Alejandro R. Trevino
Houston Methodist Hospital
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Featured researches published by Alejandro R. Trevino.
Journal of Heart and Lung Transplantation | 2013
Rey P. Vivo; Andrea M. Cordero-Reyes; Umair Qamar; Sireesha Garikipati; Alejandro R. Trevino; Molham Aldeiri; Matthias Loebe; Brian A. Bruckner; Guillermo Torre-Amione; Arvind Bhimaraj; Barry Trachtenberg; Jerry D. Estep
BACKGROUND Predictors of right ventricular failure (RVF) in patients with left ventricular assist devices (LVADs) have not been fully elucidated and are comprised mostly of clinical variables. We evaluated echocardiographic parameters associated with adverse outcomes in this population. METHODS Transthoracic echocardiograms (TTEs) before continuous-flow LVAD implantation were analyzed in 109 patients. Twenty-six 2-dimensional and Doppler parameters were assessed for their association with the primary outcome of 30-day RVF, defined as a requirement of an RV assist device or ≥ 14 consecutive days of inotropic support, and the secondary composite outcome of 30-day death or RVF. Multivariate analysis adjusted for known clinical risk prediction models was performed. RESULTS Overall, 25 (22.9%) and 27 (24.8%) patients reached the primary and secondary end-points, respectively. An increased RV/LV diameter ratio was the only TTE variable independently associated with both the primary (odds ratio [OR] = 5.40; 95% confidence interval [CI] 2.40 to 12.40; p = 0.012) and secondary (OR = 2.70; 95% CI 1.06 to 6.22; p = 0.03) outcomes after multivariate analysis. Scatterplot analysis with regression determined the optimal cut-off value for RV/LV diameter to be 0.75. Based on receiver operating characteristic curves, an increased RV/LV diameter ratio provided an additional predictive value to clinical risk scores. CONCLUSIONS A TTE-measured RV/LV diameter ratio of ≥0.75 is independently associated with a higher risk for RVF in patients with continuous-flow LVAD. When used alone, this simple, easily derived, practical echocardiographic measurement has a predictive value equivalent to known clinical risk scores, whereas their combination provides stronger risk prediction for adverse outcomes.
Circulation-cardiovascular Imaging | 2013
Farshad Forouzandeh; Su Min Chang; Kamil Muhyieddeen; Rashid R. Zaid; Alejandro R. Trevino; Jiaqiong Xu; Faisal Nabi; John J. Mahmarian
Background—Noncontrast cardiac computed tomography allows calculation of coronary artery calcium score (CACS) and measurement of epicardial adipose tissue (EATv) and intrathoracic fat (ITFv) volumes. It is unclear whether fat volume information contributes to risk stratification. Methods and Results—Cardiac computed tomography was performed in 760 consecutive patients with acute chest pain admitted thorough the emergency department. None had prior coronary artery disease. CACS was calculated using the Agatston method. EATv and ITFv were semiautomatically calculated. Median patient follow-up was 3.3 years. Mean patient age was 54.4±13.7 years and Framingham risk score 8.2±8.2. The 45 patients (5.9%) with major acute cardiac events (MACE) were older (64.8±13.9 versus 53.7±13.4 years), more frequently male (60% versus 40%), and had a higher median Framingham risk score (16 versus 4) and CACS (268 versus 0) versus those without events (all P<0.01). The MACE group had a higher median of EATv (154 versus 116 mL) and ITFv (330 versus 223 mL), and a higher prevalence of EATv >125 mL (67% versus 44%) and ITFv >250 mL (64% versus 42%) (all P<0.01). CACS, EATv, and ITFv were all independently associated with MACE. CACS was associated with MACE after adjustment for fat volumes (P<0.0001), whereas EATv and ITFv improved the risk model only in patients with CACS >400. Conclusions—CACS and fat volumes are independently associated with MACE in acute chest pain patients and beyond that provided by clinical information alone. Although fat volumes may add prognostic value in patients with CACS >400, CACS is most strongly correlated with outcome.
European Heart Journal | 2014
Keith A. Youker; Christian Assad-Kottner; Andrea M. Cordero-Reyes; Alejandro R. Trevino; Jose H. Flores-Arredondo; Roberto Barrios; Evaristo Fernández-Sada; Jerry D. Estep; Arvind Bhimaraj; Guillermo Torre-Amione
AIMS Various reports have raised the possibility of humoral immune responses as contributors for the progression of heart failure. Previous studies, however, have focused on the analysis of serum and documented circulating antibodies against a variety of cardiac proteins. However, there is little evidence on whether anti-cardiac antibodies are deposited in end-stage failing myocardium. Our objective was to determine whether or not there was evidence of deposition of anti-cardiac antibodies and/or activated complement components in end-stage failing human myocardium. METHODS AND RESULTS Myocardial samples were obtained from 100 end-stage heart failure patients and 40 donor control biopsies. Sections were cut and stained using standard fluorescent immunohistochemistry techniques with anti-human immunoglobulin G (IgG), IgG3, and C3c. Gel electrophoresis and protein identification by mass spectrometry were used to confirm the presence of IgG and its antigen. Immunoglobulin G was localized to the sarcolemma in 71% of patients, 48% of those being positive for the subtype IgG3. The proportion of patients with ischaemic heart disease that was positive for IgG was 65% and among those with non-ischaemic aetiologies was 76%. In a subgroup analysis, the presence of IgG and its subunits were confirmed by mass spectrometry and adenosine triphosphate synthase β subunit identified as an antigen. Complement was activated in 31% of all patients. The presence of IgG, IgG3, and C3c was directly correlated with the length of disease (r = 0.451, P = 0.006). CONCLUSION Evidence of anti-cardiac antibodies and complement activation was found in a large number of patients with end-stage cardiomyopathy regardless of the aetiology. Adenosine triphosphate synthase appears to be a new prominent antigenic stimulus; but more interestingly, the simultaneous co-existence of activated complement components suggests that this humoral mechanism may participate in disease progression.
European Journal of Echocardiography | 2016
Marcos Ibarra; Luis Perez; Alejandro R. Trevino; David Rodriguez; Carlos Jerjes-Sanchez
Neurological complications appear in 20–40% of patients with left-side infective endocarditis; one-half of them correspond to ischaemic stroke, 20% to cerebral haemorrhage, and 30% to other complications (transient ischaemic attack, meningitis, infectious aneurysm, brain abscess). A 45-year-old woman presented with right-sided hemiparesis and dysarthria. She had a 5-day history of intermittent fever, malaise, and polyarthralgia. Patient denied …
Canadian Journal of Cardiology | 2015
Juan Quintanilla; Cesar Avila; Manuel Meraz; Carlos Jerjes-Sanchez; Erasmo de la Peña-Almaguer; Antonio Diaz-Cid; Luis Sanchez; Alejandro R. Trevino; Luis Carlos Perez
A 34-year-old man was admitted after an episode of aborted sudden cardiac death. The initial investigation including electrocardiogram, chest x-ray, transthoracic echocardiogram, and biomarkers were normal. Although coronary angiography showed nonsevere stenosis, optical coherence tomography revealed severe obstruction in the artery with a layered appearance of the vessel wall; it was consistent with the presence of mural thrombus.
Revista Portuguesa De Pneumologia | 2018
Guillermo Torre-Amione; Erasmo de la Peña-Almaguer; Juan Quintanilla; Felipe Valdes; Vicente Jimenez; David Rodriguez; Alejandro R. Trevino; Luis Perez; Carlos Jerjes-Sanchez
Stent dislodgement of an unexpanded stent is a rare and potentially severe complication of percutaneous coronary interventions that can result in emergent coronary artery bypass graft surgery, embolization, or death. Several approaches have been used to identify and resolve this unusual complication; however, the best strategy, as well as the role of cardiac computed tomography (CT) in this clinical scenario, remains unknown. We report the case of an 83-year-old male with the previous history of ischemic heart disease, paroxysmal atrial fibrillation, and stroke. The patient underwent failed percutaneous coronary intervention of a proximal heavily calcified lesion in the left anterior descending coronary artery, which resulted in the dislodgment of a 2.5 mm × 2.5 mm unexpanded stent. The initial
Revista Portuguesa De Pneumologia | 2018
Luis Manautou; Vicente Jimenez; Alejandro R. Trevino; David Rodriguez; Carlos Jerjes-Sanchez
Coronary artery ectasia is observed in 0.3--5% of diagnostic angiograms; >50% of cases are related to coronary atherosclerosis, 20--30% are congenital and up to 20% are related to connective tissue or inflammatory diseases. The impact of strenuous exercise on the left ventricle’s structure has been demonstrated. Studies with ECGs and echocardiography discovered a high prevalence of increased cardiac voltage, suggestive of left ventricle enlargement and hypertrophy respectively. Coronary artery anomalies have been described in 14% of athletes. A 37-year-old man, a retired professional football soccer player with history of syncope upon exertion, presented to the ED with ischemic acute chest pain at rest. On admission, his pulse was 70 beats/min, blood pressure 146/85 mmHg. Physical examination was normal. ECG revealed ST dynamic changes and negative deep T waves on anterior-lateral region (Fig. 1A and B). Laboratory tests revealed normal values of cardiac biomarkers.
American Journal of Emergency Medicine | 2018
Alejandro R. Trevino; Luis Perez; Carlos Jerjes-Sanchez; David Rodriguez; Jathniel Panneflek; Claudia Ortiz-Ledesma; Francisco Nevarez; Vicente Jimenez; Felipe Valdes; Eduardo de Obeso
We report the case of a 61-year-old man who presented at the Emergency Department (ED), complaining of sudden-onset dyspnea and chest pain after a long flight from Tokyo to Houston. Considering his clinical stability and sPESI 0, enoxaparin 1 mg/kg BID was started for 24 h, and the patient was then considered for early discharge with apixaban 10 mg BID. Direct-factor Xa inhibition did not improve extensive thrombus burden and right ventricular dysfunction despite D-dimer measurement reduction. Because of the treatment failure, we considered thrombolysis. Currently, recommendations to use thrombolysis in patients under non-vitamin K antagonist oral anticoagulants (NOACs) do not exist. Hence, the one dose of apixaban was stopped, and 12 h later, we performed successful thrombolysis. A systematic review from 2007 to 2017 did not identify any cases related to NOACs failure to reduce thrombus burdens in patients with PE and persistent right ventricular dysfunction. We also did not find any evidence of cases that reported strategies for urgent thrombolysis in PE patients on NOACs. To the best of our knowledge, apixabans failure to reduce thrombus burden, persistent right ventricular dysfunction, and a NOACs-thrombolysis bridge in patients with PE on apixaban has not been previously described. Both the bedside risk stratification and the therapeutic failures should alert clinicians in the ED to the potential limitations of low-molecular-weight heparin, NOACs therapy, and sPESI in the setting of intermediate-high-risk PE.
Revista Portuguesa De Pneumologia | 2016
Erasmo de la Peña-Almaguer; Alejandro R. Trevino; Lilia Mercedes Sierra-Galán; José Ramón Azpiri-López; José Luis Assad-Morell; Jacobo Kirsch; Su Min Chang
OBJECTIVE To correlate the left ventricular parameters obtained with 64-slice Volumetric Computed Tomography (VCT) with those obtained with the reference standard, cardiovascular magnetic resonance (CMR) imaging. METHODS VCT and a 3.0T MRI scanner were used. Results from both studies were independently evaluated by two cardiologists. A linear correlation and a paired Students t test were used to analyze the data with a P<0.05 being considered significant. RESULTS Thirty consecutive patients were evaluated with VCT and CMR. The left ventricular indices for CMR and VCT were, respectively, mass 86.4±25.8 vs. 82.7±27.6g (P=0.31); ESV 45.5±27.8 vs. 48.7±40.4ml (P=.405); EDV 101.3±32.7 vs. 105.1±44.0ml (P=0.475); SV 55.9±16.1 vs. 56.8±15.6ml (P=0.713); LVEF 57.5±13.2% vs. 56.9±12.4% (P=0.630). No differences in intraobserver variability for both methods were found, CT r=0.96, r(2)=0.92 P<0.0001 and MR r=0.96 r(2)=0.93 P<0.0001. There was no significant statistical difference in the presence of artifacts. CONCLUSION There is a close correlation between CMRI and VCT in the evaluation of LV function. VCT is as useful as 3T CMR, and could be incorporated as another resource for evaluating LV function.
Journal of the American College of Cardiology | 2015
Kongkiat Chaikriangkrai; Alejandro R. Trevino; Naveed Anwar; Farshad Forouzandeh; Faisal Nabi; John J. Mahmarian; Su Min Chang
Long-term prognostic value of renal function and coronary artery calcium score (CACS) in symptomatic patients without known coronary artery disease (CAD) is unclear. Renal function and CACS was assessed in patients without known CAD who presented with chest pain to our emergency room. Chronic