Left Ventricular Hypertrophy and Incidence of Acute Coronary Heart Disease and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS).

Objective: To examine the relationship between left ventricular hypertrophy (LVH) and the incidence of acute coronary heart disease (CHD) and mortality in the modern era. Methods: We studied 16, 390 black and white participants free of clinical CHD from a US national sample. The independent prognostic value of ECG-LVH was determined by Cornell voltage (CV) for risk of incident acute CHD and total mortality overall and by race and sex. Results: 410 incident acute CHD events and 993 deaths occurred over a median follow-up of 4.8 years. CV LVH was associated with outcomes: more common in blacks (4.1%) than whites (1.2%) and in women (3.9%) than men (1.3%). However, men with CV LVH (HR 2.12 [95% CI 1.02-4.42) had greater risk for incident acute CHD than women (HR 1.29 [95% CI 0.79-2.11]) after adjusting for demographic, behavioral and clinical variables. By contrast, CV LVH conferred similar hazards for incident acute CHD among blacks (HR 1.63 [1.00-2.68; p=0.050]) and whites (HR 1.58 [95% CI 0.76-3.28; p=0.22]). Mortality associated with CV LVH was elevated overall (HR 1.31 [95% CI 1.00- 1.71]) and for blacks (HR 1.36 [95% CI 1.00-1.86]) but not whites (HR 1.16 [95% CI 0.70-1.94]), with similar risk for women (HR 1.24 [95% CI 0.92-1.67] and for men (HR 1.30 [95% CI 0.72-2.35]). Conclusion: In this contemporary cohort, CV LVH was significantly prognostic for incident acute CHD for men but not women and there was no evidence of race differences. However, CV LVH was significantly prognostic for total mortality for blacks but not whites without evidence of sex differences.

Predictores de rehospitalización en pacientes con insuficiencia cardíaca congestiva / Predictors of readmission in patients with congestive heart failure

Repeated hospitalizations among patients (pts) with congestive heart failure (CHF) are common. Purpose: This retrospective study was designed to determine predictors of readmission. Methods: Inclusion criteria: admitted to University Hospital with a primary diagnosis of CHF between 10/1/94-9/30/95: lived in Jefferson county. Exclusions: cardiac transplant during study period; major comorbidity (e.g. malignancy, advanced renal failure). Predictors of readmission were determined by stepwise logistic regression analysis and predictor of time to readmission with Cox Proportionate Hazards modeling p<0.05 was considered statistically significant. Results: Mean age of the 237 pts was 66.5 yrs; 56 percent women. Mean left ventricular ejection fraction (LVEF) was 29 percent; 96 percent were in NYHA Class III/IV. Mean length of stay was 5 days; 52 pts (22 percent) had >1 admission. CHF etiologies: Ischemic (42 percent), hypertensive (37 percent), idiopathic (12 percent). Demographic characteristics and insurance status did not predict readmission risk. Predictors of readmission in the logistic and Cox models were similar. Increased risk of readmission was associated with myocardial ischemia (logistic OR 42.7), past NYHA Class III and IV (OR 32.8), plasmatic creatinine at discharge (OR 1.9) and continued smoking (OR 3.26). History of CABG was associated with a decreased risk of rehospitalization (OR 0.12). Beta-blocker use was associated with decreased risk, but did not achieve statistical significance. ACE-I use (prescribed in 78 percent of pts), did not contribute to the model. Diabetes Mellitus and a lower LVEF were more frequent in the readmitted group, but they did not predict readmission. Conclusion: CHF pts who have evidence of ischemia, advanced symptoms, renal dysfunction, and who continue to smoke are at increased risk for hospital readmission. Pts with these characteristics should be identified prior to hospital discharge and considered for intensive outpatient intervention

Dolor torácico de origen desconocido

En este interesante artículo los autores establecen los puntos claves de la historia, del cuadro clínico y de los resultados de laboratorio para establecer un adecuado diagnóstico diferencial en el paciente con dolor torácico de origen no aclarado, y pasan revista a los primeros pasos en el tratamiento.