Publications by authors named "Jose Maria 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
- - The study aims to compare immediate versus staged percutaneous coronary intervention (PCI) strategies for patients with aneurysmatic right coronary artery (ARCA) during acute coronary syndrome (ACS), analyzing outcomes from 85 patients.
- - Results show that both PCI strategies had similar rates of procedural success and long-term outcomes, but the staged approach led to a higher incidence of bleeding and longer hospital stays.
- - The findings suggest that while both methods are viable, immediate PCI might be preferable due to lower complications and shorter hospital duration.
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
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.
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
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.
View Article and Find Full Text PDFSurgical 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.
Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices.
JACC Cardiovasc Interv
September 2023
Article Synopsis
- This study examined the rates and causes of sudden cardiac death (SCD) and heart failure (HF)-related deaths in 5,421 patients who underwent transcatheter aortic valve replacement (TAVR) using newer devices.
- Findings revealed that 18% of patients died within two years, with over half of those deaths attributed to cardiovascular issues, notably advanced HF and SCD.
- Key predictors for HF-related death included atrial fibrillation and reduced heart function, while factors linked to increased SCD risk included certain procedural complications like periprocedural ventricular arrhythmias.*
Article Synopsis
- This study investigates the incidence and effects of late bleeding events (LBEs) in patients who undergo percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR).
- Among 1,457 patients analyzed, 7.9% experienced LBEs after TAVR, with various severities impacting long-term mortality rates.
- It concludes that LBEs significantly heighten the risk of death after TAVR and highlights the need for effective strategies to prevent these events and optimize antithrombotic treatments.
Article Synopsis
- The study focused on the use of intracoronary pressure wires in guiding treatment for patients with coronary artery disease, aiming to assess changes in diagnosis, treatment strategies, and clinical outcomes.
- Involving 1,414 patients and observing 1,781 lesions, the study found significant changes in the extent of coronary disease and treatment plans, with over half of the patients experiencing adjustments after using the pressure wire.
- The findings indicated that using the pressure wire was generally safe and led to a lower incidence of major adverse cardiovascular events (MACE), particularly when percutaneous coronary intervention (PCI) was the initial treatment strategy.
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.
Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study.
Circ Cardiovasc Interv
November 2022
Article Synopsis
- This study investigates the agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in patients with intermediate stenosis in the left main coronary artery (LMCA), finding an 80% concordance between the two methods.
- The research involved 300 patients and emphasized the role of intravascular ultrasound (IVUS) for assessing cases where FFR and iFR results disagreed, identifying minimal lumen areas as a factor in decision-making.
- Over a 20-month follow-up, deferral of revascularization based on iFR and IVUS showed a lower incidence of major adverse cardiac events compared to those who underwent revascularization, suggesting that deferring treatment
Background: The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave-free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized.
Methods: A multicenter registry including patients of four high-volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs).
Aim: To investigate key aspects of the problem of myocardial revascularization failure (MRF) and repeat or secondary myocardial revascularization (SR) in contemporary practice.
Methods: The registry of secondary revascularization (REVASEC) is an investigator-initiated, multicenter, prospective registry enhanced with data monitoring and independent event adjudication (ClinicalTrials.govNCT03349385).
Background: We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.
Methods: Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.
Background: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes.
Objectives: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome.
Article Synopsis
- This study aimed to analyze the characteristics and outcomes of patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR), focusing on clinical features, long-term results, and events in those with complex coronary issues.
- Around 25% of TAVR candidates need PCI, but limited data exist on the procedure's details and outcomes over time.
- Among 1,197 patients studied, half had multivessel disease, with significant rates of major cardiovascular events observed, particularly in those with specific risk factors and complex lesions.
Aims: The aim of this study was to investigate the diagnostic performance of quantitative flow ratio (QFR) in assessing the physiological relevance of coronary lesions in the presence of severe aortic valve stenosis (SAS).
Methods And Results: A total of 115 SAS patients (138 coronary arteries) were included. Functional assessment of coronary stenoses was performed with fractional flow reserve (FFR) before transcatheter aortic valve implantation (TAVI).
Aims: This study sought to investigate the prognostic effect of a protocol with optimisation targets for intravascular ultrasound (IVUS)-guided left main (LM) revascularisation.
Methods And Results: A protocol was prospectively applied for IVUS-guided LM revascularisation (IVUS-PRO group) including predefined optimisation targets. Using propensity score matching, we selected as control groups patients with angiography-guided PCI (ANGIO group) and IVUS-guided PCI (IVUS group) from a large multicentre registry.
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics.
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