Publications by authors named "Francisco J Hernandez-Perez"
Article Synopsis
- * A total of 614 patients from nine studies were analyzed, showing the score's ability to predict in-hospital mortality with an area under the curve (AUC) of 0.678 and for V-A-ECMO mortality with an AUC of 0.652, both statistically significant.
- * Results indicate that the PC-ECMO score can be an effective tool for assessing patient risk in clinical settings, making it useful for future research and potential treatment strategies.
Antibodies directed against donor-specific human leukocyte antigens (HLAs) can be detected de novo after heart transplantation and play a key role in long-term survival. De novo donor-specific antibodies (dnDSAs) have been associated with cardiac allograft vasculopathy, antibody-mediated rejection, and mortality. Advances in detection methods and international guideline recommendations have encouraged the adoption of screening protocols among heart transplant units.
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- Patients undergoing postcardiotomy V-A-ECMO have a high risk of early mortality, with a 66.7% in-hospital mortality rate found in the analysis of 1269 patients across 25 hospitals.
- The study utilized a systematic review and methods like propensity score matching to identify performance differences among hospitals, revealing that some hospitals had significantly higher mortality rates than others.
- The research indicates that lower annual volumes of V-A-ECMO procedures may lead to worse outcomes, and it highlights the potential for improvement in many hospitals' results for this treatment.
Article Synopsis
- Endomyocardial biopsy (EMB) is important for diagnosing fulminant myocarditis in adults, but its timing and effects on patient outcomes are still being studied.
- In a study involving 419 patients across 36 centers, those who had an early EMB (within 2 days of ICU admission) showed significantly better survival rates (63%) without needing heart transplants or LVAD compared to those with delayed EMB (40%).
- The research suggests that early EMB is associated with lower mortality rates and better overall outcomes, supporting its prompt use in ICU patients suspected of having fulminant myocarditis.
Article Synopsis
- A study was conducted to assess the prevalence and prognostic significance of donor-transmitted coronary artery disease (TCAD) in heart transplant patients across 11 Spanish hospitals from 2008 to 2018.
- Out of 1,918 heart transplant patients, 937 had coronary angiography (c-angio) within the first three months, revealing that 18.3% had TCAD, with 6.9% having significant TCAD (s-TCAD) and 11.4% having nonsignificant TCAD (ns-TCAD).
- The study found that while s-TCAD did not significantly impact overall survival, it was linked to a higher risk of cardiovascular death and major adverse cardiovascular events, indicating a
Article Synopsis
- Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) has a high mortality rate, and determining which patients are at the greatest risk for death is challenging, making clinical judgment essential for initiating the procedure.
- A systematic review analyzed data from 1269 patients across 10 studies, revealing that higher arterial lactate levels at the start of V-A-ECMO correlate with increased in-hospital mortality rates and a significant cut-off level of 6.8 mmol/L for predicting outcomes.
- The findings suggest that monitoring arterial lactate levels may aid clinicians in making more informed decisions on when to start V-A-ECMO, especially in older patients with elevated lactate levels.
Article Synopsis
- Despite advances in mechanical circulatory support, patients with cardiogenic shock still have a poor prognosis, prompting the need for improved rapid care initiatives.
- This document emphasizes the importance of a structured "SC code" to enhance the organization, activation, and care flow for cardiogenic shock patients.
- The authors aim to outline the unique aspects of cardiogenic shock, team logistics, management strategies, and the challenges of implementing an SC code in both adult and pediatric cases.
Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle.
Article Synopsis
- - The LEONE-HT study investigates the poor heart transplant (HT) survival rates and the role of anti-HLA antibodies, which may cause cardiac allograft dysfunction in patients receiving heart transplants.
- - It involves a cohort of HT patients, comparing those with positive anti-HLA antibodies to those without, utilizing advanced assessment methods like imaging and immunological analyses to understand the extent of myocardial damage.
- - Ethical standards for the study are met, adhering to global guidelines, and findings will be shared through patient associations and registered on clinicaltrials.gov for transparency.
Article Synopsis
- There is limited understanding of how gender affects the clinical presentation, treatment, and outcomes of patients experiencing cardiogenic shock (CS), particularly in a hospital setting.
- The study aimed to explore gender-related differences in characteristics, management, and in-hospital mortality among CS patients, while also evaluating the prognostic accuracy of the SCAI classification for predicting mortality by sex.
- An analysis of 163 CS patients showed that women were less likely to smoke and had lower rates of certain conditions compared to men, but in-hospital survival rates were similar across genders, indicating no significant differences in outcomes.
Introduction And Objectives: Endomyocardial biopsy (EMB) is the only technique able to establish an etiological diagnosis of myocarditis or inflammatory cardiomyopathy (ICM). The aim of this study was to analyze the clinical profile, outcomes, and prognostic factors of patients with suspected myocarditis/ICM undergoing EMB.
Methods: We retrospectively analyzed the clinical characteristics, histological findings, and follow-up data of all patients with suspected myocarditis or ICM who underwent EMB between 1997 and 2019 in a Spanish tertiary hospital.
Background: Cardiac allograft vasculopathy (CAV) remains a major cause of morbidity and mortality among long-term heart transplant recipients. There is an unmet need for a non-invasive biomarker of CAV that could obviate the need to perform surveillance coronary angiograms in these patients. Our aim was to evaluate the performance of Donor-derived Cell Free DNA (dd-cfDNA) as a biomarker of CAV.
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- Controlled donation after circulatory death (cDCD) is an emerging method to expand the organ donor pool, with new techniques allowing heart transplants from cDCD donors to become viable.
- A case in Spain involved a 43-year-old female donor whose heart was successfully procured using thoraco-abdominal normothermic regional perfusion, contrasting with traditional methods that required ex-situ devices.
- This case demonstrates the potential for effective heart transplantation from cDCD donors while also paving the way for increased multiorgan donation opportunities.
Article Synopsis
- Early recognition and risk stratification are important for managing cardiogenic shock (CS), but there are concerns about lower adherence to recommendations in women with cardiovascular diseases.
- Data from the Red-Shock registry included 793 patients, revealing that women were older and had different health backgrounds but showed similar treatment approaches and in-hospital mortality rates compared to men.
- Both CardShock and IABP-SHOCK II risk scores were effective in predicting in-hospital mortality for both men and women, indicating that gender does not significantly affect management or outcomes in CS.
Article Synopsis
- The study focuses on improving outcomes for patients with cardiogenic shock (CS), particularly those requiring mechanical circulatory support (MCS), by analyzing a care program implemented by a multidisciplinary team in a regional hospital network from 2014 to 2019.
- A total of 130 patients were examined, with a majority being middle-aged men; most cases were due to heart failure or myocardial infarction, and 81% of patients used MCS, primarily extracorporeal membrane oxygenation (ECMO).
- The program achieved a 57% survival rate to discharge, suggesting that a coordinated approach with specialized teams significantly benefits patients in critical conditions like refractory CS.
Article Synopsis
- Cardiac amyloidosis (CA) is caused by amyloid fiber buildup in the heart, primarily from light chains (AL) or transthyretin (ATTR), and this study aimed to describe its diagnosis and treatment outcomes in a Spanish hospital.
- The study involved 180 patients diagnosed with CA, where the majority were diagnosed with ATTR, showing that heart failure was the most common symptom, but AL patients had higher mortality rates.
- The research highlighted significant diagnostic delays for ATTR patients and identified key mortality predictors, emphasizing the need for improved early detection and treatment strategies for CA.
Background: Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients.
View Article and Find Full Text PDFBackground: Cardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described.
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- The study investigates the use of paracorporeal pulsatile-flow ventricular assist devices (VADs) as a bridge to transplant (BTT) in adults, highlighting their advantages and limitations compared to continuous-flow devices.
- A retrospective analysis of patients treated with the EXCOR VAD from 2009 to 2015 was conducted, revealing that 80% of patients successfully received heart transplants after an average of 112 days of support.
- The main complications encountered included infections, neurological issues, bleeding, and device malfunctions, indicating the need for close monitoring in patients using this VAD method.