Publications by authors named "Juan Cinca"
Analysis of the spatio-temporal distribution of calcium sparks showed a preferential increase in sparks near the sarcolemma in atrial myocytes from patients with atrial fibrillation (AF), linked to higher ryanodine receptor (RyR2) phosphorylation at s2808 and lower calsequestrin-2 levels. Mathematical modeling, incorporating modulation of RyR2 gating, showed that only the observed combinations of RyR2 phosphorylation and calsequestrin-2 levels can account for the spatio-temporal distribution of sparks in patients with and without AF. Furthermore, we demonstrate that preferential calcium release near the sarcolemma is key to a higher incidence and amplitude of afterdepolarizations in atrial myocytes from patients with AF.
View Article and Find Full Text PDFCharacterization of atrial myocardial infarction is hampered by the frequent concurrence of ventricular infarction. Theoretically, atrial infarct scarring could be recognized by multifrequency tissue impedance, like in ventricular infarction, but this remains to be proven. This study aimed at developing a model of atrial infarction to assess the potential of multifrequency impedance to recognize areas of atrial infarct scar.
View Article and Find Full Text PDFAims: Atrial fibrillation (AF) has been associated with excessive spontaneous calcium release, linked to cyclic AMP (cAMP)-dependent phosphorylation of calcium regulatory proteins. Because β-blockers are expected to attenuate cAMP-dependent signaling, we aimed to examine whether the treatment of patients with β-blockers affected the incidence of spontaneous calcium release events or transient inward currents (I).
Methods: The impact of treatment with commonly used β-blockers was analyzed in human atrial myocytes from 371 patients using patch-clamp technique, confocal calcium imaging or immunofluorescent labeling.
Article Synopsis
- The study investigates the use of Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock, focusing on determining optimal flow rates and identifying risk factors for high ECMO flow.
- Out of 209 patients analyzed over seven years, 50% were classified as 'high-flow', exhibiting more severe conditions at admission compared to the 'low-flow' group.
- The findings revealed that while high-flow patients experienced more complications and a higher incidence of ventilator-associated pneumonia, there was no significant difference in overall lengths of stay or survival rates between the two groups.
Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up.
View Article and Find Full Text PDFMost multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. We included 830 patients enrolled consecutively in a prospective multicenter registry.
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- The study looks at how β-adrenergic stimulation changes how calcium is released from special clusters in heart cells called RyR2 clusters, which can lead to calcium waves.
- Researchers used fluorescent techniques to track calcium release in heart cells from mice and human tissue, finding most calcium "sparks" come from a single cluster.
- They discovered that β-adrenergic stimulation increases the size and number of these calcium sparks, which is similar to changes seen in patients with a heart condition called atrial fibrillation.
Awake venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock.
Eur Heart J Acute Cardiovasc Care
August 2021
Article Synopsis
- VA-ECMO is a key treatment for severe cardiogenic shock, but its use is complicated by risks associated with mechanical ventilation.
- A study analyzed data from 231 patients to compare outcomes between those kept awake during VA-ECMO (awake ECMO) and those who required more sedation (non-awake ECMO).
- The results showed that awake ECMO resulted in lower rates of pneumonia, fewer complications, and reduced mortality at both 60 days and one year compared to non-awake ECMO patients.
Article Synopsis
- * Results showed that men with AF had a lower L-type calcium current density compared to those without, while women with AF exhibited increased inward currents and more frequent calcium sparks.
- * The findings suggest that calcium regulation issues in AF are influenced by sex, highlighting increased calcium release and electrical activity in women, but decreased calcium current in men.
Background: Differentiation between exercise induced adaptive myocardial hypertrophy (athlete's heart) and hypertrophic cardiomyopathy (HCM) is currently based on echocardiographic and cardiac magnetic resonance (CMR) criteria, but these may be insufficient in patients with subtle phenotype expression. This study aimed to assess whether left ventricular (LV) fractal pattern could permit to differentiate athlete's heart from HCM.
Methods: We recruited retrospectively 61 elite marathon runners, 67 patients with HCM, and 33 healthy subjects.
Modes of death in patients with heart failure (HF) have been well characterized in randomized studies, but data from real-life are scarce, especially in the elderly, women and in HF with mid-range or preserved left ventricular ejection fraction (LVEF). Our purpose was to examine modes of death in HF patients according to age, sex and LVEF. We analysed the mode of death of HF patients from two prospective multicentre contemporary Spanish registries conducted by cardiologists (REDINSCOR, n = 2150) and by internists (RICA, n = 1396).
View Article and Find Full Text PDFHeart failure (HF) is one of the main causes of morbidity, mortality, and high healthcare costs. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, reduced cardiovascular mortality and hospitalization for HF compared to placebo in patients with chronic HF, and reduced ejection fraction (EF) in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Our aim was to estimate the number of patients with DAPA-HF characteristics in Spain.
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- The study examines the prevalence and impact of residual pulmonary congestion in heart failure patients at discharge, using lung ultrasound (LUS) to identify subclinical congestion.
- Results showed that, despite 81% of patients appearing 'dry' during physical exams, 41 out of 100 had subclinical congestion indicated by ≥5 B-lines on LUS.
- The presence of subclinical pulmonary congestion was linked to worse outcomes such as rehospitalization or death within 6 months, with related factors including anemia and higher NYHA class.
Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI).
View Article and Find Full Text PDFBackground: Atrial coronary branch occlusion is a hardly recognizable clinical entity that can promote atrial fibrillation. The low diagnostic accuracy of the ECG could deal with the characteristics of the ischemia-induced changes in local atrial electrograms, but these have not been described.
Objectives: We analyzed the effects of selective acute atrial branch occlusion on local myocardial structure, atrial electrograms, and surface ECG in an experimental model close to human cardiac anatomy and electrophysiology.
Background: Hyponatraemia is common in patients with acute heart failure (HF).
Aims: To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF).
Methods: This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments.
Article Synopsis
- The study aimed to assess how heart rate at admission, discharge, and the difference between the two affects long-term outcomes in acute heart failure patients with either sinus rhythm or atrial fibrillation.
- It included 1398 patients and found that only the heart rate at discharge was linked to one-year mortality, with higher rates indicating a greater risk for both sinus rhythm and atrial fibrillation patients.
- The conclusions suggest that a lower discharge heart rate is associated with better long-term outcomes in these patients, while admission heart rate and the difference didn't show significant prognostic impact.
Introduction And Objectives: In patients with heart failure and reduced ejection fraction (HFrEF), several therapies have been proven to reduce mortality in clinical trials. However, there are few data on the effect of the use of evidence-based therapies on causes of death in clinical practice.
Methods: This study included 2351 outpatients with HFrEF (< 40%) from 2 multicenter prospective registries: MUSIC (n=641, period: 2003-2004) and REDINSCOR I (n=1710, period: 2007-2011).
Background: Identifying readmission predictors in heart failure (HF) patients may help guide preventative efforts and save costs. We aimed to identify 15- and 30-day readmission predictors due to cardiovascular reasons.
Methods And Results: A total of 1831 patients with acute HF admission were prospectively followed during a year.
Aims: Lung ultrasound (LUS) is a useful tool with which to assess subclinical pulmonary congestion and to stratify the prognosis of patients with heart failure (HF). The aim of this study was to evaluate whether an LUS-guided follow-up protocol improves the outcomes of patients with HF.
Methods And Results: In this single-blind clinical trial, 123 patients admitted for HF were randomized to either a standard follow-up (n = 62, control group) or a LUS-guided follow-up (n = 61, LUS group).
Background: Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalisation.
Aim: To determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups.
Methods: Multicentre prospective registry in 20 Spanish hospitals.
Electrocardiographic (ECG) diagnosis of acute myocardial ischemia is hampered in the presence of left bundle branch block (LBBB). We analyzed the influence of location and duration of myocardial ischemia on the ECG changes in pigs with LBBB. LBBB was acutely induced in 14 closed chest anesthetized pigs by local electrical ablation.
View Article and Find Full Text PDFPreviously reported electrocardiographic (ECG) criteria to distinguish left circumflex (LCCA) and right coronary artery (RCA) occlusion in patients with acute inferior ST-segment elevation myocardial infarction (STEMI) afford a modest diagnostic accuracy. We aimed to develop a new algorithm overcoming limitations of previous studies. Clinical, ECG, and coronary angiographic data were analyzed in 230 nonselected patients with acute inferior STEMI who underwent primary percutaneous coronary intervention.
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