Papers by Xavier García-moll
European journal of preventive cardiology, Apr 9, 2024
European Heart Journal
Primary subanalysis pre-and post-PCI health check-up (n=31 887) The opinions expressed in this ar... more Primary subanalysis pre-and post-PCI health check-up (n=31 887) The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.
BMC Cardiovascular Disorders, Feb 10, 2023
Background Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused b... more Background Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. Methods Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48-72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, †
European Heart Journal, Aug 1, 2017
highest activity group had significantly higher NC to C ratio compared to lowest activity group (... more highest activity group had significantly higher NC to C ratio compared to lowest activity group (1.85±0.31 vs 1.63±0.35, p=0.04) (Figure ). Conclusions: In a middle-aged general population, we observed a greater degree of trabeculation in highly active people free from pre-existing cardiovascular disease. Our finding indicates that exercise-associated variation in LV trabeculation is not an athlete-specific phenomenon and trabeculation may be a sensitive phenotype which remodels in response to physical activity.
Frontiers in Cardiovascular Medicine, Jun 9, 2022
Background: Renal function in acute decompensated heart faiulre (ADHF) is a strong predictor of d... more Background: Renal function in acute decompensated heart faiulre (ADHF) is a strong predictor of disease evolution and poor outcome. Current biomarkers for early diagnostic of renal injury in the setting of ADHF are still controversial, and their association to early pathological changes needs to be established. By applying a proteomic approach, we aimed to identify early changes in the differential urine protein signature associated with development of renal injury in patients hospitalised due to ADHF. Materials and Methods: Patients (71 [64-77] years old) admitted at the emergency room with ADHF and hospitalised were investigated (N = 64). Samples (urine/serum) were collected at hospital admission (day 0) and 72 h later (day 3). Differential serum proteome was analysed by two-dimensional electrophoresis and matrix-assisted laser desorption/ionisation-time of flight (MALDI-ToF/ToF). Validation studies were performed using ELISA. Results: Proteomic analysis depicted urinary vitamin D binding protein (uVDBP) as a two spots protein with increased intensity in ADHF and significant differences depending on the glomerular filtration rate (GFR). Urinary VDBP in patients with ADHF at hospitalisation was > threefold higher than in healthy subjects, with the highest levels in those patients with ADHF already presenting renal dysfunction. At day 3, urine VDBP levels in patients maintaining normal renal function dropped to normal values (P = 0.03 vs. day 0). In contrast, urine VDBP levels remained elevated in the group developing renal injury, with values twofold above the normal range (P < 0.05), while serum creatinine and GF levels were within the physiological range in this group. Urinary VDBP in ADHF positively correlated with markers of renal injury such as cystatin C and Kidney Injury Molecule 1 (KIM-1). By ROC analysis, urinary VDBP, when added to cystatin C and KIM-1, improved the prediction of renal injury in patients with ADHF. We showed increased urine VDBP in patients with ADHF at hospital admission and a differential uVDBP evolution pattern at early stage of renal dysfunction, before pathological worsening of GFR is evidenced.
European Heart Journal, Sep 26, 2017
Circulation, Aug 29, 2000
Frontiers in Endocrinology
BackgroundLow-density lipoprotein receptor-related protein 1 (LRP1) negatively modulates circulat... more BackgroundLow-density lipoprotein receptor-related protein 1 (LRP1) negatively modulates circulating atrial natriuretic peptide (ANP) levels. Both molecules are involved in the regulation of cardiometabolism.ObjectivesTo evaluate soluble LRP1 (sLRP1) and ANP levels in people with newly diagnosed type 2 diabetes mellitus (T2DM) and determine the effects of metabolic optimization.MethodsThis single-center longitudinal observational study recruited patients with newly diagnosed T2DM (n = 29, HbA1c > 8.5%), and 12 healthy control, age- and sex-matched volunteers. sLRP1 and ANP levels were measured by immunoassays at T2DM onset and at one year after optimization of glycemic control (HbA1c ≤ 6.5%).ResultsT2DM had higher sLRP1 levels than the control group (p = 0.014) and lower ANP levels (p =0.002). At 12 months, 23 T2DM patients reached the target of HbA1c ≤ 6.5%. These patients significantly reduced sLRP1 and increased ANP levels. Patients who did not achieve HbA1c < 6.5% failed t...
Journal of Clinical Medicine
Patients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk ... more Patients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk of developing major adverse cardiovascular events (MACE). This is a multicenter, retrospective, and observational study performed in Spain aimed to characterize these patients in a real-world setting. Unstructured data from the Electronic Health Records were extracted by EHRead®, a technology based on Natural Language Processing and machine learning. The association between new MACE and the variables of interest were investigated by univariable and multivariable analyses. From a source population of 2,184,662 patients, we identified 4072 adults diagnosed with T2DM and CAD (62.2% male, mean age 70 ± 11). The main comorbidities observed included arterial hypertension, hyperlipidemia, and obesity, with metformin and statins being the treatments most frequently prescribed. MACE development was associated with multivessel (Hazard Ratio (HR) = 2.49) and single coronary vessel disease (HR = 1.7...
Journal of Clinical Medicine
This study was aimed to ascertain the clinical profile and management of patients with ischemic h... more This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = ...
European Heart Journal, 2017
Background: Transcutaneous electrical nerve stimulation (TENS) improves quality of life of patien... more Background: Transcutaneous electrical nerve stimulation (TENS) improves quality of life of patients with refractory angina (RA). However, the natural history and predictors of adverse outcome in series with long follow-up are not well-known. Purpose: To describe the clinical profile and long-term prognosis of patients with refractory angina with TENS. Methods: A cohort of 159 RA patients with TENS was prospectively followed for a median of 4.4 years. Baseline characteristics were compared with the last visit at follow-up at a RA clinic. Mixed-effects logistic regressions were used to identify independent predictors of mortality. Results: Clinical data are summarized in table. Mean age was 70.1 years and 59.7% were male. The mean number of vessels disease was 2.6, and the mean evolution of ischemic heart disease was 13.1 years. As compared with baseline, there was a significant reduction in the number of chest pain episodes per week (10.1 vs. 3.1, p<0.001) and consumption of sublingual nitrates per week ((9.5 vs. 2.6, p<0.001). 31 patients died (19.5%) and 39 (24.5%) were readmitted for acute coronary syndrome. The independent predictors of all-cause mortality were age (OR 1.08; CI 95%: 1.03-1.13), peripheral artery disease (OR 3.16; CI 95%: 1.29-7.74), and treatment with statins (OR 0.43; CI 95%: 0.20-0.96).
Revista Clínica Española, 2020
Insuficiencia cardiaca estable; Péptidos natriuréticos; Cardiología; Atención primaria Resumen Ob... more Insuficiencia cardiaca estable; Péptidos natriuréticos; Cardiología; Atención primaria Resumen Objetivo: Conocer la percepción y el manejo del cardiólogo clínico de la insuficiencia cardiaca con fracción de eyección reducida (IC-FER) y establecer un consenso con recomendaciones. Métodos: Se empleó el método Delphi modificado entre un panel de 150 expertos que respondieron un cuestionario que incluyó tres bloques: definición y percepción del paciente con IC-FER «estable» (15 afirmaciones), manejo del paciente con IC-FER «estable» (51 afirmaciones) y recomendaciones para optimizar el manejo y el seguimiento (9 afirmaciones). El nivel de acuerdo se evaluó utilizando una escala tipo Likert de 9 puntos. Resultados: Se llegó a un consenso de acuerdo en 49 afirmaciones, a un consenso en el desacuerdo en 16 y quedaron indeterminadas 10 afirmaciones. Hubo consenso en cuanto a la definición de IC «estable» (82%), en que la IC-FER tiene una naturaleza silenciosa que puede contribuir a aumentar el riesgo de muerte en pacientes poco sintomáticos (96%), y que independientemente de que el paciente con IC-FER se mantenga estable en la misma clase funcional el tratamiento farmacológico debe optimizarse (98,7%). En cambio, hubo consenso en el desacuerdo con respecto a que el tratamiento con un inhibidor de neprilisina y receptor de angiotensina solo está justificado cuando hay un empeoramiento de la clase funcional (90,7%). Conclusiones: El conocimiento actual sobre la IC «estable» es insuficiente; es necesaria la optimización del tratamiento, incluso en pacientes aparentemente estables, para disminuir el riesgo de progresión de la enfermedad.
European Heart Journal, 2017
200 Stable CAD density lipoprotein cholesterol (LDL-C) levels (p=0,001). Such duplex scanning ind... more 200 Stable CAD density lipoprotein cholesterol (LDL-C) levels (p=0,001). Such duplex scanning indicators as intima-media thickness in systole, intima-media thickness increasing, carotid stenosis degree, significantly different between groups with and without atherosclerotic plaques in carotid arteries (p=0,001, p=0,025 and p=0,001, respectively). Correlation analysis detect statistically significant positive correlations between Lp-PLA2 levels and total cholesterol (p=0,000, p=0,01, p=0,001, respectively); between Lp-PLA2 levels and LDL-C (p=0,000, p=0,03, p=0,000, respectively) in all 3 groups. Besides, it was determined that Lp-PLA2 levels positively correlates with intima-media thickness of carotid arteries increasing in patients of 2 and 3 groups (p=0,03 and p=0,000, respectively), which is not found in 1 group, where patients were without carotid atherosclerosis. Conclusion: A significant relationship between elevated Lp-PLA2 and the degree of carotid stenosis, and increased levels of total cholesterol, LDL-C. Elevated levels of Lp-PLA2 in serum, combined with the presence of increasing the degree of carotid stenosis, levels of total cholesterol, LDL-C, can be considered as probable risk factor for cardiovascular events.
European Heart Journal, 2017
Latest on STEMI 1203 (p=0.13 and p=0.05, respectively) and female gender was not significantly as... more Latest on STEMI 1203 (p=0.13 and p=0.05, respectively) and female gender was not significantly associated with mortality (HR 1.0 p=0.9 for female gender, HR 2.00 p<0.01 for age) Conclusions: Data from nation-wide registry of acute MI patients does not support existence of a significant gender difference in time to intervention. Apparent higher mortality of women in non-balanced sample may be explained by different age and clinical risk profile of female cases.
Nephrology Dialysis Transplantation, 2019
Ischaemic heart disease, sudden cardiac death and arrhythmias, heart failure, stroke and peripher... more Ischaemic heart disease, sudden cardiac death and arrhythmias, heart failure, stroke and peripheral arterial disease make up >50% of the causes of death in advanced chronic kidney disease (CKD). Calcification of the vascular tree and heart valves is partially related to these complications and has received growing attention in the literature. However, the main focus of research has been on the pathophysiology and consequences of vascular calcification, with less attention being paid to valvular calcification (VC) and its impact on the survival of CKD patients. Although VC has long been seen as an age-related degenerative disorder with minimal functional impact, several studies proved that it carries an increased risk of death and clinical consequences different from those of vascular calcification. In dialysis patients, the annual incidence of aortic valve calcification is nearly 3.3% and the reported prevalence of aortic and mitral VC varies between 25% and 59%. Moreover, calcif...
F1000Research, 2019
Introduction: Worldwide, near 200 million adults undergo major non cardiac surgery each year, a... more Introduction: Worldwide, near 200 million adults undergo major non cardiac surgery each year, and 10 million of them are estimated to suffer a myocardial injury after non-cardiac surgery (MINS), defined as an elevated high sensitive troponin T (hs-cTnT) in the first 3 days after surgery. Troponin levels need to be monitored in order to diagnose MINS, high sensitive cardiac Troponin T (hs-cTnT) assays being currently the most frequently used. Perioperative hs-cTnT screening could lead to care decisions that can potentially improve clinical outcomes. However, many of the clinical and economic implications of perioperative hs-cTnT monitoring remain unclear, and need to be elucidated. Methods and analysis: Prospective cohort that will include patients with high cardiovascular risk undergoing major non-cardiac surgery, expected to require at least an overnight hospital admission. Three determinations of hs-cTnT in each patient (before surgery, at 48, and 72 hours after surgery) will be...
Revista Española de Cardiología (English Edition), 2016
Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the ... more Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups.
Revista Española de Cardiología (English Edition), 2016
Revista Española de Cardiología, 2016
Journal of Clinical Medicine
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardia... more Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65–75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also ...
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Papers by Xavier García-moll