Características de la insuficiencia cardíaca en pacientes con fracción de eyección preservada: Resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO / Characteristics of heart failure with preserved ejection fraction: Results of the Chilean National Registry of Heart Failure, ICARO

Background: Heart failure (HF) with preserved ejection fraction (EF) is a condition of growing interest due to its high prevalence and difficult management. Aim: To evaluate the clinical profile of patients hospitalized with HF and preserved EF in Chilean hospitals. Material and Methods: Prospective registry of 15 centers. Among 649 patients hospitalized in functional class III and IV, an echocardiogram was performed to 353. Preserved EF was defined quantitatively as an EF >50%. Results: Out the 353 patients, 45% presented an EF >50%. Mean age in patients with EF >50 and ­50% was 66±13 and 67±13 years, respectively. Among patients with HF and EF >50%, the proportion of women was higher (73.7 and 36.3%, p <0.001), the proportion of patients with a history of hypertension (76.8 and 65.5%, p <0.05) and the presence of atrial fibrillation was also higher (62.3 and 47.8%, p <0.01) and a history of myocardial infarction was lower (17.1 and 29.5%, p <0.05). The diastolic diameter of the left ventricle was significantly lower in HF with preserved EF (51.0+10 and 63.5+10 mm respectively, p <0.001). No differences in the length of hospital stay and mortality were observed between HF with depressed and preserved EF. Female gender was an independent predictor for the presence of HF with preserved EF (Odds ratio: 2.62; confidence intervals: 1.1-6.1). Conclusions: HF and preserved EF is common among hospitalized patients, particularly in women and subjects with a history of hypertension and atrial fibrillation. Hospitalization length and mortality were similar in patients with either preserved or depressed EF.

Comparación de digoxina y enalapril en insuficiencia cardíaca secundaria a insuficiencia mitral / Comparison of the effects of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency

Background: There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency. Aim: to compare digoxin and enalapril in the treatmen of heart failure due to mitral insufficiency. Patients and methods: Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmil were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency. Results: Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76ñ168 sec (p= 0.022), whereas this change was not significant with enalapril (38ñ158 sec; p= 0.2). With enalapril treatmen, ventricular diastolic dimensiondecreased from 59.3ñ8.1 to 58ñ9.3 mm and the area of mitral insufficiency decreased from 8.1ñ3.5 to 6.6ñ3.1 cm2. Digoxin did not induce any significant echocardiographic change. Conclusions: In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency

Efectos colaterales del dipiridamol en el test de talio / Side effects of dypiridamole during thallium myocardial perfusion imaging

La prueba de Talio con Dipiridamol constituye en la actualidad un método no invasivo de gran utilidad para evaluar a pacientes en quienes se sospecha o se ha confirmado una enfermedad coronaria. El Dipiridamol se puede administrar por vía endovenosa u oral, produce vasodilatación coronaria y puede poner en evidencia defectos de reperfusión miocárdica. Su administración puede asociarse a una incidencia variable de efectos colaterales. Comunicamos nuestra experiencia con la administración de Dipiridamol en 286 pacientes, 223 de ellos por vía endovenosa y 63 por vía oral. El 87% de los pacientes tenía evidencia previa de enfermedad coronaria. La administración de Dipiridamol se asoció a un aumento significativo de la frecuencia cardiaca y descenso también significativo de la presión arterial. Encontramos efectos colaterales en el 29,7% de los pacientes que recibieron Dipiridamol endovenoso y en el 32,3% de los que recibieron Dipiridamol oral. El síntoma colateral más frecuente, 15,4%, fue el dolor torácico, que se presentó de preferencia, 81,3%, en pacientes con enfermedad coronaria y cedió con la administración de Trinitina y/o Aminofilina. Otros síntomas colaterales fueron cefalea, náuseas y/o vómitos, pero con una incidencia menor. Concluimos en que los síntomas colaterales durante la prueba de Talio con Dipiridamol son frecuentes, la mayoría de ellos leves y no son diferentes según el tipo de administración oral o endovenosa de la droga. El síntoma colateral más severo, dolor torácico, revierte facilmente con la administración de Trinitina o Aminofilina

Muerte súbita en el adulto joven sin cardiopatía demostrable: características clínicas y electrofisiológicas en 3 casos / Sudden cardiac death in 3 young patients without overt heart disease

We reported 3 young adult males who developed spontaneous ventricular fibrillation in the abscence of demonstrable heart disease. Extensive clincial and elelcrophysiilogic evaluation failed to disclose a cause for the arrhythmia. Antiarrhythmic drugs were empirically used in all patients but 2 of then eventually died. Thus, unexplained ventricular fibrillation without demonstrable heart disease carries a serious short term prognosis. An implantable cardiovertodefibrillator may be the therapy of choice in these cases