Xavier Bosch
Universidad de Barcelona, Medicina, Faculty Member
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Early ischemia, defined as angina with transient ST-T changes during hospitalization, 24 hr or more after an acute myocardial infarction (MI), was observed in 79 (18%) of a consecutive series of 449 patients surviving an MI and... more
Early ischemia, defined as angina with transient ST-T changes during hospitalization, 24 hr or more after an acute myocardial infarction (MI), was observed in 79 (18%) of a consecutive series of 449 patients surviving an MI and catheterized a mean of 10 +/- 3 days after admission. Three clinical factors present 24 hr after admission could identify patients at low, medium, and high risk of factors had a risk greater than 50% and the 118 patients with Q wave MI, no previous angina, and absence of risk factors had a risk of less than 8%. The angiographic correlates of early ischemia were number of vessels with 70% or more stenosis (2.1 +/- 0.8 vs 1.7 +/- 0.8/patient, p less than .0001), number of diseased coronary artery segments (2.8 +/- 1.4 vs 2.1 +/- 1.2, p less than .0001), left anterior descending coronary involvement (77% vs 62% of patients, p = .01), number of normally contractile segments at jeopardy because of a coronary stenosis (1.9 +/- 1.3 vs 1.3 +/- 1.1/patient, p less tha...
Research Interests: Risk, Medicine, Prospective studies, Humans, Female, and 12 moreMale, Follow-up studies, Clinical Sciences, Middle Aged, Coronary Angiography, Myocardial Infarction, Coronary heart disease, Public health systems and services research, Time Factors, Prognosis, Circulation, and Cardiovascular medicine and haematology
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This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not... more
This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS. We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences. A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a medi...
Serum soluble AXL (sAXL) and its ligand, Growth Arrest-Specific 6 protein (GAS6), intervene in tissue repair processes. AXL is increased in end-stage heart failure, but the role of GAS6 and sAXL in ST-segment elevation myocardial... more
Serum soluble AXL (sAXL) and its ligand, Growth Arrest-Specific 6 protein (GAS6), intervene in tissue repair processes. AXL is increased in end-stage heart failure, but the role of GAS6 and sAXL in ST-segment elevation myocardial infarction (STEMI) is unknown. To study the association of sAXL and GAS6 acutely and six months following STEMI with heart failure and left ventricular remodelling. GAS6 and sAXL were measured by enzyme-linked immunosorbent assay at one day, seven days and six months in 227 STEMI patients and 20 controls. Contrast-enhanced magnetic resonance was performed during admission and at six months to measure infarct size and left ventricular function. GAS6, but not sAXL, levels during admission were significantly lower in STEMI than in controls. AXL increased progressively over time ( p<0.01), while GAS6 increased only from day 7. GAS6 or sAXL did not correlate with brain natriuretic peptide or infarct size. However, patients with heart failure (Killip >1) ha...
This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction. 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18-32) mean PVC... more
This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction. 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18-32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done. Left ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60-284) to 46 (23-81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5-20) g. Mean scar mass was s...
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Left ventricular (LV) outflow tract ventricular arrhythmias (OTVA) are associated with hypertension (HT), older age, and LV dysfunction, suggesting that LV overload plays a role in the aetiopathogenesis. We hypothesized that anatomical... more
Left ventricular (LV) outflow tract ventricular arrhythmias (OTVA) are associated with hypertension (HT), older age, and LV dysfunction, suggesting that LV overload plays a role in the aetiopathogenesis. We hypothesized that anatomical modifications of the LV outflow tract (LVOT) could predict left vs. right OTVA site of origin (SOO). Fifty-six (32 men, 53 ± 18 years old) consecutive patients referred for OTVA ablation were included. Cardiac multidetector computed tomography was performed before ablation and then imported to the CARTO system to aid the mapping and ablation procedure. Anatomical characteristics of the aortic root as well as aortopulmonary valvular planar angulation (APVPA) were analysed. The LV was the OTVA SOO (LVOT-VA) in 32 (57%) patients. These patients were more frequently male (78% vs. 22%, P = 0.001), older (57 ± 18 vs. 47 ± 18 years, P = 0.055), and more likely to have HT (59% vs. 21%, P = 0.004), compared to right OTVA patients. Aortopulmonary valvular plana...
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Patients with transmural myocardial infarction (MI) who undergo endocardial-only substrate ablation are at an increased risk of ventricular tachycardia (VT) recurrence. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) could... more
Patients with transmural myocardial infarction (MI) who undergo endocardial-only substrate ablation are at an increased risk of ventricular tachycardia (VT) recurrence. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) could be used to assess infarct transmurality (IT). However, the degree of IT associated to epicardial arrhythmogenic substrate (AS) has not been determined. To determine the degree of IT observed in LGE-CMR and multi-detector computed tomography (MDCT) that predicts the presence of epicardial AS. The study included 38 post-myocardial infarction (PMI) patients. Ten patients with a subendocardial infarction underwent endocardial-only mapping and 28 with a "classical transmural MI" (C-TMI), defined as hyperenhancement ≥75% of myocardial wall thickness (WT), underwent an endo-epicardial mapping. LGE-CMR/MDCT data were registered to high-density endocardial or epicardial maps to be analyzed with respect to the presence of AS. Of 28 PMI patients with ...
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ST-segment elevation myocardial infarction (STEMI) network activation by a noncardiologist reduces delay times but may increase the rate of false-positive STEMI diagnoses. We aimed to determine the prevalence, predictors, and clinical... more
ST-segment elevation myocardial infarction (STEMI) network activation by a noncardiologist reduces delay times but may increase the rate of false-positive STEMI diagnoses. We aimed to determine the prevalence, predictors, and clinical impact of false-positive activations within the Catalonian STEMI network (Codi Infart). From January 2010 through December 2011, all consecutive patients treated within the Codi Infart network were included. Code activations were classified as appropriate if they satisfied both electrocardiogram and clinical STEMI criteria. Appropriate activations were classified as false positives using 2 nonexclusive definitions: a) "angiographic" if a culprit coronary artery was not identified, and b) "clinical" if the discharge diagnosis was other than STEMI. In total, 5701 activations were included. Appropriate activation was performed in 87.8% of the episodes. The rate of angiographic false positives was 14.6%, while the rate of clinical false...
Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction. The purpose of this study was to identify the clinical pattern of patients having a "pure PVC-induced"... more
Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction. The purpose of this study was to identify the clinical pattern of patients having a "pure PVC-induced" cardiomyopathy at presentation. This prospective multicenter study included 155 consecutive patients (age 55 ± 12 years, 96 men [62%], 23% ±12% mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation and followed up for at least 12 months. Patients with a previously diagnosed structural heart disease (50 [32%]) and those without complete PVC abolition during follow-up who did not normalize LV ejection fraction (LVEF) (24 [15%]) were excluded from the analysis. Of the remaining 81 patients, 41 (51%) had a successful sustained ablation, did not have normalized LVEF, and were classified as having PVC-worsened nonischemic cardiomyopathy, and 40 (49%) who had normalized LVEF were considered as having pure PVC-induced cardiomyopathy. The latter ...
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The aim of this study was to analyze whether scar characterization could improve the risk stratification for life-threatening ventricular arrhythmias and sudden cardiac death (SCD). Among patients with a cardiac resynchronization therapy... more
The aim of this study was to analyze whether scar characterization could improve the risk stratification for life-threatening ventricular arrhythmias and sudden cardiac death (SCD). Among patients with a cardiac resynchronization therapy (CRT) indication, appropriate defibrillator (CRT-D) therapy rates are low. Primary prevention patients with a class I indication for CRT were prospectively enrolled and assigned to CRT-D or CRT pacemaker according to physician's criteria. Pre-procedure contrast-enhanced cardiac magnetic resonance was obtained and analyzed to identify scar presence or absence, quantify the amount of core and border zone (BZ), and depict BZ distribution. The presence, mass, and characteristics of BZ channels in the scar were recorded. The primary endpoint was appropriate defibrillator therapy or SCD. 217 patients (39.6% ischemic) were included. During a median follow-up of 35.5 months (12 to 62 months), the primary endpoint occurred in 25 patients (11.5%) and did ...
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Predicting sudden cardiac death risk in the first months after ST-segment elevation myocardial infarction (STEMI) remains challenging. To investigate late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) capacity to identify... more
Predicting sudden cardiac death risk in the first months after ST-segment elevation myocardial infarction (STEMI) remains challenging. To investigate late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) capacity to identify the potentially arrhythmogenic substrate and its temporal evolution after a STEMI. One hundred consecutive patients with a first STEMI were included. A 3D high-resolution LGE-CMR was obtained at 3T at day 7 and 180. Left ventricular wall was segmented and characterized by pixel signal intensity algorithm at 5 layers from endocardium to epicardium. A 3D color-coded shell map was obtained for each layer, depicting scar core and border zone (BZ) distribution. Presence/characteristics of BZ channels were registered for each layer. At 180 days, left ventricular ejection fraction (LVEF) had improved significantly (from 46.7±10% to 51.5±10%, p<0.001) and scar mass was reduced (from 22.6±20 to 13.8±12 g, p<0.001). Most (89%) BZ channels were identified ...
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Research Interests: Chest Pain and Risk Score
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Women with ST-segment-elevation myocardial infarction have a worse prognosis than men. However, information about the prognosis of women with non-ST-segment-elevation acute coronary syndromes (NSTEACS) is scarce. The aim of this study was... more
Women with ST-segment-elevation myocardial infarction have a worse prognosis than men. However, information about the prognosis of women with non-ST-segment-elevation acute coronary syndromes (NSTEACS) is scarce. The aim of this study was to determine if the long-term prognosis of men and women with NSTEACS differs. Case-control study. In a consecutive series of 300 patients admitted for a NSTEACS and ischemic ECG changes, we compared the clinical characteristics, in-hospital and long-term follow-up of 95 women and 95 men matched for age, presence of diabetes, and past history of hypertension. The median age of patients was 69 years, 36% had diabetes, and 65% had a history of hypertension. There were no gender differences in the history of angina or hypercholesterolemia, clinical presentation, number of patients with ST-segment depression, and CK-MB elevation. However, smoking, coronary artery disease, and peripheral vascular disease were less frequent in women. Treatment at admissi...
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Hyperglycemia at admission has been associated with bad prognosis in patients with myocardial infarction (MI). The clinical benefit of intensive insulin treatment has been evaluated in diabetic patients admitted to intensive care units.... more
Hyperglycemia at admission has been associated with bad prognosis in patients with myocardial infarction (MI). The clinical benefit of intensive insulin treatment has been evaluated in diabetic patients admitted to intensive care units. The aim of our study was to assess the short-term effects and the safety of strict glycemic control in subjects with MI and hyperglycemia without a previous history of diabetes. Twenty-eight non-previously diabetic patients admitted with MI and hyperglycemia were randomized to 2 treatment arms during the first 48 h: a) the intensive group (n = 13) received intravenous insulin with target glycemia levels of 80-110 mg/dl, and b) the conventional group (n = 15) received subcutaneous insulin only when glycemia was 160 mg/dl. High-sensitivity C-reactive protein was determined at 48 h and before discharge. An oral glucose tolerance test was performed after one month. During the first 48 h, glycemia was significantly lower in the intensive than in the conve...