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Jaume Figueras - One of the best experts on this subject based on the ideXlab platform.
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predictors of moderate to severe pericardial effusion cardiac tamponade and Electromechanical Dissociation in patients with st elevation myocardial infarction
American Journal of Cardiology, 2014Co-Authors: Jaume Figueras, Jose A Barrabes, Rosamaria Lidon, Antonia Sambola, Jordi Baneras, Jose Rodriguez F Palomares, Gerard Marti, David Garcia DoradoAbstract:Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden Electromechanical Dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p
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changes in hospital mortality rates in 425 patients with acute st elevation myocardial infarction and cardiac rupture over a 30 year period
Circulation, 2008Co-Authors: Jaume Figueras, Jose A Barrabes, Josefa Cortadellas, Oscar Alcalde, Vicens Serra, Joan Alguersuari, Rosamaria LidonAbstract:Background— Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. Methods and Results— The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006). Of a total of 6678 consecutive patients, 425 experienced a free wall rupture (280 with cardiac tamponade: 227 with Electromechanical Dissociation and 53 with hypotension) or a septal rupture (145). After the exclusion of referrals from other centers (n=44), the incidence of definite cardiac rupture (septal rupture, anatomic evidence of free wall rupture, or Electromechanical Dissociation) declined progressively (6.2% in 1977 to 1982 to 3.2% in 2001 to 2006; P<0.001) in parallel with a progressive use of reperfusion therapy (0% to 75.1%; P<0.001). In addition, amo...
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Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction.
Journal of the American College of Cardiology, 1997Co-Authors: Jaume Figueras, Josefa Cortadellas, Arturo Evangelista, Jordi Soler-solerAbstract:Abstract Objectives. This study sought to evaluate the effects of prolonged rest and blood pressure control on survival of patients in whom left ventricular free wall rupture (LVFWR) was strongly suspected. Background. Left ventricular free wall rupture in myocardial infarction is often fatal, and only a few patients may undergo operation. However, survival without surgical repair has not yet been evaluated. Methods. Eighty-one consecutive patients with a first transmural acute myocardial infarction in Killip class I or II who presented with acute hypotension due to cardiac tamponade, with Electromechanical Dissociation (EMD) in 72, were prospectively evaluated. Patients with early recovery were managed with prolonged bed rest and blood pressure control with beta-blockade as tolerated. Results. Forty-seven patients died within 2 h of acute tamponade, and autopsy in 21 showed LVFWR in all. In 15 others, an emergency surgical repair resulted in 2 survivors. The remaining 19 patients, 10 with EMD, had early recovery with dobutamine and colloid solution, and 15 required pericardiocentesis. Shortly thereafter, these 19 patients still showed a paradoxic pulse ≥20 mm Hg, relevant pericardial effusion (24 ± 7 mm [mean ± SD]) and comparable elevation of right and left ventricular filling pressures (15.8 ± 3.9 and 15.9 ± 3.8 mm Hg, respectively). Subsequent management included bed rest (8.2 ± 4.8 days) and control of systolic blood pressure (≤120 mm Hg) with beta-adrenergic blocking agents as tolerated (n = 12). Four patients died, and autopsy in three revealed a rupture that was sealed in two. A sealed rupture was also seen at thoracotomy in 2 other patients who, like the remaining 13, survived for 52.5 ± 35.2 months. Conclusions. Long-term survival of selected patients with prompt hemodynamic recovery after LVFWR is possible without surgical repair. Prolonged bed rest and blood pressure control are likely to contribute favorably to their initial outcome. (J Am Coll Cardiol 1997;29:512–8)
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reliability of Electromechanical Dissociation in the diagnosis of left ventricular free wall rupture in acute myocardial infarction
American Heart Journal, 1996Co-Authors: Jaume Figueras, Antoni Curos, Josefa Cortadellas, Jorge SolersolerAbstract:The reliability of Electromechanical Dissociation (EMD) in diagnosing acute left ventricular free wall rupture (LVFWR) was assessed in 479 consecutive patients with acute myocardial infarction (AMI). EMD was the mechanism of death in 193 patients, 140 without heart failure (group A, 74%), and 53 with heart failure (group B, 26%). Autopsies performed on 121 patients with EMD showed LVFWR in 81 (95%) of 85 from group A and in 7 (17%) of 36 from group B. Of the 106 patients without EMD (group C) autopsied, 5 (4.7%) had LVFWR. Excluding the eight patients with associated septal rupture, LVFWR occurred in 79 (95.2%) of 83 patients from group A, 4 (12.1%) of 33 from group B, and 2 (1.9%) of 103 from group C. Predictive accuracy of EMD for LVFWR in group A was 95% but only 17% in group B. Moreover, in 13 consecutive cases with a first AMI without heart failure and EMD, emergency surgery demonstrated LVFWR in all. Thus EMD has a highly predictive accuracy in diagnosing LVFWR in patients with a first AMI without overt heart failure.
Rosamaria Lidon - One of the best experts on this subject based on the ideXlab platform.
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predictors of moderate to severe pericardial effusion cardiac tamponade and Electromechanical Dissociation in patients with st elevation myocardial infarction
American Journal of Cardiology, 2014Co-Authors: Jaume Figueras, Jose A Barrabes, Rosamaria Lidon, Antonia Sambola, Jordi Baneras, Jose Rodriguez F Palomares, Gerard Marti, David Garcia DoradoAbstract:Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden Electromechanical Dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p
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changes in hospital mortality rates in 425 patients with acute st elevation myocardial infarction and cardiac rupture over a 30 year period
Circulation, 2008Co-Authors: Jaume Figueras, Jose A Barrabes, Josefa Cortadellas, Oscar Alcalde, Vicens Serra, Joan Alguersuari, Rosamaria LidonAbstract:Background— Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. Methods and Results— The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006). Of a total of 6678 consecutive patients, 425 experienced a free wall rupture (280 with cardiac tamponade: 227 with Electromechanical Dissociation and 53 with hypotension) or a septal rupture (145). After the exclusion of referrals from other centers (n=44), the incidence of definite cardiac rupture (septal rupture, anatomic evidence of free wall rupture, or Electromechanical Dissociation) declined progressively (6.2% in 1977 to 1982 to 3.2% in 2001 to 2006; P<0.001) in parallel with a progressive use of reperfusion therapy (0% to 75.1%; P<0.001). In addition, amo...
Josefa Cortadellas - One of the best experts on this subject based on the ideXlab platform.
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changes in hospital mortality rates in 425 patients with acute st elevation myocardial infarction and cardiac rupture over a 30 year period
Circulation, 2008Co-Authors: Jaume Figueras, Jose A Barrabes, Josefa Cortadellas, Oscar Alcalde, Vicens Serra, Joan Alguersuari, Rosamaria LidonAbstract:Background— Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. Methods and Results— The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006). Of a total of 6678 consecutive patients, 425 experienced a free wall rupture (280 with cardiac tamponade: 227 with Electromechanical Dissociation and 53 with hypotension) or a septal rupture (145). After the exclusion of referrals from other centers (n=44), the incidence of definite cardiac rupture (septal rupture, anatomic evidence of free wall rupture, or Electromechanical Dissociation) declined progressively (6.2% in 1977 to 1982 to 3.2% in 2001 to 2006; P<0.001) in parallel with a progressive use of reperfusion therapy (0% to 75.1%; P<0.001). In addition, amo...
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Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction.
Journal of the American College of Cardiology, 1997Co-Authors: Jaume Figueras, Josefa Cortadellas, Arturo Evangelista, Jordi Soler-solerAbstract:Abstract Objectives. This study sought to evaluate the effects of prolonged rest and blood pressure control on survival of patients in whom left ventricular free wall rupture (LVFWR) was strongly suspected. Background. Left ventricular free wall rupture in myocardial infarction is often fatal, and only a few patients may undergo operation. However, survival without surgical repair has not yet been evaluated. Methods. Eighty-one consecutive patients with a first transmural acute myocardial infarction in Killip class I or II who presented with acute hypotension due to cardiac tamponade, with Electromechanical Dissociation (EMD) in 72, were prospectively evaluated. Patients with early recovery were managed with prolonged bed rest and blood pressure control with beta-blockade as tolerated. Results. Forty-seven patients died within 2 h of acute tamponade, and autopsy in 21 showed LVFWR in all. In 15 others, an emergency surgical repair resulted in 2 survivors. The remaining 19 patients, 10 with EMD, had early recovery with dobutamine and colloid solution, and 15 required pericardiocentesis. Shortly thereafter, these 19 patients still showed a paradoxic pulse ≥20 mm Hg, relevant pericardial effusion (24 ± 7 mm [mean ± SD]) and comparable elevation of right and left ventricular filling pressures (15.8 ± 3.9 and 15.9 ± 3.8 mm Hg, respectively). Subsequent management included bed rest (8.2 ± 4.8 days) and control of systolic blood pressure (≤120 mm Hg) with beta-adrenergic blocking agents as tolerated (n = 12). Four patients died, and autopsy in three revealed a rupture that was sealed in two. A sealed rupture was also seen at thoracotomy in 2 other patients who, like the remaining 13, survived for 52.5 ± 35.2 months. Conclusions. Long-term survival of selected patients with prompt hemodynamic recovery after LVFWR is possible without surgical repair. Prolonged bed rest and blood pressure control are likely to contribute favorably to their initial outcome. (J Am Coll Cardiol 1997;29:512–8)
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reliability of Electromechanical Dissociation in the diagnosis of left ventricular free wall rupture in acute myocardial infarction
American Heart Journal, 1996Co-Authors: Jaume Figueras, Antoni Curos, Josefa Cortadellas, Jorge SolersolerAbstract:The reliability of Electromechanical Dissociation (EMD) in diagnosing acute left ventricular free wall rupture (LVFWR) was assessed in 479 consecutive patients with acute myocardial infarction (AMI). EMD was the mechanism of death in 193 patients, 140 without heart failure (group A, 74%), and 53 with heart failure (group B, 26%). Autopsies performed on 121 patients with EMD showed LVFWR in 81 (95%) of 85 from group A and in 7 (17%) of 36 from group B. Of the 106 patients without EMD (group C) autopsied, 5 (4.7%) had LVFWR. Excluding the eight patients with associated septal rupture, LVFWR occurred in 79 (95.2%) of 83 patients from group A, 4 (12.1%) of 33 from group B, and 2 (1.9%) of 103 from group C. Predictive accuracy of EMD for LVFWR in group A was 95% but only 17% in group B. Moreover, in 13 consecutive cases with a first AMI without heart failure and EMD, emergency surgery demonstrated LVFWR in all. Thus EMD has a highly predictive accuracy in diagnosing LVFWR in patients with a first AMI without overt heart failure.
Jose A Barrabes - One of the best experts on this subject based on the ideXlab platform.
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predictors of moderate to severe pericardial effusion cardiac tamponade and Electromechanical Dissociation in patients with st elevation myocardial infarction
American Journal of Cardiology, 2014Co-Authors: Jaume Figueras, Jose A Barrabes, Rosamaria Lidon, Antonia Sambola, Jordi Baneras, Jose Rodriguez F Palomares, Gerard Marti, David Garcia DoradoAbstract:Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden Electromechanical Dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p
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changes in hospital mortality rates in 425 patients with acute st elevation myocardial infarction and cardiac rupture over a 30 year period
Circulation, 2008Co-Authors: Jaume Figueras, Jose A Barrabes, Josefa Cortadellas, Oscar Alcalde, Vicens Serra, Joan Alguersuari, Rosamaria LidonAbstract:Background— Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. Methods and Results— The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006). Of a total of 6678 consecutive patients, 425 experienced a free wall rupture (280 with cardiac tamponade: 227 with Electromechanical Dissociation and 53 with hypotension) or a septal rupture (145). After the exclusion of referrals from other centers (n=44), the incidence of definite cardiac rupture (septal rupture, anatomic evidence of free wall rupture, or Electromechanical Dissociation) declined progressively (6.2% in 1977 to 1982 to 3.2% in 2001 to 2006; P<0.001) in parallel with a progressive use of reperfusion therapy (0% to 75.1%; P<0.001). In addition, amo...
Jose Lopezsendon - One of the best experts on this subject based on the ideXlab platform.
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primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction
Journal of the American College of Cardiology, 2002Co-Authors: Raul Moreno, Jose Lopezsendon, Eulogio Garcia, Leopoldo Perez De Isla, Ana Ortega, Mar Moreno, Rafael Rubio, Javier Soriano, Manuel Abeytua, Miguelangel GarciafernandezAbstract:Abstract Objectives This study aimed to evaluate the effect of primary angioplasty (PA) over the risk of free wall rupture (FWR) in reperfused acute myocardial infarction (AMI). Background It has been suggested that PA reduces the risk of FWR compared with thrombolysis. However, few studies have evaluated this issue, and there are no data demonstrating this hypothesis. Methods A total of 1,375 patients with AMI treated with PA (n = 762, 55.4%) or thrombolysis (n = 613, 44.6%) within 12 h after symptoms onset were included. The diagnosis of FWR was made either in the presence of sudden death due to Electromechanical Dissociation with large pericardial effusion on an echocardiogram or when demonstrated post mortem or at surgery. A multivariable analysis was performed including type of reperfusion strategy. Results The overall incidence of FWR was 2.5% (n = 34): 1.8% and 3.3% in patients treated with PA and with thrombolysis, respectively (p = 0.686). The following characteristics were associated with a higher rate of FWR in the univariable analysis: age >70 (5.2% vs. 1.2%, p 2 h after symptoms onset (3.6% vs. 1.7%, p = 0.043). In the multivariable analysis, age >70 (odds ratio [OR]: 4.12, 95% confidence interval [CI]: 2.04 to 8.62, p Conclusions In patients with AMI, PA reduces the risk of FWR in comparison with thrombolysis.
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diagnosis of subacute ventricular wall rupture after acute myocardial infarction sensitivity and specificity of clinical hemodynamic and echocardiographic criteria
Journal of the American College of Cardiology, 1992Co-Authors: Jose Lopezsendon, Ana Gonzalez, Isabel Comacanella, Inmaculada Roldan, Francisco Jose Gonzalez Dominguez, Isidoro Gonzalez Maqueda, Luis Martin JadraqueAbstract:Abstract When ventricular free wall rupture after acute myocardial infarction is not followed by sudden death, it is referred to as subacute ventricular rupture. The sensitivity and specificity of clinical, hemodynamic and echocardiographic diagnostic variables obtained at bedside are unknown and were therefore prospectively studied in 1,247 consecutive patients with acute myocardial infarction including 33 patients with subacute ventricular rupture diagnosed at operation (group A) and 1,214 patients without ventricular rupture (at operation, postmortem study or at discharge) (group B). The incidence of syncope, recurrent chest pain, hypotension, Electromechanical Dissociation, cardiac tamponade, pericardial effusion, high acoustic intrapericardial echoes, right atrial and right ventricular wall compression identified in two-dimensional echocardiograms and hemopericardium demonstrated during pericardiocentesis was higher in group A than in group B (p 5 mm, high density intrapericardial echoes or right atrial or right ventricular wall compression had a high diagnostic sensitivity (≥ 70%) and specificity (>90%). The number of false positive diagnoses was always high for each diagnostic variable ahme (>20%), but the combination of clinical (hypotension), hemodynamic (cardiac tamponade) and echocardiographic variables allowed s sensitivity of ≥ 65% with a small number of false positive diagnoses ( The diagnosis of subacute ventricular rupture requires a surgical decision. Twenty-five (76%) of the 33 patients with subacute ventricular rapture survived the surgical procedure and 16 (48.5%) are long-term survivors. Thus, subacute ventricular wall rupture is a relatively frequent complication after acute myocardial infarction that can be accurately diagnosed and successfully treated.