Background: Several studies have evaluated the association between lipoprotein(a) plasma levels [... more Background: Several studies have evaluated the association between lipoprotein(a) plasma levels [Lp(a)] and the occurrence of aortic valve stenosis related events, with contradictory results. Objective: The main objective of this systematic review was to analyze the predictive capacity of elevated Lp(a) levels on major clinical events associated with aortic valve stenosis. Methods: This systematic review was conducted in accordance with PRISMA and STROBE recommendations. A search was carried out in order to identify studies with a cohort design evaluating the association between Lp(a) levels and the events of interest. The primary endpoint was the incidence of clinical events related with aortic valve stenosis (aortic valve replacement, death or hospitalization). This review was registered in PROSPERO. Results: Seven observational studies with a total of 58 783 patients were eligible for analysis. Our findings showed that the presence of elevated Lp(a) levels was associated with an ...
Francisco J Romeo, Maximiliano Smietniansky, Mariela Cal, Cristian Garmendia, Juan M Valle Raleig... more Francisco J Romeo, Maximiliano Smietniansky, Mariela Cal, Cristian Garmendia, Juan M Valle Raleigh, Ignacio M. Seropian, Mariano Falconi, Pablo Oberti, Vadim Kotowicz, Carla R. Agatiello, Daniel H Berrocal Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Primary percutaneous coronary intervention (PCI) has become an alternative to thrombolytic therap... more Primary percutaneous coronary intervention (PCI) has become an alternative to thrombolytic therapy as a reperfusion strategy for ST-elevation acute myocardial infarction (AMI). The main goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates, as evidenced by ST-segment resolution. Secondary end points included infarct vessel patency rates before hospital discharge and short- and long-term outcomes. Patients with ischemic chest pain with duration < or =12 hours and no contraindication for thrombolytic therapy were included. Between October 1993 and August 1995, 58 patients were randomly assigned to streptokinase (SK) and 54 patients to primary PCI. Baseline clinical characteristics and infarct location were well balanced in both groups. Median age (interquartile range) was 68 (58, 75) years, 29% were women, and 78% of the patients met at least one criterion for "not low risk" AMI (anterior location, age >70 years old, previous MI, systolic blood pressure <100 mm Hg, and/or heart rate >100 bpm). The median time from symptom onset to random assignment was 217 (139, 335) minutes in the PCI group and 210 (145, 334) minutes in the SK group. Median random assignment to balloon time was 82 (55, 100) minutes, and median random assignment to needle time was 15 (10, 26) minutes (P <.0001). TIMI grade 3 flow after primary PCI was obtained in 85% of patients. The proportion of patients with ST-segment resolution > or =50% at 120 minutes was 80% in the PCI group and 50% in the SK group (P =.001). The predischarge angiogram showed the presence of TIMI 3 flow in 96% of patients who received PCI and 65% of…
In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours mis... more In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making.
Background Brain natriuretic peptide (BNP) and troponins are useful markers for risk stratificati... more Background Brain natriuretic peptide (BNP) and troponins are useful markers for risk stratification in pulmonary embolism (PE). However, it is not clear which of the two biomarkers has better association with the clinical severity of this condition. Objective The aim of this study was to assess both biomarkers in moderate and high risk populations. Methods A prospective study was undertaken to analyze all patients diagnosed with PE who had positive troponin I (TI) or BNP levels. An echocardiogram within the first 24 hours and clinical follow up during hospitalization were performed on these patients. A composite endpoint of death, recurrent PE, shock, hypotension, mechanical respiratory assistance and thrombolytic therapy was established. The association of both serum markers with the described events was assessed. Results Seventy one consecutive patients were included in this study. Patients with moderate or severe right ventricular dysfunction had higher BNP levels (661 pg/ml (420...
Background: Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shorten... more Background: Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shortening, may help to improve risk stratification in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) especially in those with preserved left ventricular ejection fraction (LVEF). We investigated the association between MCF and 1-year all-cause mortality in patients with severe AS who underwent TAVR. Methods: MCF was calculated as the ratio of stroke volume (SV) to myocardial volume. Patients referred for TAVR from 2011 to 2015 were eligible for inclusion and were divided into two groups according to the estimated MCF (MCF ≤30% vs. MCF >30%). The primary endpoint was 1-year all-cause mortality. A Cox regression analysis was performed for independent risk factors of mortality. Receiver operating curve (ROC) was performed for assessing the best cutoff point of MCF for predicting the primary outcome [area under the curve (AUC) 0.60; 95% confidence interval (CI): 0.453-0.725]. Baseline patient and echo characteristics were included for multivariate analysis. Results: Of 126 patients (mean age 82±5 years, 45.2% male), 44.4% showed MCF ≤30%. Patient with reduced MCF showed higher body mass index (28.1±5.8 vs. 26.0±4.5 kg/m 2 , P=0.031), higher surgical EuroScore II (6.2±4.5 vs. 4.7±3.2, P=0.032), lower LVEF (54.2%±11.9% vs. 58.5%±10.8%, P=0.042) and more severe AS (indexed aortic valve area 0.40±0.09 vs. 0.45±0.10 cm 2 /m 2 , P=0.030). The median followup was of 14 [3.5-33] months, and 16% of patients died. Patients with MCF ≤30% showed significantly increased all-cause mortality (Log-rank P=0.002). In a multivariate model adjusting for clinical and echo variables, MCF ≤30% was independently associated with increased risk for all-cause 1-year mortality [hazard ratio (HR) 2.76, 95% CI: 1.03-7.77, P=0.04]. Conclusions: In a population of patients undergoing TAVR, MCF ≤30% was independently associated with increased mortality.
ObjetivoEvaluar un puntaje que incorpore variables clínicas, ecocardiográficas y de ejercicio que... more ObjetivoEvaluar un puntaje que incorpore variables clínicas, ecocardiográficas y de ejercicio que identifiquen peor evolución en pacientes con insuficiencia mitral grave de causa orgánica asintomáticos.Material y métodosSe evaluaron 375 pacientes asintomáticos con insuficiencia mitral grave de causa orgánica (61 ± 10 años, 63% hombres, fracción de eyección del ventrículo izquierdo [FEVI] 67% ± 5%). Se elaboró un puntaje basado en la presencia de fibrilación auricular, diámetro de fin de sístole = 40 mm, orificio regurgitante efectivo > 55 mm2, volumen auricular izquierdo > 120 cm3, edad > 60 años, tiempo de ejercicio < 7 minutos. El rango del puntaje fue de 0-6,5. El punto final primario fue desarrollo de síntomas y/o disfunción ventricular (caída de la FEVI > 5% o FEVI < 60%). Los puntos secundarios fueron síntomas aislados, disfunción ventricular aislada, muerte cardíaca y cirugía valvular.ResultadosDurante un seguimiento promedio de 10 ± 3,5 años, 145 pacientes ...
Resumen es: Antecedentes Pacientes asintomaticos con insuficiencia aortica (IA) grave y funcion v... more Resumen es: Antecedentes Pacientes asintomaticos con insuficiencia aortica (IA) grave y funcion ventricular normal pueden desarrollar sintomas y disfuncion ventricul...
Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usuall... more Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usually mentioned as a relative contraindication for inclusion in the list of heart transplantation since it is associated with failure of the implanted right ventricle. There is evidence suggesting that the behavior of the pulmonary circulation depends on its interaction with theright ventricle, so a parameter that evaluates ventricular-arterial coupling could predict right ventricular failure better than isolated hemodynamic parameters. Objective: The aim of this study was to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PSP) to predict the incidence of post-transplantation right ventricular failure compared with invasive hemodynamic parameters measured before transplantation. Methods: This was a retrospective cohort study using variables prospectively collected from the heart transplantation database of a University Hospital of...
Resumen es: Objetivo Evaluar la gravedad de la ateromatosis de la aorta toracica y su relacion co... more Resumen es: Objetivo Evaluar la gravedad de la ateromatosis de la aorta toracica y su relacion con la mortalidad y los eventos vasculares cerebrales y coronarios. Ma...
Background: Several studies have evaluated the association between lipoprotein(a) plasma levels [... more Background: Several studies have evaluated the association between lipoprotein(a) plasma levels [Lp(a)] and the occurrence of aortic valve stenosis related events, with contradictory results. Objective: The main objective of this systematic review was to analyze the predictive capacity of elevated Lp(a) levels on major clinical events associated with aortic valve stenosis. Methods: This systematic review was conducted in accordance with PRISMA and STROBE recommendations. A search was carried out in order to identify studies with a cohort design evaluating the association between Lp(a) levels and the events of interest. The primary endpoint was the incidence of clinical events related with aortic valve stenosis (aortic valve replacement, death or hospitalization). This review was registered in PROSPERO. Results: Seven observational studies with a total of 58 783 patients were eligible for analysis. Our findings showed that the presence of elevated Lp(a) levels was associated with an ...
Francisco J Romeo, Maximiliano Smietniansky, Mariela Cal, Cristian Garmendia, Juan M Valle Raleig... more Francisco J Romeo, Maximiliano Smietniansky, Mariela Cal, Cristian Garmendia, Juan M Valle Raleigh, Ignacio M. Seropian, Mariano Falconi, Pablo Oberti, Vadim Kotowicz, Carla R. Agatiello, Daniel H Berrocal Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Primary percutaneous coronary intervention (PCI) has become an alternative to thrombolytic therap... more Primary percutaneous coronary intervention (PCI) has become an alternative to thrombolytic therapy as a reperfusion strategy for ST-elevation acute myocardial infarction (AMI). The main goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates, as evidenced by ST-segment resolution. Secondary end points included infarct vessel patency rates before hospital discharge and short- and long-term outcomes. Patients with ischemic chest pain with duration &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =12 hours and no contraindication for thrombolytic therapy were included. Between October 1993 and August 1995, 58 patients were randomly assigned to streptokinase (SK) and 54 patients to primary PCI. Baseline clinical characteristics and infarct location were well balanced in both groups. Median age (interquartile range) was 68 (58, 75) years, 29% were women, and 78% of the patients met at least one criterion for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;not low risk&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; AMI (anterior location, age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years old, previous MI, systolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;100 mm Hg, and/or heart rate &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 bpm). The median time from symptom onset to random assignment was 217 (139, 335) minutes in the PCI group and 210 (145, 334) minutes in the SK group. Median random assignment to balloon time was 82 (55, 100) minutes, and median random assignment to needle time was 15 (10, 26) minutes (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). TIMI grade 3 flow after primary PCI was obtained in 85% of patients. The proportion of patients with ST-segment resolution &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =50% at 120 minutes was 80% in the PCI group and 50% in the SK group (P =.001). The predischarge angiogram showed the presence of TIMI 3 flow in 96% of patients who received PCI and 65% of…
In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours mis... more In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making.
Background Brain natriuretic peptide (BNP) and troponins are useful markers for risk stratificati... more Background Brain natriuretic peptide (BNP) and troponins are useful markers for risk stratification in pulmonary embolism (PE). However, it is not clear which of the two biomarkers has better association with the clinical severity of this condition. Objective The aim of this study was to assess both biomarkers in moderate and high risk populations. Methods A prospective study was undertaken to analyze all patients diagnosed with PE who had positive troponin I (TI) or BNP levels. An echocardiogram within the first 24 hours and clinical follow up during hospitalization were performed on these patients. A composite endpoint of death, recurrent PE, shock, hypotension, mechanical respiratory assistance and thrombolytic therapy was established. The association of both serum markers with the described events was assessed. Results Seventy one consecutive patients were included in this study. Patients with moderate or severe right ventricular dysfunction had higher BNP levels (661 pg/ml (420...
Background: Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shorten... more Background: Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shortening, may help to improve risk stratification in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) especially in those with preserved left ventricular ejection fraction (LVEF). We investigated the association between MCF and 1-year all-cause mortality in patients with severe AS who underwent TAVR. Methods: MCF was calculated as the ratio of stroke volume (SV) to myocardial volume. Patients referred for TAVR from 2011 to 2015 were eligible for inclusion and were divided into two groups according to the estimated MCF (MCF ≤30% vs. MCF >30%). The primary endpoint was 1-year all-cause mortality. A Cox regression analysis was performed for independent risk factors of mortality. Receiver operating curve (ROC) was performed for assessing the best cutoff point of MCF for predicting the primary outcome [area under the curve (AUC) 0.60; 95% confidence interval (CI): 0.453-0.725]. Baseline patient and echo characteristics were included for multivariate analysis. Results: Of 126 patients (mean age 82±5 years, 45.2% male), 44.4% showed MCF ≤30%. Patient with reduced MCF showed higher body mass index (28.1±5.8 vs. 26.0±4.5 kg/m 2 , P=0.031), higher surgical EuroScore II (6.2±4.5 vs. 4.7±3.2, P=0.032), lower LVEF (54.2%±11.9% vs. 58.5%±10.8%, P=0.042) and more severe AS (indexed aortic valve area 0.40±0.09 vs. 0.45±0.10 cm 2 /m 2 , P=0.030). The median followup was of 14 [3.5-33] months, and 16% of patients died. Patients with MCF ≤30% showed significantly increased all-cause mortality (Log-rank P=0.002). In a multivariate model adjusting for clinical and echo variables, MCF ≤30% was independently associated with increased risk for all-cause 1-year mortality [hazard ratio (HR) 2.76, 95% CI: 1.03-7.77, P=0.04]. Conclusions: In a population of patients undergoing TAVR, MCF ≤30% was independently associated with increased mortality.
ObjetivoEvaluar un puntaje que incorpore variables clínicas, ecocardiográficas y de ejercicio que... more ObjetivoEvaluar un puntaje que incorpore variables clínicas, ecocardiográficas y de ejercicio que identifiquen peor evolución en pacientes con insuficiencia mitral grave de causa orgánica asintomáticos.Material y métodosSe evaluaron 375 pacientes asintomáticos con insuficiencia mitral grave de causa orgánica (61 ± 10 años, 63% hombres, fracción de eyección del ventrículo izquierdo [FEVI] 67% ± 5%). Se elaboró un puntaje basado en la presencia de fibrilación auricular, diámetro de fin de sístole = 40 mm, orificio regurgitante efectivo > 55 mm2, volumen auricular izquierdo > 120 cm3, edad > 60 años, tiempo de ejercicio < 7 minutos. El rango del puntaje fue de 0-6,5. El punto final primario fue desarrollo de síntomas y/o disfunción ventricular (caída de la FEVI > 5% o FEVI < 60%). Los puntos secundarios fueron síntomas aislados, disfunción ventricular aislada, muerte cardíaca y cirugía valvular.ResultadosDurante un seguimiento promedio de 10 ± 3,5 años, 145 pacientes ...
Resumen es: Antecedentes Pacientes asintomaticos con insuficiencia aortica (IA) grave y funcion v... more Resumen es: Antecedentes Pacientes asintomaticos con insuficiencia aortica (IA) grave y funcion ventricular normal pueden desarrollar sintomas y disfuncion ventricul...
Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usuall... more Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usually mentioned as a relative contraindication for inclusion in the list of heart transplantation since it is associated with failure of the implanted right ventricle. There is evidence suggesting that the behavior of the pulmonary circulation depends on its interaction with theright ventricle, so a parameter that evaluates ventricular-arterial coupling could predict right ventricular failure better than isolated hemodynamic parameters. Objective: The aim of this study was to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PSP) to predict the incidence of post-transplantation right ventricular failure compared with invasive hemodynamic parameters measured before transplantation. Methods: This was a retrospective cohort study using variables prospectively collected from the heart transplantation database of a University Hospital of...
Resumen es: Objetivo Evaluar la gravedad de la ateromatosis de la aorta toracica y su relacion co... more Resumen es: Objetivo Evaluar la gravedad de la ateromatosis de la aorta toracica y su relacion con la mortalidad y los eventos vasculares cerebrales y coronarios. Ma...
Uploads
Papers by Pablo Oberti