Biomedical subjects

M Jiménez-Navarro

Publications and source records attributed to M Jiménez-Navarro.

6 recordsLinked to original sources

PubMed2006

[Heart failure mortality in Spain: is there an andalusian paradox?].

Congestive heart failure has a high mortality, as reflected in different clinical trials and observational studies. Spain, as other countries around the Mediterranean basin, have a relatively low rate of coronary deaths, attributed to the so-called Mediterranean lifestyle. Andalusia, in the southern most part of Spain, constitutes the paradigm of Mediterranean lifestyle. However, different reports show that the prevalence of ischemic heart disease is higher in Andalusia than in other zones of Spain. Thus the mortality rate due to heart failure in Spain in the year 2000 per 100,000 inhabitants was 27.3 in men and 28.88 in women and each one of the eight Andalusia provinces had greater rates than the national mean in both men and woman. Even in countries with a relatively low prevalence of coronary heart disease as is the case in Spain, heart failure mortality seems to be parallel to local differences in IHD prevalence.

Adolescent↗

PubMed2001

Does angina the week before protect against first myocardial infarction in elderly patients?

Mortality rates for coronary artery disease are greater in elderly patients. Although prodromal angina occurring shortly before an acute myocardial infarction (MI) has protective effects against ischemia, this effect has not been well documented in older patients. This study investigated whether angina 1 week before a first MI provides protection in this group of patients. A total of 290 consecutive elderly (>64 years old, n = 143) and adult patients (<65 years old, n = 147) with a first MI were examined to assess the effect of preceding angina on the short- and long-term prognosis. Elderly patients with a history of prodromal angina were less likely than those without angina to experience in-hospital death, heart failure, or the combined end point of in-hospital death and heart failure (6% vs 20.4%, p = 0.02; 10% vs 23.7%, p = 0.07; 14% vs 32.3%, p = 0.01, respectively). Left ventricular function was more frequently depressed (ejection fraction <40%) in elderly patients without (44.8%) than with (26%, p = 0.04) preinfarction angina, and the incidence of arrhythmias (complete heart block and ventricular fibrillation) was greater in the former group (16.1% vs 4%, p = 0.03). Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of in-hospital death and heart failure in older patients (odds ratio 0.28, p = 0.009). The occurrence of angina 1 week before a first MI may confer protection against in-hospital adverse outcomes, and may preserve left ventricular function in older patients.

Aged↗

PubMed2001

[The influence of angina the week before a first myocardial infarction on short and medium-term prognosis].

INTRODUCTION AND OBJECTIVES: The implications of early angina on the prognosis of myocardial infarction are controversial. The aim of this study was to assess the effect of angina one week before the first myocardial infarction on short and medium-term prognosis. PATIENTS AND METHOD: A total of 290 consecutive patients (107 with previous angina and 183 without it) with the first myocardial infarction were studied to determine the effect of preceding angina on short and medium-term prognosis. Further criteria for inclusion were no previous history of angina > 1 week before the first myocardial infarction, and no evidence of prior structural cardiopathy. The end points studied were death and congestive heart failure in the acute phase of myocardial infarction and during the follow-up. RESULTS: Patients with a history of prodromal angina were less likely to experience in-hospital death, heart failure or combined end-point (3.7 vs 11.5%; 4.6 vs 15.8%; 7.5 vs 21.3%) (p = 0.002). There was also a difference between groups in the follow-up (4.1 vs 13.2%; p = 0.03). Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of death and heart failure in the acute phase of myocardial infarction as well as in the follow-up. CONCLUSIONS: The occurrence of angina one week before the first myocardial infarction protects against death and heart failure in the acute phase of myocardial infarction as well as in the medium follow-up.

Analysis of Variance↗

PubMed2001

Measurement of fractional flow reserve to assess moderately severe coronary lesions: correlation with dobutamine stress echocardiography.

BACKGROUND: New techniques to evaluate coronary artery disease, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to determine the correlation between FFR and dobutamine stress echocardiography in patients with moderately severe coronary stenosis in order to judge the usefulness of FFR for commonly encountered clinical problems. METHODS AND RESULTS: We studied 21 patients with 23 moderately severe coronary artery stenoses on angiography. The FFR was calculated and dobutamine stress echocardiography was performed to detect ischemia. Of the 16 stenoses with a negative FFR (> or = 0.75), dobutamine echocardiography also was negative. In the seven stenoses with a positive FFR (< 0.75), dobutamine echocardiography was positive in three. The efficacy of FFR in detecting ischemia that was confirmed with stress echocardiography was sensitivity 100%, specificity 80%, positive and negative predictive value 42.8%, and 100%, respectively, with a global predictive value 82.6%. A moderate degree of correlation was found between the two diagnostic tests (kappa [kappa] = 0.51). CONCLUSIONS: FFR correlates moderately well with dobutamine stress echocardiography in the assessment of moderately severe lesions in patients for whom coronary arteriography is usually indicated. However, its high negative predictive value makes FFR a useful aid in reaching clinical decisions promptly in the hemodynamics laboratory.

Adult↗

PubMed2001

Clinical management of patients with coronary syndromes and negative fractional flow reserve findings.

AIMS: New interventional techniques to diagnose coronary artery stenosis, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to investigate the occurrence of cardiac events in patients with coronary syndromes and negative FFR findings in moderately severe coronary stenosis in order to determine the usefulness of this technique in predicting coronary events during follow-up for problems commonly encountered in clinical practice. A further objective was to evaluate the safety of deferring angioplasty in patients with a negative FFR result. METHODS: We studied 43 patients with 44 moderately severe coronary artery stenoses on angiography and FFR > or = 0.75. Mean age of the patients was 58 +/- 11.4 years. The indications for coronary angiography included recent unstable angina in 24 (55.8%) patients, recent acute myocardial infarction in 10 (23.2%) patients, 5 (11.6%) patients with a coronary stent who had symptoms of uncertain cause, and stable angina in 4 (9.3%) patients. RESULTS: During a mean follow-up period of 10.7 +/- 5.9 months, clinical events (unstable angina) occurred in five patients. In three patients, the initially investigated artery was involved, and in the two patients who required coronary revascularization, unstable angina was related with an artery different from the one studied initially. CONCLUSIONS: Patients with recent coronary syndromes and negative FFR findings in moderately severe coronary stenosis were unlikely to have cardiac events during a 10-month follow-up period. Our findings suggest that FFR is a potentially useful indicator of the likelihood of cardiac events and thus represents a useful aid in clinical decision-making in the hemodynamics laboratory. This diagnostic technique also is potentially useful in identifying patients for whom angioplasty can be safely deferred.

Adult↗

PubMed2000

Profiling risk from arrhythmic or hemodynamic death.

Congestive heart failure is increasing in prevalence and, despite recent advances in therapy, mortality remains high. Sudden cardiac death (SCD) represents a significant percentage of overall mortality, accounting for almost 1 in 2 deaths in patients with congestive heart failure. In patients with asymptomatic left ventricular dysfunction or mild degrees of functional impairement, overall annual mortality is low, although a significant portion of the deaths are sudden; on the other hand, in advanced heart failure annual mortality increases, but SCD contributes to it to a lesser degree. The mechanisms of SCD in heart failure are multiple, including ventricular tachycardia/ventricular fibrillation, bradyarrhythmias, electromechanical dissociation, acute coronary events, and thromboembolic events. Only a minority of patients with advanced heart failure or on the waiting list for heart transplant experience SCD as a consequence of ventricular tachycardia (VT) or ventricular fibrillation (VF). The availability of effective therapies to prevent sudden arrhythmic death, such as that provided by automatic implantable cardioverter defibrillators, may help to reduce the burden of SCD in congestive heart failure, but major efforts will be needed to identify the candidates who may benefit from this approach.

Arrhythmias, Cardiac↗