Person:
Escaned Barbosa, Javier

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First Name
Javier
Last Name
Escaned Barbosa
URI
https://hdl.handle.net/20.500.14352/78753
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Medicina
Department
Medicina
Area
Medicina
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2010 - 20152
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    Prognostic Implications of Bundle Branch Block in Patients Undergoing Primary Coronary Angioplasty in the Stent Era
    (American Journal of Cardiology, 2010) Vivas Balcones, Luis David; Pérez Vizcayno, María José; Fernández Ortiz, Antonio Ignacio; Bañuelos, Camino; Escaned Barbosa, Javier; Jiménez Quevedo, Pilar; De Agustín, José Alberto; Núñez Gil, Ivan; González Ferrer, Juan José; Macaya Miguel, Carlos; Alfonso Manterola, Fernando
    The presence of bundle branch block (BBB) in patients with ST-segment elevation myocardial infarction has been associated with a poor outcome. However, the implications of BBB in patients undergoing primary angioplasty in the stent era are poorly established. Furthermore, the prognostic implications of BBB type (right vs left and previous vs transient or persistent) remain unknown. We analyzed the data from 913 consecutive patients with ST-segment elevation myocardial infarction treated with primary angioplasty. All clinical, electrocardiographic, and angiographic data were prospectively collected. The median follow-up period was 19 months. The primary end point was the combined outcome of death and reinfarction. BBB was documented in 140 patients (15%). Right BBB (RBBB) was present in 119 patients (13%) and was previous in 27 (23%), persistent in 45 (38%), and transient in 47 (39%). Left BBB (LBBB) was present in 21 patients (2%) and was previous in 8 (38%), persistent in 9 (43%), and transient in 4 (19%). Patients with BBB were older, and more frequently had diabetes, anterior infarctions, a greater Killip class, a lower left ventricular ejection fraction, and greater mortality (all p <0.005) than patients without BBB. The short- and long-term primary outcome occurred more frequently in patients with persistent RBBB/LBBB than in those with previous or transient RBBB/LBBB. On multivariate analysis, persistent RBBB/LBBB emerged as an independent predictor of death and reinfarction. In conclusion, in patients undergoing primary angioplasty in the stent era, BBB is associated with poor short- and long-term prognosis. This risk appears to be particularly high among patients with persistent BBB
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    Platelet function in Takotsubo cardiomyopathy
    (Journal of Thrombosis and Thrombolysis, 2015) Núñez-Gil, Iván J; Bernardo, Esther; Feltes, Gisela; Escaned Barbosa, Javier; Mejía-Rentería, Hernán D; De Agustín, José Alberto; Vivas Balcones, Luis David; Nombela-Franco, Luis; Jiménez-Quevedo, Pilar; Macaya Miguel, Carlos; Fernández Ortiz, Antonio Ignacio
    Estudio observacional prospectivo donde se evaluó en 32 pacientes diagnosticados de miocardiopatía de estrés (Takotsubo) la reactividad plaquetaria, en comparación con pacientes con un síndrome coronario agudo “convencional” y voluntarios sanos. Los pacientes con Takotsubo presentaron mayores niveles de adrenalina, pero no hubo diferencias en la reactividad plaquetaria tras ajustar según el tratamiento antiagregante. Takotsubo cardiomyopathy (TK) includes a transient left ventricular dysfunction without obstructive coronary disease, sometimes after stressful situations with elevated cathecolamines. Since catecholamines activate platelets we aimed to study the platelet influence in a TK setting. We included 32 patients with a TK diagnosis, 13 with an acute coronary syndrome (ACS) and 18 healthy volunteers. Once consent informed was obtained, blood samples were extracted and processed (at admission and after 3 months follow-up). Clinical, ecg, echocardiographic and angiographic features were thoroughly recorded.Previous treatment before admission was similar between groups. No differences were observed in clinical features or any of the acute markers studied regarding platelet reactivity between TK compared to ACS. After follow-up, aggregation levels and platelet reactivity showed differences, mainly due to the antithrombotic therapy prescribed at discharge, but similar to volunteers. Circulating epinephrine during the acute phase was significantly higher in TK (p < 0.001). Patients with higher levels of epinephrine had elevated platelet activation and aggregation after 3 months. No differences were observed in Takotsubo acute platelet aggregation compared to patients with ACS, in spite of higher blood levels of adrenaline. Takotsubo patients had elevated platelet aggregation and activation compared with ACS patients at 3 months follow-up because they were less frequently on chronic clopidogrel and ASA. However, they had similar platelet aggregation and activation levels to healthy volunteers despite treatment with low-dose ASA. Takotsubo patients who had higher levels of adrenaline in the acute phase displayed increased platelet reactivity during follow-up.