Imágenes en endocarditis infecciosa: no todo es ecocardiografía / Imaging in infective endocarditis: not all is ultrasonography

Resumen La endocarditis infecciosa (EI) es una enfermedad de alta mortalidad, caracterizada por una infección endocárdica y frecuentes complicaciones multiorgánicas, que requiere un diagnóstico rápido y preciso, y un manejo agresivo, ya sea médico o quirúrgico. Su diagnóstico se realiza tomando en cuenta criterios bacteriológicos, clínicos y ecocardiográficos. Es objetivo de este artículo realizar una actualización del estudio imagenológico en paciente con EI, con especial énfasis en aquellos exámenes no ecocardiográficos disponibles en nuestro medio. En los últimos años, estudios de imagen avanzados han adquirido un rol creciente en su estudio inicial, particularmente la tomografía computada multicorte (TCMC) cardiaca y el positron emission tomography/computed tomography (PET/CT), y han sido recomendados como criterios diagnósticos en las guías recientes para el manejo de esta entidad. La TCMC cardiaca proporciona información anatómica detallada de las válvulas cardiacas y tejido perivalvular, identificando pseudoaneurismas, abscesos y dehiscencias valvulares. El PET/CT con F18-fluorodeoxiglucosa (F18-FDG) permite aumentar la sensibilidad en la detección de EI, y pesquisar con alta eficiencia fenómenos embólicos sistémicos, de elevada frecuencia en esta población. Ambos métodos prestan particular utilidad en EI de válvula protésica, donde la ecocardiografía presenta menor rendimiento diagnóstico. La resonancia magnética (RM) cerebral es el mejor método de imagen para descartar eventos isquémicos/embólicos del sistema nervioso central.

Abstract Infective endocarditis (IE) is an entity characterized by endocardial infection and frequent multiorgan complications, resulting in high mortality. It requires a rapid and accurate diagnosis, and a medical or surgical aggressive treatment. Currently, IE diagnosis rests on bacterial, clinical and ultrasonographic criteria. The objective of this article is to update the imaging study in patients with IE, with special emphasis on those non-echocardiographic examinations available in our environment. Last years, advanced imaging had achieved a growing role in IE diagnosis, especially cardiac multislice computed tomography (MSCT) and positron emission tomography/computed tomography (PET/CT), which have been recommended in recent clinical guidelines to be included as part of diagnostic criteria. Cardiac MSCT provides detailed anatomic information of cardiac valves and perivalve tissue, allowing identification of pseudoaneurysm, abscess and valve dehiscence. F18-FDG PET/CT increases sensitivity for IE detection and shows high accuracy in searching for extracranial systemic embolic events. Both MSCT and PET/CT have particular utility in cases of prosthetic valve endocarditis, where cardiac ultrasonography shows lower performance. Brain magnetic resonance imaging (MRI) is the best imaging method for evaluating ischemic/embolic events of central nervous system.

The psychological impact of permanent cardiac pacemakers on pediatric patients and their parents: A case control study

Background This study assessed anxiety and depression in children with permanent pacemakers (PPM) and quality of life of their parents. Methods Ninety children (63.3% males and 36.6% females) and their parents were included in the study and were divided into three groups. The control group (Group 1) included 30 normal healthy children (57% males and 43% females), the PPM group (Group 2) included 30 age-matched children (70% males and 30% females) with PPM and structurally normal heart, while the Group 3 included 30 children (63% males and 37% females) with PPM and congenital heart disease (PPM + CHD). Psychological assessment of children and their parents was carried out using an interview-based questionnaires. Results Psychiatric disorders were more prevalent in PPM + CHD group including depression (P = 0.04), anxiety (P = 0.02) and lower parents’ QoL (P = 0.01). The PPM group had higher depression and lower parents’ QoL than the control group. Family income was independent factor for depression (r2 = −6.3, with P < 0.05). Sex of the child and CCU admission were independent factors for anxiety (r2 = −9.5, P < 0.05 & r2 = 10.5, P = 0.001) in PPM group. Conclusion Children with pacemakers have higher psychiatric disorders and their parents have lower QoL.

Capacidad de agencia de autocuidado y calidad de vida de las personas que tienen dispositivos cardiacos implantables / Self-care agency capacity and quality of life of people with implantable cardiac devices

El objetivo de este estudio fue describir la relación que existe entre la capacidad de agencia de autocuidado y la calidad de vida relacionada con la salud de las personas que tienen dispositivos cardiacos implantables en la ciudad de Bogotá. Este estudio es cuantitativo correlacional, de corte transversal. El Autocuidado se midió con la escala "Capacidad de Agencia de Autocuidado" diseñada por Isemberg, Evers y Otros; y la calidad de vida con el cuestionario de salud SF-36 desarrollado por Ware y Sherbourne, ambos cuentan con validez y confiabilidad para el contexto colombiano. Fueron aplicados a 125 personas, quienes voluntariamente accedieron a participar. Se encontró una relación débil positiva (r=0,34, p< 0,01) entre autocuidado y calidad de vida. Existen asociaciones estadísticamente significativas entre las dimensiones. Desde el autocuidado, el bienestar personal, actividad y reposo y promoción del funcionamiento y desarrollo personal, se relacionó con todas las dimensiones de calidad de vida. La promoción del funcionamiento y desarrollo personal es la dimensión que mostró mejor asociación con la calidad de vida, específicamente con el desempeño físico. Análisis adicionales del estudio, determinaron que la calidad de vida se relaciona de manera significativa con el género y el estado civil. Estadísticamente, no existen diferencias significativas entre la calidad de vida y el autocuidado según el tiempo de convivencia con el dispositivo cardiaco y el tipo de terapia. Se reporta un alfa de Cronbach de 0,78 para la escala que mide la Capacidad de Agencia de Autocuidado y 0,93 para el cuestionario de salud SF-36.

The objective of this study was to determine the existing relation between the capacity of self-care agency and the quality of life related to the health of people that have implantable cardiac devices in the city of Bogotá. This quantitative study is corelational and cross-sectional. Self-care was measured with a scale titled "Self-care Agency Capacity", designed by Isemberg, Evers second version in Spanish; quality of life was measured with the SF-36 Health Questionnaire, developed by Ware y Sherbourne. Both measurements are reliable and valid within the Colombian context. These were applied to 125 people, which volunteered to participate. A weak, positive co-relation was found (r=0.34, p< 0.01) between self-care and quality of life. Some statistically significant associations exist between these dimensions. Personal healthcare, physical activity and rest, and promotion regarding personal development and functions have all been related to all the dimensions of quality of life, all derived from selfcare. The promotion of personal development and functions is the most co-related dimension in regards to quality of life, especially in terms of physical performance. Additional analysis from the study determined that quality of life has a significant corelation with gender and civil status. Statistically, there is no significant difference between quality of life and self-care, according to time spent with the cardiac device and the type of therapy. The alfa Chronbach's reliability coefficient was applied to the "Self-care Agency Capacity" scale and a value of 0,78 was obtained, and a value of 0,93 was obtained for SF-36 Health Questionnaire.