed with Cox regression analysis. The follow-up was limited to 6 months.349 (66%) patients showed serum levels of CA12535 U/ml (established cut-off point …
Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease
2020
Abstract Objectives This study explored the association of ischemic burden, as measured by vasodilator stress cardiovascular magnetic resonance (CMR), with all-cause mortality and the effect of revascularization on all-cause mortality in patients with stable ischemic heart disease (SIHD). Background In patients with SIHD, the association of ischemic burden, derived from vasodilator stress CMR, with all-cause mortality and its role for decision-making is unclear. Methods The registry consisted of 6,389 consecutive patients (mean age: 65 ± 12 years; 38% women) who underwent vasodilator stress CMR for known or suspected SIHD. The ischemic burden (at stress first-pass perfusion imaging) was com…
Estrategias diuréticas en insuficiencia cardiaca aguda con disfunción renal: terapia convencional frente a guiada por el antígeno carbohidrato 125. D…
2017
Resumen Introduccion y objetivos El tratamiento optimo de pacientes con insuficiencia cardiaca aguda (ICA) y sindrome cardiorrenal tipo 1 (SCR-1) no esta bien definido. La hipoperfusion arterial y la congestion venosa tienen un papel fundamental en la fisiopatologia del SCR-1. El antigeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diuretico de pacientes con SCR-1. Metodos Ensayo clinico multicentrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a) estrategia convencional: titulacion ba…
Prognostic Value of Myocardial Ischemia and Necrosis in Depressed Left Ventricular Function: a Multicenter Stress Cardiac Magnetic Resonance Registry
2013
A B S T R A C T Introduction and objectives: The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. Methods: In a multicenter registry using stress magnetic resonance, the presence ( 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. Results: In 391 patients, perfusion defect or late enhancement were p…
Cardiovascular magnetic resonance-derived intramyocardial hemorrhage after STEMI: Influence on long-term prognosis, adverse left ventricular remodeli…
2011
T2 weighted cardiovascular magnetic resonance (CMR) can detect intramyocardial hemorrhage (IMH) after ST-elevation myocardial infarction (STEMI). The long-term prognostic value of IMH beyond a comprehensive CMR assessment with late enhancement (LE) imaging including microvascular obstruction (MVO) is unclear. The value of CMR-derived IMH for predicting major adverse cardiac events (MACE) and adverse cardiac remodeling after STEMI and its relationship with MVO was analyzed.CMR including LE and T2 sequences was performed in 304 patients 1 week after STEMI. Adverse remodeling was defined as dilated left ventricular end-systolic volume indexes (dLVESV) at 6 months CMR.During a median follow-up …
Valor pronóstico a largo plazo del análisis completo de los índices de resonancia magnética cardiaca tras un infarto de miocardio con elevación del s…
2013
Resumen Introduccion y objetivos Se ha demostrado el valor pronostico de varios indices de resonancia magnetica cardiaca a medio plazo tras un infarto agudo de miocardio con elevacion del segmento ST. La extension de la necrosis transmural permite una prediccion simple y exacta de viabilidad miocardica. Sin embargo, se desconoce su valor pronostico a largo plazo mas alla de una completa evaluacion clinica y por resonancia. Nuestra hipotesis es que la evaluacion semicuantitativa de la extension de la necrosis transmural es el mejor indice de resonancia para predecir el pronostico a largo plazo tras un infarto con elevacion del segmento ST. Metodos Se realizo un estudio cuantitativo con reson…
Valor pronóstico de la fracción de eyección del ventrículo izquierdo en pacientes con insuficiencia cardíaca aguda
2008
Fundamento y objetivo La influencia de la fraccion de eyeccion del ventriculo izquierdo (FEVI) en el pronostico de los pacientes con insuficiencia cardiaca es motivo de controversia. El objetivo de nuestro estudio ha sido determinar, durante un seguimiento a largo plazo, el valor pronostico de la FEVI sobre la mortalidad y el reingreso hospitalario por insuficiencia cardiaca aguda (ICA) en una poblacion no seleccionada de pacientes ingresados por ICA. Pacientes y metodo Estudiamos a 507 pacientes consecutivos ingresados por ICA en el Servicio de Cardiologia de nuestro centro. Se determino la FEVI mediante ecocardiografia transtoracica durante el ingreso indice, y durante el seguimiento se r…
Prognostic differences between routine invasive and conservative strategies for the management of high-risk, non-ST segment acute coronary syndromes:…
2007
Abstract Background The optimal revascularization strategy for non-ST elevation acute coronary syndromes (NSTE-ACS) remains controversial, especially in a real world context. The objective of this work was to assess differences at 1 year in all-cause mortality and the composite endpoint of mortality or acute myocardial infarction (MI) between two management strategies for NSTE-ACS: a conservative strategy (CS) versus a routine invasive strategy (RIS). Methods Of 799 consecutive patients admitted to our institution, 369 were treated with CS (from January 2001 to October 2002); 430 patients admitted with the same diagnosis were treated with RIS (from November 2002 to November 2004). A propens…
Perfusión miocárdica alterada tras un infarto en pacientes con flujo TIMI 3 mantenido. ¿Sólo un fenómeno agudo?
2007
Introduccion y objetivos Se ha senalado que la perfusion anormal analizada mediante resonancia magnetica cardiaca (RMC) es una alteracion transitoria de la microcirculacion despues de un infarto agudo de miocardio (IAM) con flujo TIMI 3. Planteamos la hipotesis de que las alteraciones de la perfusion miocardica pueden persistir en los meses siguientes. Metodos Estudiamos 47 pacientes con un primer IAM y flujo TIMI 3 mantenido mediante ecografia miocardica con inyeccion intracoronaria de contraste (EMC) en la primera semana y el sexto mes postinfarto. Se considero que habia perfusion anormal mediante EMC si habia mas de un segmento hipoperfundido. Resultados En la primera semana 20 pacientes…
New Risk Score for Patients With Acute Chest Pain, Non-ST-Segment Deviation, and Normal Troponin Concentrations
2005
Objectives The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram (ECG), and normal troponin levels. Background Prognosis assessment in this population remains a challenge. Methods A total of 646 consecutive patients were evaluated by clinical history (risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days (similar to the Thrombol…
CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction
2020
BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-gui…
A non-valvular infective endocarditis in an HIV patient with myocardiopathy
2006
A 37-year-old woman presented in the emergency department revealing a history of HIV infection and C virus hepatitis diagnosed 15 years ago, acquired after a period of intravenous drug abusing. The patient was receiving triple antiHIV therapy and was in an A1 stage (last lymphocite recount of CD4: 0.63 10/l and no AIDS disease manifestation to the present moment). She described episodes, starting 20 days before, of torathic pain coexisting with shivers. There were no symptoms or signs of any focal infection. In the physical examination the only findings were a temperature of 38.4 8C, a 4 cm hepatomegaly and lipodystrophy. We found in the electrocardiogram a sinus rhythm, 96 bpm and no ST se…
Length of stay and risk of very early readmission in acute heart failure
2016
In patients admitted for acute heart failure (AHF), optimal length of stay (LOS) remains controversial. Longer hospitalizations are associated with worse prognosis, but little is known about short hospitalizations. The aim of this work was to evaluate the relationship between LOS and the risk of short-term readmission in patients discharged after a hospitalization for AHF.We included 2110 consecutive patients. The independent associations between LOS and unplanned 10, 15 and 30-day readmissions were evaluated by Cox regression analysis adjusted for competing events. LOS was categorized as LOS1: ≤4days, LOS2: 5-7days, LOS3: 8-10days, and LOS4:10days.The mean age was 73±11years and 52.6% exhi…
Evolution of 5 cardiovascular magnetic resonance–derived viability indexes after reperfused myocardial infarction
2007
The objective of this study was to evaluate the simultaneous evolution of 5 cardiovascular magnetic resonance-derived myocardial viability indexes.We studied 72 patients with a first ST-elevation myocardial infarction and sustained TIMI 3 flow. In the first week and in the sixth month of the study, using cardiovascular magnetic resonance imaging, we determined wall thickening (WT) and the following viability indexes: wall thickness, WT with low-dose dobutamine, microvascular perfusion in first-pass imaging, microvascular obstruction in late-enhancement imaging, and transmural extent of necrosis.In 250 dysfunctional segments, the evolution outcomes for the viability indexes were as follows: …
Abnormal Myocardial Perfusion After Infarction in Patients With Persistent TIMI Grade-3 Flow. Only an Acute Phenomenon?
2007
Introduction and objectives It has been suggested that abnormal perfusion as derived from cardiovascular magnetic resonance imaging (CMR) is a transient dysfunction of microcirculation after myocardial infarction (MI) with TIMI 3 flow. We hypothesized that defects of myocardial perfusion may persist during the following months. Methods Forty-seven patients with MI and sustained TIMI 3 flow underwent intracoronary myocardial contrast echocardiography (MCE) 1 week and 6 months after infarction. Abnormal perfusion by MCE was regarded as >1 hypoperfused segment. Results At one week, 20 patients showed abnormal perfusion as derived from MCE. At six months 10 patients displayed chronic abnormal p…
Valor pronóstico del recuento leucocitario en el infarto agudo de miocardio: mortalidad a largo plazo
2005
Introduccion y objetivos. Publicaciones recientes respaldan el papel pronostico del recuento leucocitario (RL) en pacientes con infarto agudo de miocardio (IAM). El objetivo de este trabajo fue determinar el valor predictivo atribuible al RL, con independencia de otras variables de contrastado valor pronostico, para predecir mortalidad a largo plazo en pacientes con IAM sin elevacion del segmento ST (IAMSEST) y con elevacion del segmento ST (IAMEST). Pacientes y metodo. Analizamos a 1.118 pacientes admitidos de forma consecutiva con el diagnostico de IAM (IAMSEST = 569; IAMEST = 549). El RL se obtuvo en la primera determinacion analitica. Se utilizaron modelos de regresion de Cox para deter…