Valor pronóstico del análisis del vector de bioimpedancia en pacientes ingresados por descompensación aguda de insuficiencia cardiaca: cohorte de validación / Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: a validation cohort

Objetivos. Evaluar el impacto pronóstico del análisis del vector de bioimpedancia (bioelectrical impedance vector analysis [BIVA]) en pacientes ingresados por insuficiencia cardiaca (IC). Material y métodos. Cohorte prospectiva de 105 pacientes ingresados por IC. El BIVA se realizó previo al alta, y la muestra final se dividió en 3 grupos según el valor obtenido: hiperhidratación [hiperH] (>74,3%), normohidratación [normoH] (72,7-74,3%) y deshidratación [desH] (<72,7%). En el seguimiento, se consideraron eventos adversos la mortalidad total y los reingresos por IC. Resultados. Se observó una mayor incidencia de eventos en los pacientes hiperH y desH respecto a los normoH (Kaplan-Meier: log rank 2,1; p=0,04), con un incremento de riesgo independiente en el análisis multivariado (HR 2,6 [1,05-6,44]; p=0,039). Conclusiones. El análisis BIVA en pacientes ingresados por IC permite estratificar el riesgo de reingreso por IC y mortalidad total en el seguimiento a largo plazo (AU)

Objectives. To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). Material and methods. A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. Results. A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). Conclusions. BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF (AU)

Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: A validation cohort.

OBJECTIVES: To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). MATERIAL AND METHODS: A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. RESULTS: A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). CONCLUSIONS: BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF.

Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario / Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital

Introducción. La fibrilación auricular es el principal motivo de anticoagulación oral en nuestro medio. Los nuevos anticoagulantes orales (NACO) superan las desventajas de los antagonistas de la vitamina K (AVK), aunque existen pocos datos de uso en nuestro medio. Nos planteamos evaluar el uso de NACO y el control en rango terapéutico (CRT) con AVK en un escenario clínico real. Métodos. Análisis de cohortes retrospectivo de 816 ingresos en cardiología durante 3 años con el diagnóstico de fibrilación auricular y tratamiento anticoagulante al alta, evaluando el porcentaje de prescripción de NACO y el CRT con AVK. Se compararon eventos de seguridad y eficacia durante un seguimiento de 15 meses entre los pacientes con NACO, los pacientes con AVK y buen CRT, y aquellos con mal CRT. Resultados. El porcentaje de prescripción de NACO fue del 7,6%. La determinación seriada de INR encontró un 71,3% de pacientes con mal CRT. Aunque los grupos no fueron comparables, se observó una mayor incidencia del evento combinado (ictus o infarto de miocardio, y mortalidad) en los tratados con AVK y mal CRT que en aquellos con NACO (p=0,01). Conclusiones. En pacientes con ingreso previo en cardiología en un hospital terciario y diagnóstico de fibrilación auricular, el índice de prescripción de NACO es bajo y el CRT con AVK es pobre (AU)

Introduction. Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. Methods. A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. Results. The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). Conclusions. For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor (AU)

Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital. / Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario.

INTRODUCTION: Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. METHODS: A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. RESULTS: The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). CONCLUSIONS: For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor.

Lipoproteínas de alta densidad y necrosis miocárdica en pacientes con infarto agudo de miocardio y elevación del segmento ST / High-density lipoproteins and myocardial necrosis in patients with acute myocardial infarction and ST segment elevation

Introducción y objetivo. Las concentraciones plasmáticas de colesterol unido a lipoproteínas de alta densidad (cHDL) descendidas constituyen un indicador de mal pronóstico en pacientes con síndrome coronario agudo. Hemos evaluado la relación entre las cifras de cHDL y la extensión de la necrosis miocárdica estimada por cardiorresonancia magnética en pacientes con infarto agudo de miocardio y elevación persistente del segmento ST en quienes se indicó reperfusión miocárdica. Pacientes y métodos. Análisis retrospectivo de 139 pacientes (edad media: 59,8 años; hombres: 79%) ingresados por infarto agudo de miocardio con elevación persistente del segmento ST y a quienes se efectuó una cardiorresonancia magnética. Las imágenes indicativas de necrosis miocárdica (realce tardío del gadolinio) se cuantificaron y relacionaron con la concentración de cHDL. Resultados. Los pacientes con cHDL≤40mg/dl (69% del total), en comparación con los que tenían un cHDL >40mg/dl, mostraron un área de necrosis miocárdica más extensa: el número de segmentos miocárdicos con patrón de necrosis transmural fue significativamente mayor (4,7 vs. 2,1; p<0,001), al igual que el porcentaje de necrosis miocárdica de la masa miocárdica total (18,2 vs. 11,3%; p=0,01). Los pacientes con disminución de cHDL tuvieron una menor fracción de eyección del ventrículo izquierdo (49,7 vs. 57,2%; p<0,001). Conclusiones. La concentración de cHDL disminuido es muy frecuente en los pacientes con infarto agudo de miocardio y elevación persistente del segmento ST. Este descenso de cHDL se asoció a una mayor área de necrosis y peor fracción de eyección del ventrículo izquierdo(AU)

Introduction and aim. Low plasma levels of high-density lipoprotein cholesterol (HDLC) is a prognostic factor in patients with acute coronary syndrome. The aim of this study was to evaluate the relationship between HDLC and myocardial necrosis estimated by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI) and reperfusion strategy. Methods. Retrospective analysis of 139 patients (mean age 59.8 years; 79% men) admitted with STEMI who underwent a CMR in the first week. Results. With a comparable reperfusion strategy used and time of ischemia, patients with HDLC ≤ 40mg/dL (69% of total) had more extensive areas of myocardial necrosis after STEMI, in number of segments with late gadolinium enhancement (RTG) with transmural necrosis pattern (4.7 vs. 2.1, P<.001) and in percentage of RTG with respect total mass myocardial (18.2 vs. 11.3%, P<.01), and worst left ventricular ejection fraction (LVEF) (49.7 vs. 57.2%, P<.001). Conclusions. We conclude that low HDLC are very common in patients with STEMI and associated with increased necrosis and a worse LVEF in the CRM study(AU)

High-density lipoproteins and myocardial necrosis in patients with acute myocardial infarction and ST segment elevation.

INTRODUCTION AND AIM: Low plasma levels of high-density lipoprotein cholesterol (HDLC) is a prognostic factor in patients with acute coronary syndrome. The aim of this study was to evaluate the relationship between HDLC and myocardial necrosis estimated by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI) and reperfusion strategy. METHODS: Retrospective analysis of 139 patients (mean age 59.8 years; 79% men) admitted with STEMI who underwent a CMR in the first week. RESULTS: With a comparable reperfusion strategy used and time of ischemia, patients with HDLC ≤40 mg/dl (69% of total) had more extensive areas of myocardial necrosis after STEMI, in number of segments with late gadolinium enhancement (RTG) with transmural necrosis pattern (4.7 vs. 2.1%, p < .001) and in percentage of RTG with respect to total mass myocardial (18.2 vs. 11.3%, p < .01), and worst left ventricular ejection fraction (LVEF) (49.7 vs. 57.2%, p < .001). CONCLUSIONS: We conclude that low HDLC are very common in patients with STEMI and associated with increased necrosis and a worse LVEF in the CRM study.

[Differences in the degree of control of arterial hypertension according to the measurement procedure of blood pressure in patients ≥ 65 years. FAPRES study]. / Diferencias en el grado de control de la hipertensión arterial según procedimiento de medida de la presión arterial en pacientes de edad ≥ 65 años. Estudio FAPRES.

BACKGROUND AND OBJECTIVES: Control of arterial blood pressure (BP) in hypertensive patients differs based on the evaluation procedure. This fact can be enhanced in subjects over 65 years of age. We have studied the degree of BP control with determinations in the office or ambulatory blood pressure monitoring (ABPM). METHODS: A multicenter, cross-sectional study was conducted in primary care (PC) and hypertension units in the Valencian Community. The first three hypertensive patients ≥ 65 years who attended the consultation on the first day of visits of the week of each investigator were included in the study. Cardiovascular risk factors, target organ damage and associated cardiovascular disease were recorded. Good clinical control values were defined as < 140/90 in the office and < 130/80 by ABPM for 24-hour according to 2007 ESH/ESC guidelines. RESULTS: A total of 1,028 hypertensive patients were included, 52.7% of whom were women, with a mean age of 72.6 years. Mean clinical BP was 146.7/81.1 mmHg and 24-hour ABPM 128.5/70.8 mmHg. Ninety-two percent of the patients were treated with antihypertensive drugs (35.6% monotherapy and 56.4% with combinations of two or more drugs). Good clinical control was found in 35.3% of cases (CI 95%: 32.4-38.2) and 50.9% (CI 95%: 47.8-54.0) (P < .001) had good control of 24-hour BP in ABPM. Male gender, personal background of heart disease and stroke were associated with good control of hypertension (P < .01) in 24-hour ABPM. CONCLUSIONS: In hypertensive patients over 65 years, and compared to the clinical determination of BP, the evaluation of ABMP showed a better proportion of controlled subjects. These findings support a wider use of ABPM to evaluate the control of BP in this population.

Diferencias en el grado de control de la hipertensión arterial según procedimiento de medida de la presión arterial en pacientes de edad >= 65 años. Estudio FAPRES / Differences in the degree of control of arterial hypertension according to the measurement procedure of blood pressure in patients >= 65 years. FAPRES study

Antecedentes y objetivos. El control de la presión arterial (PA) en pacientes hipertensos difiere en función del procedimiento de valoración. Este hecho puede estar acentuado en los mayores de 65 años. Hemos examinado el grado de control de la PA con determinaciones en consulta y monitorización ambulatoria de la PA (MAPA). Metodología. Estudio transversal multicéntrico realizado en Atención Primaria y unidades de HTA de la Comunidad Valenciana. Se incluyeron los tres primeros pacientes hipertensos ≥ 65 años que acudieron a consulta el primer día de visita de la semana de cada investigador. Se registraron factores de riesgo cardiovascular, lesión de órgano diana y enfermedad cardiovascular. Se definió buen control clínico. Valores < 140/90 mmHg y buen control ambulatorio valores por MAPA en 24 horas < 130/80 mmHg. Resultados. Se incluyó a 1.028 pacientes, edad media 72,8 años (52,7% de mujeres). La PA clínica media fue de 146,7/81,1 mmHg y con MAPA de 24 horas 128,5/70,8 mmHg. El 92% de los pacientes estaba tratado con antihipertensivos (35,6% monoterapia y 56,4% con combinaciones de dos o más fármacos). El 35,3% (IC95%,32,4-38,2) presentó buen control clínico y un 50,9% (IC95%: 47,8-54,0). Buen control con MAPA (p < 0,001). El género masculino y los antecedentes personales de cardiopatía e ictus fueron los factores significativamente asociados al buen control de la PA (p < 0,01) con MAPA. Conclusiones. En los pacientes hipertensos mayores de 65 años y en comparación con las determinaciones clínicas de PA, la valoración con MAPA muestra una mayor proporción de sujetos controlados. Estos hallazgos sustentan un uso más amplio de la MAPA para valorar el control de la PA en esta población(AU)

Background and objectives. Control of arterial blood pressure (BP) in hypertensive patients differs based on the evaluation procedure. This fact can be enhanced in subjects over 65 years of age. We have studied the degree of BP control with determinations in the office or ambulatory blood pressure monitoring (ABPM). Methods. A multicenter, cross-sectional study was conducted in primary care (PC) and hypertension units in the Valencian Community. The first three hypertensive patients ≥ 65 years who attended the consultation on the first day of visits of the week of each investigator were included in the study. Cardiovascular risk factors, target organ damage and associated cardiovascular disease were recorded. Good clinical control values were defined as < 140/90 in the office and < 130/80 by ABPM for 24-hour according to 2007 ESH/ESC guidelines. Results. A total of 1,028 hypertensive patients were included, 52.7% of whom were women, with a mean age of 72.6 years. Mean clinical BP was 146.7/81.1 mmHg and 24-hour ABPM 128.5/70.8 mmHg. Ninety-two percent of the patients were treated with antihypertensive drugs (35.6% monotherapy and 56.4% with combinations of two or more drugs). Good clinical control was found in 35.3% of cases (CI 95%: 32.4-38.2) and 50.9% (CI 95%: 47.8-54.0) (P < .001) had good control of 24-hour BP in ABPM. Male gender, personal background of heart disease and stroke were associated with good control of hypertension (P < .01) in 24-hour ABPM. Conclusions. In hypertensive patients over 65 years, and compared to the clinical determination of BP, the evaluation of ABMP showed a better proportion of controlled subjects. These findings support a wider use of ABPM to evaluate the control of BP in this population(AU)

Utilidad de la correcta medida de la presión arterial / Utility of correct measurement of blood pressure arterial

La correcta medición de la presión arterial (PA) es fundamental para el diagnóstico y seguimiento del paciente hipertenso. Sin embargo, los errores en la toma de la PA relacionados con la patología local del paciente son poco frecuentes y pasan desapercibidos. Presentamos los casos de dos pacientes hipertensos con obstrucción de la arteria subclavia, lo que provocó errores en la medida de la PA e incorrecto manejo debido a esta circunstancia

Correct measurement of blood pressure (BP) is essential for diagnosis and follow-up of the hypertensive patient. However, errors in measuring BP related with local condition of the patient are uncommon and are overlooked. We present the cases of two hypertensive patients with obstruction of subclavian artery that caused errors in BP measurement and incorrect management due to this circumstance

[Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?]. / Niveles de glucemia en pacientes no diabéticos. 'Es un factor pronóstico en el síndrome coronario agudo?

INTRODUCTION: The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. METHODS: We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. RESULTS: Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). CONCLUSIONS: In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers.

Niveles de glucemia en pacientes no diabéticos. ¿Es un factor pronóstico en el síndrome coronario agudo? / Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?

Introducción. No está bien definido el papel de la elevación de glucosa por encima de los valores considerados como normales en los pacientes no diabéticos con síndrome coronario agudo (SCA). El objetivo del presente estudio es analizar los efectos sobre el pronóstico a un año de los niveles de glucemia obtenidos durante el ingreso en este tipo de pacientes. Métodos. Estudiamos a 648 pacientes no diabéticos consecutivos con SCA, en los cuales se midieron los niveles de glucosa durante su estancia hospitalaria junto con los factores de riesgo clásicos, los marcadores bioquímicos e inflamatorios. El criterio de evaluación principal fue la muerte por todas las causas a un año. Resultados. Los pacientes con glucemia normal durante el ingreso presentaban un menor porcentaje de fallecimientos en el seguimiento que los que presentaban una glucosa basal alterada (14,1% frente a 5,7%), así como en rango de diabetes (24,7% frente a 5,7%). Conclusiones. Los niveles de glucosa obtenidos durante el ingreso en los pacientes no diabéticos con SCA sin elevación del ST son predictores de muerte, independientemente de factores bioquímicos, epidemiológicos clásicos e inflamatorios

Introduction. The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. Methods. We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. Results. Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). Conclusions. In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers

Una causa infrecuente de trombosis masiva intracardíaca / Arare case of intracardiac massive thrombosis

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Valsalva sinus pseudoaneurysm causes acute myocardial infarction and stroke simultaneously.

Spontaneous Valsalva sinus pseudoaneurysm is a rare and highly lethal condition. Below we present a clinical case of a young woman with spontaneous Valsalva sinus pseudoaneurysm diagnosed presenting with acute myocardial infarction (AMI) and ischemic stroke.