Publications by authors named "Rocio Toro"

39 Publications

[Performance of entero-insular axis in an athletic population: diet and exercise influence].

Nutr Hosp 2015 May 1;31(5):2187-94. Epub 2015 May 1.

Departamento de Medicina, Facultad de Medicina, Cádiz..

Introduction: The relationship between physical exercise and appetite regulation can lead to improved competitive performance of athletes. Mediators of the entero-insular axis generate neurohumoral signals that influence on the appetite regulation and energy homeostasis.

Aim: Determine the influence of diet and prolonged exercise on intestinal peptide, ghrelin, resistin, leptin, and incretins (GLP-1 and GIP) in an athlete population.

Methods: It is a prospective intervention study, conducted from October 2012 to March 2013. 32 healthy semiprofessional rugby players, aged 13-39 years were included. Anthropometric measurements and blood samples were taken at time 0 and after six months of study. Athletes were randomized to a protein diet (PD) or Mediterranean diet (MD) and plasma levels of intestinal peptide, ghrelin, resistin, leptin, and incretins were calculated.

Results: In the PD group, GLP-1 and GIP plasmatic levels showed a significant decrease (p <0.03; p <0.01 respectively). GLP-1 and ghrelin plasmatic concentration demonstrated a significant decrease (p <0.03 respectively) in those who experienced gain of muscle mass (MM). Finally, the athletes related to the PD who showed increased total weight and muscle mass presented significantly decreased GLP-1 concentration (p <0.03 and p<0.002, respectively).

Conclusion: GLP-1 plasmatic concentration was decreased, with the PD suggesting to be more beneficial for the athletes in order to avoid hypoglycemia. Furthermore, muscle mass and total weight gain, linked to the PD, could enhance athletic performance in certain sport modalities.
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http://dx.doi.org/10.3305/nh.2015.31.5.8828DOI Listing
May 2015

Relationship between lipoprotein (a) and micro/macro complications in type 2 diabetes mellitus: a forgotten target.

J Geriatr Cardiol 2015 Mar;12(2):93-9

Department of Medicine, Cádiz University, School of Medicine, Cádiz 11002, C/ Dr Marañon S/N, Cádiz, Spain ; Department of Internal Medicine, University Hospital Puerta del Mar, Cádiz 11002, Ana de Viya S/N, Cádiz, Spain.

Objectives: Increased lipoprotein (a) serum concentrations seems to be a cardiovascular risk factor; this has not been confirmed in extracoronary atherosclerosis complications. We therefore wished to gain a deeper insight into relationship between the plasma concentrations of lipoprotein (a) and the micro- and macro-vascular complications of type 2 diabetes mellitus and to identify possible differences in this association.

Methods: This is a descriptive observational cross-sectional study. Two-hundred and seventeen elderly patients with type 2 diabetes mellitus were included from the internal medicine outclinic. Anthropometric data, analytical data (insulin reserve, basal and postprandial peptide C, glycosylated hemoglobin, renal parameters, lipid profile and clinical data as hypertension, obesity, micro- and macrovascular complications were collected.

Results: Patients were grouped according to the type 2 diabetes mellitus time of evolution. The mean plasma concentration of lipoprotein (a) was 22.2 ± 17.3 mg/dL (22.1 ± 15.9 mg/dL for males, and 22.1 ± 18.4 mg/dL for females). Patients with hypertension, coronary heart disease, cerebrovascular accident, microalbuminuria and proteinuria presented a statistically significant increased level of lipoprotein (a). Similarly, the patients with hyperlipoprotein (a) (≥ 30 mg/dL) presented significantly increased levels of urea and total cholesterol. In the multivariate regression model, the level of lipoprotein (a) is positively correlated with coronary heart disease and diabetic nephropathy (P < 0.01 and P < 0.005, respectively).

Conclusions: The elevation of plasma levels of lipoprotein (a) are associated with the development of coronary heart disease and diabe tic nephropathy. Therefore, we consider that the determination of lipoprotein (a) may be a prognostic marker of vascular complications in patients with type 2 diabetes mellitus.
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http://dx.doi.org/10.11909/j.issn.1671-5411.2015.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394322PMC
March 2015

Efficacy and safety of rivaroxaban in real-life patients with atrial fibrillation.

Expert Rev Cardiovasc Ther 2015 Apr;13(4):341-53

Coordinador de Área. Servicio de Cardiología Hospital Universitario Virgen del Rocío. Universidad de Sevilla, Sevilla, Spain.

Rivaroxaban is a once-daily oral anticoagulant currently marketed for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. This indication is largely based on the results of the ROCKET-AF trial. Although these results are robust, studies performed in clinical practice are necessary to confirm these data in real-life patients. These studies have shown rates of stroke and bleeding similar to that found in ROCKET-AF. As an anticoagulant, attention should be paid to making a correct prescription of rivaroxaban, particularly in fragile patients, to reduce the risk of bleeding. In addition, a number of studies have shown that rivaroxaban is cost-effective in clinical practice. Moreover, rivaroxaban is a good alternative to warfarin in patients undergoing elective cardioversion or atrial fibrillation ablation.
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http://dx.doi.org/10.1586/14779072.2015.1026259DOI Listing
April 2015

A novel mutation in lamin a/c causing familial dilated cardiomyopathy associated with sudden cardiac death.

J Card Fail 2015 Mar 9;21(3):217-25. Epub 2014 Dec 9.

Cardiovascular Genetics Center, IDIBGI, University of Girona, Girona, Spain; Department of Medical Science, School of Medicine, University of Girona, Girona, Spain; Cardiomyopathy Unit, Hospital Josep Trueta, University of Girona, Girona, Spain. Electronic address:

Background: Dilated cardiomyopathy (DCM), a cardiac heterogeneous pathology characterized by left ventricular or biventricular dilatation, is a leading cause of heart failure and heart transplantation. The genetic origin of DCM remains unknown in most cases, but >50 genes have been associated with DCM. We sought to identify the genetic implication and perform a genetic analysis in a Spanish family affected by DCM and sudden cardiac death.

Methods And Results: Clinical assessment and genetic screening were performed in the index case as well as family members. Of all relatives clinically assessed, nine patients showed clinical symptoms related to the pathology. Genetic screening identified 20 family members who carried a novel mutation in LMNA (c.871 G>A, p.E291K). Family segregation analysis indicated that all clinically affected patients carried this novel mutation. Clinical assessment of genetic carriers showed that electrical dysfunction was present previous to mechanical and structural abnormalities.

Conclusions: Our results report a novel pathogenic mutation associated with DCM, supporting the benefits of comprehensive genetic studies of families affected by this pathology.
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http://dx.doi.org/10.1016/j.cardfail.2014.12.003DOI Listing
March 2015

Relationship between endothelin-1 levels and pulmonary arterial hypertension in HIV-infected patients.

AIDS 2014 Nov;28(18):2693-9

aCardiology Department, Hospital Carlos III, Madrid bDepartment of Medicine, School of Medicine, Cadiz cInfectious Diseases Department, Hospital Carlos III dCardiology Department, Hospital Clínico San Carlos, Madrid, Spain. *Maribel Q. Feijoo and Rocío Toro contributed equally to this paper.

Objective: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease with average survival of less than 3 years if left untreated. It is most common in patients infected with HIV. Although the pathogenesis in this population is not fully understood, it is thought that HIV infection, through the immune response and release of different inflammatory mediators such as endothelin-1, may contribute directly to endothelial damage. Our objective was to quantify endothelin-1 levels in HIV-infected patients and determine whether or not there is an association between this marker and PAH.

Design: A case-control study in patients attending an infectious diseases clinic.

Methods: The sample was composed of 79 patients divided into three groups: 23 HIV patients with PAH (HIV+/PAH+), 45 HIV patients without PAH (HIV+/PAH-) and a control group of 11 healthy individuals. The ratio between the HIV+/PAH- and HIV+/PAH+ groups was 2 : 1. Patients were matched by age, sex, risk group and viral load; the control group by age and sex. All patients had blood taken for endothelin-1 plasma quantification.

Results: We found lower endothelin-1 levels in the controls than in the HIV+/PAH- group [0.71 pg/ml (interquartile range, IQR 0.54-0.94) vs. 1.13 pg/ml (IQR 0.87-1.38); P = 0.005] and the HIV+/PAH+ cohort [1.16 pg/ml (IQR 0.86-2.37); P = 0.003]. Patients with severe PAH had higher endothelin-1 levels [2.94 pg/ml (IQR 1.81-6.33)] than patients with mild and moderate PAH.

Conclusion: Plasma endothelin-1 levels are higher in HIV patients with PAH than in the HIV-noninfected population and levels increase with the severity of the PAH.
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http://dx.doi.org/10.1097/QAD.0000000000000470DOI Listing
November 2014

[Diet and exercise influence on the proteomic profile of an athlete population].

Nutr Hosp 2014 Nov 1;30(5):1110-7. Epub 2014 Nov 1.

Departamento de Salud Pública y Biotecnología, Facultad de Medicina, Cádiz. España..

Introduction: Nutrition has emerged as a fundamental tool included in the training program of athletes. Body composition seeks different objectives depending on type of sport, position, or time of the season. Furthermore, analysis proteomics allows us to know the structure and function of proteins.

Aims: To study, using proteomics, the influence of two different diets on the anthropometric profile in a rugby players group.

Methods: It is a prospective and interventionist study. Thirty-two rugby players were included. Two groups were defined, one followed proteic diet (PD) and, the other group subscribed the Mediterranean diet (MD). All participants were evaluated anthropometrically at the beginning and after six months. A blood sample was taken to twenty -two players, half of each group, used for the proteomic analysis.

Results: MD highlight more benefit for these athletes. Two groups were defined based on their anthropometric behavior, G1 and G2. The proteomic analysis related significantly some TGF-family mediators with these groups.

Conclusions: MD improves the muscular mass without increasing the total body weight, so this data could be determinant to define profiles for athletes. Some TGF-members could be implicated in the adipose tissue and muscular mass balance.
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http://dx.doi.org/10.3305/nh.2014.30.5.7697DOI Listing
November 2014

Impaired right and left ventricular mechanics in adults with pulmonary hypertension and congenital shunts.

J Cardiovasc Med (Hagerstown) 2016 Mar;17(3):209-16

aDepartment of Medicine, Cadiz University School of Medicine, CadizbAdult Congenital Heart Disease Unit, Clinical Management Area of the Heart, University Hospital 'Virgen del Rocio', SevillecCardiology Department, Hospital Carlos III, Madrid, Spain.

Aims: To assess left ventricle mechanics in Eisenmenger physiology patients with congenital shunts, and their relationship with the right ventricle, and to consider the clinical usefulness of this information.

Methods: The study involved 28 patients with pulmonary artery hypertension (PAH) and congenital shunt, matched with 28 healthy participants. Standard echocardiography and pulsed wave tissue Doppler imaging were employed to analyze systolic and diastolic ventricular function, the myocardial performance index (MPI) of ventricles, and the strain and strain rate along the left ventricle lateral wall, septum, and right ventricle free wall.

Results: The left ventricle ejection fraction was similar in the two groups. However, despite normal standard left ventricle measures, patients presented parameters of defective myocardial mechanics: mitral peak systolic velocity (S') (cm/s) (8.6 (7.6-10.9) vs. 10.7 (8.6-12.5); P = 0.002) was higher, whereas left ventricle-MPI was lower (0.54 ± 01 vs. 0.32 ± 0.07, P < 0.001). Right ventricle-MPI and right ventricle global strain were correlated significantly with left ventricle-MPI and left ventricle global strain (r = 0.74, P < 0.001; r = 0.442, P < 0.001, respectively). Clinically, the six-minute walking test results were correlated negatively with left ventricle-MPI (r = -0.69, P < 0.001), whereas the functional class was positively correlated (r = 0.36, P < 0.001). In conclusion, left ventricle mechanics and geometry are impaired in Eisenmenger syndrome patients, although conventional evaluation is in the normal range. Our results highlight the significance of ventricular interdependence in PAH and provide a useful tool for improving the clinical management of these patients.
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http://dx.doi.org/10.2459/JCM.0000000000000172DOI Listing
March 2016

[Calcified aortic valve disease: association with atherosclerosis].

Med Clin (Barc) 2011 May 24;136(13):588-93. Epub 2010 Apr 24.

Unidad de Cardiología, Hospital Virgen de la Montaña, Cáceres, España.

Calcified aortic valve disease (CAVD) is a prevalent condition, affecting 25% of people older than 65 years. CAVD and atherosclerosis share common risk factors and pathogenic mechanisms. Nevertheless, they present different pathologic lesions. The main factors involved in the pathogenesis of CAVD are genetic predisposition, the process of valvular calcification, deposition of lipoproteins, and chronic inflammation. Studies have suggested a potential benefit from early treatment with angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, and particularly with statins. Observational studies on risk factors for the CAVD, and randomized clinical trials on primary and secondary prevention in subjects with high risk for the disease, would be necessary to improve the clinical management of CAVD.
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http://dx.doi.org/10.1016/j.medcli.2010.02.019DOI Listing
May 2011

Clinical usefulness of tissue Doppler imaging in predicting preclinical Fabry cardiomyopathy.

Int J Cardiol 2009 Feb 8;132(1):38-44. Epub 2008 Aug 8.

Hospital Clínico San Carlos, Madrid, Spain.

Unlabelled: Fabry cardiomyopathy (FC) is characterized by left ventricular hypertrophy (LVH). The aim of this study is to determine whether early changes revealed by tissue Doppler imaging (TDI) are useful for detecting preclinical cardiac abnormalities in patients with this X-linked genetic disorder. If so, this tool could help in deciding whether to begin enzymatic therapy earlier than otherwise.

Methods And Results: 59 consecutive patients with confirmed Fabry disease (FD) underwent conventional and TD echocardiography. FD patients with and without LVH had significantly lower early diastolic tissue Doppler velocities (Ea) compared with the control group (P<0.001); The isovolumic relaxation time (IVRT) was significantly longer in the FD group with LVH (P<0.001). Isovolumic contraction time (IVCT) was significantly shorter in the FD group without LVH compared with the control group (P<0.001). Additionally, peak systolic wall motion velocity (Sa) was significantly lower in patients with LVH, compared with those without LVH (P<0.001). The systolic myocardial velocity correlates inversely with septum and posterior wall thickness (r: -0.74 and r: -0.90; P<0.001 respectively). In respect of predicting preclinical cardiac impairment, the area under the ROC curve of 0.83 suggests an optimal IVRT cut-off point of 60 ms for separating early cardiac impairment from the established condition. This gives a 96.6% specificity rate for the early detection of cardiac involvement. The best parameter for detecting preclinical FC is the IVCT, with a cut-off point of 105 ms, which shows high sensitivity and specificity (100% and 91%, respectively; AUC: 0.97).

Conclusions: Myocardial contraction and relaxation evaluation confirms that TDI is a reliable method for early identification of preclinical FC, even before FC patients develop LVH.
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http://dx.doi.org/10.1016/j.ijcard.2008.04.075DOI Listing
February 2009
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