[Predictive variables of early hospital readmission in cardiac failure]. / Variables predictivas del reingreso hospitalario precoz en la insuficiencia cardíaca.

BACKGROUND: Heart failure (HF) is one of the diagnosis leading to a high number of readmissions in our hospitals. There is some controversy about the role played by two groups of variables on the risk or readmissions: patient-dependent variables, such as clinical severity, and the characteristics of medical care during the previous admission, in terms of care quality. STUDY POPULATION: admissions due to HF with home discharge. DESIGN: case-control study. CASES: episodes followed by emergent admission within 30 days because of related diagnosis ("early readmission") (n = 51). CONTROLS: random sample of episodes not followed by an early readmission (n = 51). Information collected: review of clinical records. Groups of predictive variables studied: demographics, clinical severity, clinical parameters prognostic of HF and characteristics of medical care. Bivariate and multivariate statistical analysis: logistic regression (LR). RESULTS: LR analysis detected only one variable predicting early readmission, the ischemic etiology. Odds ratio = 4.78 (95% CI: 1.44; 15.88). There were no differences between the study groups regarding age, sex, clinical instability at discharge, hospital stay length, severity (APACHE III and other evaluation methods) and other prognostic parameters of HF (ejection fraction, functional degree, cardiomegaly, concurrent diabetes, valvular disease, atrial fibrillation, hyponatremia, and use of anti-arrhythmic drugs). CONCLUSIONS: The risk for an early readmission is mainly explained by the clinical variables of patients, basically ischemic etiology, and not by the characteristics of medical care: clinical instability at discharge or hospital stay length.

[Cardiomyopathies (VII). Natural history of hypertrophic cardiomyopathy]. / Miocardiopatías (VII). Historia natural de la miocardiopatía hipertrófica.

After a short historic review of conceptual developments in hypertrophic cardiomyopathy, the natural history of the disease is analyzed according to each of its morphologic and functional abnormalities. The lack of association between hypertrophic morphology and sudden death is considered. Diastolic dysfunction and LV obstruction, although a frequent cause of dyspnea and heart failure, is not a risk factor for sudden death. Something similar occurs with the infrequent appearance in this disease of contractile failure. Myocardial ischemia is frequent in hypertrophic cardiomyopathy and general prognostic information about it is still lacking. Nevertheless, in young patients with family history of sudden death, a positive Thallium effort test may be a marker of sudden death (without an arrhythmogenic substrate), and may respond to verapamil. Finally, the new knowledge about genetic mutations in hypertrophic cardiomyopathy are analized. We conclude with some futuristic comments about hypertrophic cardiomyopathy.

[Differences in prediction of mortality and non-fatal complications after acute myocardial infarction: a multivariate analysis]. / Diferencias en la predicción de mortalidad y complicaciones no fatales postinfarto agudo de miocardio: un análisis multivariable.

The global prognostic after acute myocardial infarction depends of the left ventricular function and the residual ischemia. However, there is controversy about the capacity of some variables reflecting this prognostic factors to predict futures complications. The main objective of this study is to know the influence of the kind of complications in the prognostic value of the variables more frequently used in the clinical practice. We studied 121 consecutive patients with acute myocardial infarction discharged from hospital. The previous and during acute infarction clinical variables were analyzed. The regional and global left ventricular function was studied by 2D echocardiography. An exercise test symptoms-limited was performed at 3rd week after discharge in 94 patients selected. The patients were followed during selected one year. The first year cardiac mortality rate was 8.6%. In the multivariate, the independent predictors of mortality were: age > 60 years (p = 0.02) and the impossibility to perform exercise test (p = 0.0002). In the univariate analysis the echocardiographic motility score > or = 17, eyection fraction < 35% and Killip class > or = II were also death predictors. Non fatal complications (angina, reinfarction o heart failure) were present in 47 patients (42.3%) of 111 survivors. The ischemic complications were predicted in multivariate analysis only by postinfarction angina (p = 0.0007), and heart failure by eyection fraction < 35% (p = 0.006), previous infarct (p = 0.002) and Killip class (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

[Right-sided endocarditis due to Fusobacterium nucleatum]. / Endocarditis derecha por Fusobacterium nucleatum.

We present 1 case of right sided endocarditis caused by Fusobacterium nucleatum in a patient with intravenous drug addiction and human immunodeficiency. The clinical features were fever, anemia, and pulmonary embolism. The echocardiogram showed a giant vegetation originated from the right atrial wall prolapsing in diastole into the right ventricle which disappeared after the patient presented pulmonary embolism. The clinical course was uncontrolled with empiric antimicrobial therapy but it was good with metronidazol. The cases previously described in the literature caused by gram-negative anaerobic bacteria are discussed and compared with the present case.