Nuevos avances diagnósticos y terapéuticos en las enfermedades cardiovasculares

RESEARCH INTEREST

Our group is pursuing several lines of research encompassing the entire spectrum of cardiovascular diseases, including medical clinical entities cardiovascular surgery and intensive care management of acute respiratory diseases. This provides a comprehensive and multidisciplinary perspective of many important research areas.

“Stent failure” is a main research focus. Stent failure includes both “intra-stent restenosis” and “stent thrombosis.” It has recently been suggested that neoatherosclerosis may provide a link between these two conditions. Specifically, we seek to determine the value of the new generation of drug-eluting stents in the treatment of patients with different clinical and anatomical characteristics. We are also developing strategies to optimize stent implantation. In this regard, randomized “head-to-head” clinical trials comparing different therapeutic devices are of the utmost interest. Furthermore, we are deeply interested in the process of vascular healing and repair following stent implantation. To this end, a detailed assessment of the target coronary segment using sophisticated intracoronary imaging techniques (optical coherence tomography, intravascular ultrasound), and the functional evaluation of blood vessel wall physiology (wire pressure and reserve flow fraction) are also of great value.

Furthermore, new intracoronary diagnostic techniques offer new insights into “vulnerable plaque” and may also help elucidate the mechanisms involved in the pathophysiology of acute coronary syndromes and in the progression and regression of coronary atherosclerosis. In this regard, our group is actively involved in research projects on disease progression and the establishment of additional criteria to define lesion severity. The diagnosis and clinical management of patients with acute coronary syndrome represent a significant workload in our daily clinical practice and, therefore, also drive many of our research projects. Different strategies are being evaluated in patients with ST-segment elevation acute myocardial infarction. This includes the evaluation of preventive strategies, diagnosis, and management approaches for these patients.

New and potent antiplatelet and antithrombotic drugs are currently available, and we are studying their value in various subgroups of patients with coronary artery disease who require coronary revascularization or medical follow-up alone. Last but not least, structural heart disease is another important and rapidly evolving field. We are deeply interested in determining the role of certain emerging interventional techniques, such as transcatheter aortic valve implantation in elderly patients with severe aortic stenosis, and the value of other new devices for correcting various structural heart conditions.
Other areas of clinical cardiology are also addressed. In this regard several projects focus in spontaneous coronary artery dissection, takotsubo syndrome, heart failure (from primary care to sophisticated left ventricle support devices) and frailty in the elderly. In addition, several research areas are related to cardiac surgery including coronary revascularization, valvular replacement and mechanical support devices. Finally, several research projects are being developed in the field of intensive care with special emphasis in the respiratory distress syndrome.

1) Incidence, prevention, diagnosis, and treatment of coronary “stent failure”
Our group has led studies in our country analyzing stent failure. Stent failure may be secondary to thrombosis (a rare but very serious complication) or to stent restenosis (more common, but managed electively and with more established protocols).

A) Stent thrombosis.
We have conducted numerous studies, including those incorporating intracoronary imaging (intravascular ultrasound and optical coherence tomography) in patients with stent thrombosis. Our group was the only Spanish group to participate in the European PRESTIGE project (European Union’s 7th Framework Program) on the diagnosis and treatment of stent thrombosis.
B) Stent restenosis.

Our group has led the RIBS (Intra-stent Restenosis, Balloon Angioplasty vs. Stent Implantation) program in our country (Dr. Alfonso, Dr. Cuesta)). This program includes both randomized multicenter studies (4 randomized studies: RIBS I, II, IV, V) and prospective multicenter registries (4 studies: RIBS Acute, RIBS III, RIBS VI, RIBS VI Scoring, RIBS VII), dedicated to identifying the best treatment for patients with in-stent restenosis of a conventional metal stent or drug-eluting stent, led by the HULP. The therapeutic strategies evaluated to date have included conventional balloon, conventional metal stent, cutting balloon, various drug-eluting stents, drug-eluting balloon (paclitaxel or limus derivatives), bioresorbable vascular devices, and intracoronary lithotripsy. We have also participated in meta-analyses at the study level and in meta-analyses using patient-level data, as part of various international collaborations.

2. Drug-Eluting Balloons
Drug-eluting balloons represent a highly promising new therapeutic option in percutaneous coronary intervention. Our group has conducted extensive research on these balloons over the past decade, making us the leading national group in terms of scientific contributions in this field. Initially, as part of the RIBS studies, but subsequently in multiple new applications, including in de novo lesions. Interestingly, over the past 5 years, there has been an exponential increase in the use of these devices in clinical practice. Our group has led multiple projects on this therapeutic modality at the national and international levels.

3. Spontaneous Coronary Dissection
Our group has worked intensively over the past 15 years on the diagnosis and treatment of spontaneous coronary dissection. Dr Teresa Bastante and Dr Alfonso are coordinating this research line in our center. It is a rare but increasingly well-diagnosed cause of acute myocardial infarction predominantly affecting young women (90% of patients). We are leading the first randomized clinical trial of spontaneous coronary artery dissection (60 sites in Spain) (Betablockers and Antiplatelet Treatment in Spontaneous Coronary Artery Dissection) and are also coordinating the official Spanish National Registry on Spontaneous Coronary artery dissection for the past 10 years.

4. Takotsubo Syndrome
Takotsubo syndrome (TS) is a clinical condition of unknown cause characterized by transient ventricular dyskinesia in the absence of significant coronary lesions that also occurs primarily in women (90% of cases), usually following an episode of stress (stress cardiomyopathy or transient apical dyskinesia). We are leading the first randomized clinical trail in this clinical entity (B-TAKO randomized clinical trial). Dr Salamanca and Dr Alfonso are coordinating this area.

5. Intracoronary Imaging Techniques
Our group has led the clinical application and research of intracoronary diagnostic techniques (intravascular ultrasound [IVUS] and optical coherence tomography [OCT]) in our country. Essentially, we have carried out numerous projects primarily aimed at identifying the presence of “vulnerable plaque” (a precursor to myocardial infarction) in the coronary arteries and at guiding and optimizing the placement of coronary stents.

6. Research in Coronary Physiology
Our research group has established itself as an international leader in the study of invasive functional assessment of epicardial coronary lesions and coronary microcirculation. Our group conducts its scientific work with a clear translational focus, integrating clinical research with technological development in the cardiovascular field. Our strategic vision is grounded in advancing toward a model of personalized medicine, based on functional and molecular diagnostic tools that allow for a more precise characterization of coronary artery disease in all its forms: obstructive, non-obstructive, and microvascular. This area is coordinated by Dr Fernando Rivero.

7. Research in Structural Interventional Cardiology
Our group has conducted various studies on the percutaneous treatment of structural heart disease. The Cardiology Department has established collaborations (Dr David Del Val) with internationally renowned research groups, such as the Institut Universitaire de Cardiologie et de Pneumologie de Québec at Laval University (Canada), thereby strengthening the IIS-HULP’s international standing in the field of cardiovascular research.

8. Research in Advanced Cardiac Imaging
Our group has conducted multiple in-house studies (HULP) on cardiac imaging, primarily based on echocardiography, CT, and cardiac MRI. These studies have focused primarily on cardiomyopathies (especially hypertrophic cardiomyopathy) and valvular heart disease. Dr. Jesús Jiménez Borreguero, also from the Cardiology Department, has coordinated all these studies.

9. Research in Clinical Cardiology (Heart Failure, Older Adults with Cardiovascular Disease, and the Impact of Frailty and Other Geriatric Syndromes)
Within the field of clinical cardiology, these three main lines of research stand out; they are coordinated and led by Dr. Pablo Diez Villanueva. This has enabled the group to promote multiple academic initiatives and lead various studies on heart failure and the consequences of frailty and other geriatric syndromes in patients with cardiovascular diseases.

10. Translational Research (Immunology / CNIC)
Our group maintains a formal collaboration with the Immunology Department (Professor Sanchez Madrid and Hortensia de la Fuente ) and with the National Center for Cardiovascular Diseases (CNIC) (Dr. Pilar Martin) on various studies, funded through competitive grants, focusing on the development and pathophysiology of atherosclerotic coronary artery disease, inflammatory and molecular mechanisms of atherothrombotic complications and spontaneous coronary dissection, and, during the pandemic, inflammatory mechanisms in COVID-19.
The group is also collaborating in several lines of pharmacogenetic research with Dr Francisco Abad in the department of Clinical Pharmacology.

11. Research in Cardiovascular Surgery
Dr Guillermo Reyes is actively involved in different studies related to cardiac surgery. Research span from coronary interventions and valve replacement to advanced systems of cardiocirculatory support.

12. Intensive Care Medicine Group Research
The main line of research focuses on aspects related to mechanical ventilation and advanced cardiopulmonary monitoring. Several research projects are being developed in the field of intensive care with special emphasis in the respiratory distress syndrome. This research line has received major competitive grants. The main research is focused on mechanical ventilation and advanced cardiopulmonar monitoring. Currently active research projects include. 1. “Capnodynamic Project”: use of CO2 cynetic of expirated gas. 2. Electric impedance tomography (EIT). 3. Projects on mechanical ventilation: new ventilatory strategies, artificial intelligence and new monitoring parameters. 4: Research on new drugs for the acute respiratory distress syndrome. (Dexa and MAIDEN studies within the respiratory CIBERES and in collaboration with CNIC).