Publications by authors named "Jose M de la Torre-Hernandez"
Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs.
Article Synopsis
- Researchers studied 1,729 patients with coronary artery aneurysms (CAAs) to understand their clinical characteristics and predict outcomes, using data from an international registry across 9 countries.
- The majority of patients were male (78.6%) averaging 66 years old, with significant cardiovascular issues such as coronary artery disease (85.8%) and a median of 1 aneurysm per patient, primarily affecting the left anterior descending artery.
- During a median follow-up of about 45 months, 21.9% of patients died, and 37.1% experienced major adverse cardiovascular events; factors like age, diabetes, and kidney disease were linked to worse outcomes.
Clinical Validation of Non-invasive Simulation-Based Determination of Vascular Impedance, Wave Intensity, and Hydraulic Work in Patients Undergoing Transcatheter Aortic Valve Replacement.
Ann Biomed Eng
November 2024
Article Synopsis
- Aortic Stenosis (AS) affects the left ventricle not just through pressure drops across the valve, but also due to added afterload from the vascular system; thus, measuring aortic input impedance is crucial for understanding total myocardial afterload.
- Researchers developed a novel, non-invasive simulation-based method to measure aortic input impedance using standard echocardiographic data and simple blood pressure readings, avoiding the need for invasive procedures.
- Validation results showed a strong correlation between the simulation-based method and traditional measurement techniques, highlighting its potential for broader clinical application and improved insights into how vascular impedance impacts left ventricular function.
Background: Severe aortic stenosis (AS) coexists with coronary artery disease (CAD) in approximately 50% of patients. The preferred treatment is combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). However, transcatheter aortic valve replacement (TAVR) along with percutaneous coronary intervention (PCI) has emerged as a viable alternative.
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- A study evaluated the effectiveness of closing a patent foramen ovale (PFO) after a cryptogenic stroke, comparing those who had it done within 9 months (early closure) to those who had it done after 9 months (delayed closure).
- The research found no significant differences in recurrence rates of cerebrovascular events or systemic embolisms between the early and delayed closure groups, indicating similar outcomes regardless of when the procedure was performed.
- The results suggest that PFO closure might be beneficial even in patients with a cryptogenic event that occurred more than 9 months ago, challenging the notion that the timing of the closure is critical.
Thrombocytopenia after transcatheter aortic valve implantation.
Rev Esp Cardiol (Engl Ed)
September 2024
Introduction And Objectives: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.
Methods: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *10/L.
Introduction And Objectives: Impact of gender on long-term outcomes after transcatheter aortic valve implantation (TAVI) remains uncertain. We aimed to investigate gender-specific differences in TAVI and its impact on outcomes.
Methods: This analysis used data from the prospective Spanish TAVI registry, which included consecutive TAVI patients treated in 46 Spanish centers from 2009 to 2021.
Background: In patients with in-stent restenosis (ISR) bioresorbable vascular scaffolds (BVS) provide similar results to drug-coated balloons (DCBs) but are inferior to drug-eluting stents (DES) at 1 year. However, the long-term efficacy of BVS in these patients remains unknown.
Objectives: This study sought to assess the long-term safety and efficacy of BVS in patients with ISR.
Article Synopsis
- Patients with cardiogenic shock (CS) and mitral regurgitation (MR) face high surgical risks, but the study investigates the effectiveness of transcatheter edge-to-edge therapy (TEER) combined with mechanical circulatory support (MCS) for these patients.
- The MITRA-ASSIST study looked at 24 patients with CS and MR treated with TEER and MCS across nine Spanish centers, revealing a procedural success rate of 95.8% and 87.5% in-hospital survival.
- At 12 months, 25% of patients died, and 33.3% experienced either death or hospitalization for heart failure, suggesting that TEER combined with MCS could be a viable treatment
Background: The current incidence and outcomes of structural transcatheter procedures in heart transplant (HTx) recipients and left-ventricular assist devices (LVAD) carriers is unknown.
Aims: To provide insights on structural transcatheter procedures performed across HTx and LVAD patients in Spain.
Methods: Multicenter, ambispective, observational nationwide registry.
Article Synopsis
- Shortening dual-antiplatelet therapy (DAPT) to 1 month after percutaneous coronary intervention (PCI) is effective and safe for high bleeding risk (HBR) patients, regardless of chronic kidney disease (CKD) status.
- A study analyzed data from 3 prospective studies involving 3,286 patients, of whom 43.6% had CKD, comparing outcomes between 1-month and 3-month DAPT.
- Results indicated that both durations had similar rates of death and myocardial infarction after 12 months, with a slight trend for fewer bleeding complications at 1 month compared to 3 months in both CKD and no-CKD groups.
Article Synopsis
- Some doctors suggest giving patients with a high bleeding risk a shorter treatment of medication after getting a special type of heart stent.
- This study looked at how safe and effective 1 month of this medication is compared to 3 months for patients who also had a type of heart problem or not.
- They found that 1-month treatment had the same chance of serious heart issues as the 3-month treatment, but it caused less bleeding after a year.
Introduction And Objectives: In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup.
Methods: This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease.
Article Synopsis
- Acute coronary syndromes (ACS) include serious heart conditions like STEMI and NSTE-ACS, posing significant challenges in treatment due to their complex nature and impacts on health.
- The 2023 European Society of Cardiology (ESC) guidelines for managing ACS highlight updates in treatment timing, patient assessment strategies, and various advanced imaging techniques to improve diagnostic accuracy.
- These guidelines also suggest personalized approaches in antiplatelet therapy and introduce low-dose colchicine, while noting that there are still areas for improvement in adopting personalized care and technology in ACS management.
Older patients have been remarkably underrepresented in bleeding risk cohorts. Thus, the PRECISE-DAPT (Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy) and Academic Research Consortium for High Bleeding Risk (ARC-HBR) scores are not validated in older adults. Therefore, we sought to evaluate the PRECISE-DAPT and ARC-HBR scores in an exclusively older population and assess the prognostic value of a truly simplified clinical evaluation (SCE), consisting of only 3 binary clinical variables (hemoglobin <11 g/100 ml, previous bleeding, and anticipated use of anticoagulants).
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- Intravascular lithotripsy (IVL) is effective for treating calcified coronary lesions in patients with stable coronary disease, as shown in a study involving 426 patients across 26 centers in Spain.
- The study found that IVL was successfully delivered in 99% of cases, achieving procedural success in 66% of patients and similar outcomes for both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) groups.
- The safety analysis showed a relatively low rate of major adverse cardiovascular events (MACE) at 30 days, with 3% overall (1% for CCS and 5% for ACS), indicating that IVL is both safe and effective in real-life clinical settings.
Article Synopsis
- A study found that using Quantitative Flow Ratio (QFR) for virtual angioplasty before and after PCI (Percutaneous Coronary Intervention) led to better outcomes than traditional angiographic methods, but there is a lack of correlation between pre-PCI QFR and post-PCI FFR (Fractional Flow Reserve).
- The study involved 84 patients with significant coronary lesions, focusing on measuring various flow ratios before and after the procedure, with an average age of 65.5 years and a majority having lesions in the left anterior descending artery.
- Despite achieving procedural success and improvements in post-PCI FFR, the pre-PCI QFR did not show reliable correlation with the post-PCI FFR, indicating
Article Synopsis
- The analysis evaluated the impact of 1-month versus 3-month dual antiplatelet therapy (DAPT) in older patients after percutaneous coronary intervention (PCI), focusing on those with high bleeding risk.
- In a study of 3,364 patients, they found similar rates of all-cause death or myocardial infarction for both therapy durations, regardless of whether patients were ≥75 years or <75 years old.
- However, patients aged ≥75 experienced significantly less bleeding with the 1-month DAPT compared to the 3-month treatment, suggesting a clearer benefit in reducing bleeding risk without increasing heart-related complications.
Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study.
JACC Cardiovasc Interv
February 2024
Article Synopsis
- The COVID-19 pandemic led to significant treatment delays for patients needing transcatheter aortic valve replacement (TAVR), with a marked decrease in procedure volumes during the first two waves of the pandemic.
- The study analyzed TAVR case data from 130 centers in 61 countries, finding a 15% drop in cases during the first wave and 7% in the second, particularly affecting regions like Africa, Central-South America, and Asia.
- Factors such as hospital type (private vs public), urban vs rural location, low procedure volumes, a country's socioeconomic status, and stringent public health measures contributed to these reductions, highlighting the need for improved public health policies for future health crises.
Article Synopsis
- - Patients undergoing transcatheter aortic valve implantation (TAVI) often face poor quality of life, with up to 20% not surviving beyond a year afterward; a new predictive method aims to improve patient outcomes.
- - The study involved 102 TAVI patients, with 80.4% showing significant functional improvement after 6 months, and those patients experienced much lower 2-year mortality rates (9% compared to 44%).
- - The new flow velocity-pressure analysis proved to be a better predictor of improvement than traditional methods, especially for those with low-gradient aortic stenosis, with a C-statistic showing good accuracy in both the main study and validation cohort.
Article Synopsis
- The study investigates the factors contributing to impaired functional status (NYHA class III-IV) after transcatheter aortic valve replacement (TAVR) and its impact on patient outcomes.
- It involved 3,462 patients and found that 6% had impaired functional status one month post-procedure, with predictors including poor baseline functional class, chronic obstructive pulmonary disease, and severe mitral regurgitation.
- Patients in the impaired functional status group faced significantly higher risks of death and heart failure-related hospitalizations within a year following TAVR.
Purpose: Recently developed handheld ultrasound devices (HHUD) represent a promising method to evaluate the cardiovascular abnormalities at the point of care. However, this technology has not been rigorously evaluated. The aim of this study was to explore the correlation and the agreement between the LVEF (Left Ventricular Ejection Fraction) visually assessed by a moderately experienced sonographer using an HHUD compared to the routine LVEF assessment performed at the Echocardiography Laboratory.
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- - The study examined the effects of 1-month vs. 3-month dual antiplatelet therapy (DAPT) in patients who had undergone percutaneous coronary intervention (PCI), particularly those on long-term oral anticoagulation (OAC) therapy.
- - Results showed that patients on OAC had similar rates of death or myocardial infarction (MI) whether they were on 1-month or 3-month DAPT, but those on 1-month therapy experienced lower rates of bleeding complications.
- - Overall, 1-month DAPT was found to be as effective as 3-month DAPT in preventing serious cardiovascular events while significantly reducing bleeding risks for patients, regardless of their OAC status.
Surgical transcatheter aortic valve replacement in patients over 75 years with aortic stenosis: sociodemographic profile, clinical characteristics, quality of life and functionality.
PeerJ
October 2023
Background: Aortic valve stenosis (AVS) affects 25% of the population over 65 years. At present, there is no curative medical treatment for AVS and therefore the surgical approach, consisting of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), is the treatment of choice.
Methodology: The aim of this study was to analyze the sociodemographic and clinical characteristics, quality of life and functionality of a sample of patients with AVS over 75 years of age, who underwent TAVR or SAVR, applying standard clinical practice.