Person: Alonso Salinas, Gonzalo Luis
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Alonso Salinas
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Gonzalo Luis
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Ciencias de la Salud
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Publication Open Access Review of advancements in managing cardiogenic shock: from emergency care protocols to long-term therapeutic strategies(MDPI, 2024-08-16) Martínez León, Amaia; Bazal Chacón, Pablo; Herrador Galindo, Lorena; Ugarriza Ortueta, Julene; Plaza Martín, María; Pastor Pueyo, Pablo; Alonso Salinas, Gonzalo Luis; Ciencias de la Salud; Osasun ZientziakCardiogenic shock (CS) is a complex multifactorial clinical syndrome of end-organ hypoperfusion that could be associated with multisystem organ failure, presenting a diverse range of causes and symptoms. Despite improving survival in recent years due to new advancements, CS still carries a high risk of severe morbidity and mortality. Recent research has focused on improving early detection and understanding of CS through standardized team approaches, detailed hemodynamic assessment, and selective use of temporary mechanical circulatory support devices, leading to better patient outcomes. This review examines CS pathophysiology, emerging classifications, current drug and device therapies, standardized team management strategies, and regionalized care systems aimed at optimizing shock outcomes. Furthermore, we identify gaps in knowledge and outline future research needs.Publication Open Access Accuracy of smartwatch electrocardiographic recording in the acute coronary syndrome setting: rationale and design of the ACS WATCH II Study(MDPI, 2024) Buelga Suárez, Mauro; Pascual Izco, Marina; García Montalvo, Jesús; Alonso Salinas, Gonzalo Luis; Ciencias de la Salud; Osasun ZientziakBackground: Acute Coronary Syndrome (ACS), with or without ST-segment elevation, is a major contributor to global mortality and morbidity. Swift diagnosis and treatment are vital for mitigating cardiac damage and improving long-term outcomes. The 12-lead electrocardiogram (ECG) currently serves as the gold standard for diagnosis in ACS with ST-segment elevation and may support the diagnosis in ACS without ST-segment elevation. However, the growing prevalence of smartwatches enables the acquisition of electrocardiographic data without traditional ECG equipment. While smaller studies support smartwatch ECG use, larger-scale validation within ACS remains lacking. The ACS WATCH II study aims to validate smartwatch ECG recordings for ACS. Methods: The primary objective is to validate smartwatch-obtained electrocardiographic data in patients presenting with ACS. Two cohorts of 120 patients each, presenting ACS with and without ST-segment elevation, will be assessed. Smartwatches will capture recordings of leads I, III, and V2 alongside standard ECGs. These leads, chosen due to a 97% ACS diagnosis sensitivity in previous studies, will undergo blind evaluation by two experienced external assessors against conventional ECG. Additionally, a control sample of 60 healthy individuals will be included. Conclusions: ACS WATCH II pioneers large-scale prospective validation of smartwatch ECG recordings in ACS patients. Additionally, it indirectly validates a swift diagnostic approach using three leads (I, III, and V2). This could expedite time-critical ACS diagnoses and simplify access through smartwatch-based diagnosis.Publication Open Access Right bundle branch block predicts appropriate implantable cardioverter defibrillator therapies in patients with non-Iischemic dilated cardiomyopathy and a prophylactic implantable cardioverter defibrillator(MDPI, 2024-06-01) Jiménez-Blanco Bravo, Marta; Alonso Salinas, Gonzalo Luis; Parra Esteban, Carolina; Toquero Ramos, Jorge; Amores Luque, Miguel ; Zamorano Gómez, José Luis; García-Izquierdo, Eusebio ; Álvarez-García, Jesús; Fernández Lozano, Ignacio; Castro Urda, Víctor; Ciencias de la Salud; Osasun ZientziakBackground: the benefit of prophylactic implantable cardioverter defibrillators (ICDs) in patients with severe systolic dysfunction of non-ischemic origin is still unclear, and the identification of patients at risk for sudden cardiac death remains a major challenge. Aims/Methods: we retrospectively reviewed all consecutive patients with non-ischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify the predictors of appropriate ICD therapies (anti-tachycardia pacing [ATP] and/or shocks) in this cohort of patients. Results: a total of 224 patients were included. After a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD therapies. Patients with appropriate ICD therapies were more frequently men (87% vs. 69%, p = 0.006), of younger age (59 years, (53-65) vs. 64 years, (57-70); p = 0.02), showed more right bundle branch blocks (RBBBs) (15% vs. 4%, p = 0.007) and less left bundle branch blocks (LBBBs) (26% vs. 47%, p = 0.005) in the ECG, and had higher left ventricular end-diastolic (100 mL/m2, (90-117) vs. 86, (71-110); p = 0.011) and systolic volumes (72 mL/m2, (59-87) vs. 61, (47-81), p = 0.05). In a multivariate competing-risks regression analysis, RBBB (HR 2.26, CI 95% 1.02-4.98, p = 0.043) was identified as an independent predictor of appropriate ICD therapies. Conclusion: RBBBs may help to identify patients with NICM at high risk of ventricular arrhythmias and requiring ICD intervention.Publication Open Access Smartwatch ECG tracing and ischemic heart disease: ACS watch study(Karger, 2023) Buelga Suárez, Mauro; Pascual Izco, Marina; Pastor Pueyo, Pablo; Lozano Granero, Cristina; García Montalvo, Jesús; Alonso Salinas, Gonzalo Luis; Ciencias de la Salud; Osasun ZientziakBACKGROUND: Smartwatches have become a widely used tool for health self-care. Its role in ischemic heart disease (IHD) has not been assessed. OBJECTIVES: To evaluate the usefulness of smartwatch ECG registry in IHD. METHODS: We present an observational study of 25 consecutive patients with acute IHD. Conventional ECG and smartwatch tracing were obtained simultaneously at admission. Waves of conventional and smartwatch ECGs were objectively compared. A survey on medical attitude was conducted among 12 physicians (3 cardiologists, 3 intensivists, 3 emergency physicians, and 3 general practitioners) and a score (1 to 5) of concordance between the records was requested. RESULTS: There were no differences in Q wave, R wave, ST segment, or T wave. There was a very strong correlation between ST segments, a strong correlation in Q waves and R waves, and a moderate correlation in T wave measurements.All specialists obtained a high level of agreement (4.45 +/- 0.45). Smartwatch tracings would lead to similar management compared to conventional ECG. There were only 6 (2%) discrepant cases due to differences in inferior repolarization, showing an almost perfect agreement (kappa=0.96). CONCLUSIONS: In most patients with acute IHD, smartwatch ECG tracing is a reliable tool to make the diagnosis and guide appropriate medical care. However, due to their intrinsic limitations, inferior myocardial infarctions may be missed and require a conventional 12-lead ECG to rule them out.Publication Open Access The impact of geriatric conditions in elderly patients with coronary heart disease: a state-of-the-art review(MDPI, 2024) Alonso Salinas, Gonzalo Luis; Cepas-Guillén, Pedro; Martínez León, Amaia; Jiménez-Méndez, César; Lozano Vicario, Lucía; Martínez-Avial, María; Díez-Villanueva, Pablo; Ciencias de la Salud; Osasun ZientziakThe growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.