Clinical characteristics of heart failure patients with mid-range ejection fraction.

BACKGROUND: We aimed to characterise and compare the clinical profile of heart failure (HF) with mid-range (HFmrEF), reduced (HFrEF) and preserved (HFpEF) left-ventricular ejection fraction. METHODS: We conducted a descriptive, observational study in 267 HF patients admitted to the Internal Medicine department of a tertiary hospital during 2010-2016. The study population was divided into three groups according to the ejection fraction rate: HFrEF (<40%), HFmrEF (40-49%), and HFpEF (≥50%). We analysed and compared their demographic, clinical, and analytical characteristics. RESULTS: The mean age of the study population was 79.5 (standard deviation, 8.14) years; 56.6% were males. The most common phenotype was HFpEF (58.1%), followed by HFrEF (21.7%) and HFmrEF (20.2%). Ischaemic cardiopathy was the primary aetiology in the HFmrEF and HFrEF groups, and arterial hypertension in the HFpEF group. The most common comorbidities among HFmrEF patients were diabetes (43.4%), chronic obstructive pulmonary disease (35.8%), and anaemia (35.8%); 49.1% had impairment of segmental myocardial contractility, and 35.8% ventricular dilatation. No differences in HF outcomes were observed among the three phenotypes. CONCLUSION: HFmrEF shows characteristics similar to both HFpEF and HFrEF. Further large-scale studies with longer follow-up are needed to ascertain if it is worth distinguishing this phenotype in clinical practice in terms of management and prognosis.

Cardiopatía asociada a infección por VIH / HIV-associated heart disease

Resumen La infección por VIH continúa representando un problema sanitario de primer orden en el mundo. El aumento de la esperanza de vida gracias a la terapia antirretroviral ha aumentado la prevalencia de la enfermedad de manera importante. La infección por VIH es una causa importante de cardiopatía adquirida, en especial en relación con el desarrollo de cardiopatía isquémica (manifestación cardiovascular más frecuente en los países desarrollados en la actualidad). Se presenta el caso de una paciente de 42 años, con infección por VIH, sin factores de riesgo cardiovascular clásicos, quien presentó un síndrome coronario agudo de alto riesgo. Se discuten la etiopatogenia de la cardiopatía isquémica asociada a la infección por VIH y sus aspectos particulares diagnósticos y terapéuticos.

Abstract Human immunodeficiency virus (HIV) infection continues to be a leading health problem worldwide. Increased life expectancy due to antiretroviral therapy has significantly increased the prevalence of the disease. Human immunodeficiency virus infection is an important cause of acquired heart disease, especially the development of ischemic heart disease (the most common cardiovascular manifestation in developed countries today). We present the case of a 42-year-old patient with HIV infection with no classical cardiovascular risk factors who developed a high-risk acute coronary syndrome. We discuss the etiopathogenesis of HIV-associated ischemic heart disease and its particular diagnostic and therapeutic aspects.

Fibroelastoma papilar mitral como causa de ictus en paciente joven / Mitral papillary fibroelastoma as a cause of stroke in a young patient

RESUMEN El fibroelastoma papilar es un tumor poco frecuente, con una prevalencia estimada entre el 1 y el 7,9% de todos los tumores cardíacos primarios, los que -a su vez- presentan una muy baja incidencia (entre 0,001 y 0,28%), pues la gran mayoría de ellos (casi un 90%) son benignos. Se presenta el caso de un hombre de 41 años de edad que debutó con un accidente cerebrovascular. En el estudio ecocardiográfico se halló un tumor cardíaco en la valva anterior mitral sugerente de fibroelastoma papilar. Se decidió la intervención quirúrgica ante la posibilidad de complicaciones embólicas derivadas, con recurrencia de episodios isquémicos cerebrovasculares. Se realizó resección triangular de dicha tumoración y anuloplastia mitral con buen resultado. El estudio anatomopatológico confirmó el diagnóstico.

ABSTRACT Papillary fibroelastoma is an infrequent tumor, with a prevalence estimated between 1 and 7.9% of all primary cardiac tumors, which -at the same time- have a very low incidence (between 0.001 and 0.28%), because the great majority of them (almost a 90%) are benign. Here is presented the case of a 41-year-old man who had a stroke. A cardiac tumor in the anterior mitral valve suggestive of papillary fibroelastoma was found in the echocardiographic study. The surgical intervention was decided because of the possibility of resulting embolic complications with recurrence of cerebrovascular ischemic events. A triangular resection of the tumor and mitral annuloplasty were performed with good results. The pathological study confirmed the diagnosis.

Interferencia analítica en la determinación de troponina por anticuerpos heterófilos / Interference in the determination of Troponin due to heterophile antibodies

Resumen Por su elevada especificidad y sensibilidad, y a raíz de la tercera definición universal de infarto estas isoformas cardiacas han sido aceptadas en el ámbito internacional como los biomarcadaores de elección en la práctica clínica para el diagnóstico de síndrome coronario agudo, preferibles a la determinación de las enzimas creatina quinasa y su isoforma MB. Se presenta el caso de un varón de ochenta años, quien, de manera persistente, tuvo valores elevados de troponinas, pese a evolución clínica no compatible con síndrome coronario agudo ni otras causas de elevación de este biomarcador.

Abstract Due to its elevated specificity and sensitivity, and on being the third universal definition of myocardial infarction, these cardiac isoforms have been accepted internationally as the biomarkers of choice in clinical practice for the diagnosis of acute coronary syndrome, and are preferable to the determinations of creatine kinase and its MB isoform. A case is presented on an eighty year-old man, who persistently had elevated Troponin values, despite a clinical course that was incompatible with an acute coronary syndrome or any other causes of elevation of this biomarker.

Disfunción sinusal transitoria secundaria a tratamiento con lacosamida / Transient sinus dysfunction secondary to lacosamide treatment

RESUMEN Se presenta el caso de una paciente de 84 años de edad, con antecedentes de hipertensión arterial, dislipemia, insuficiencia venosa crónica y osteoartrosis, que -debido a una neuralgia del trigémino- había recibido tratamiento con varios fármacos, sin lograr control del dolor neuropático, por lo que se inició tratamiento con lacosamida en monoterapia, con incremento de dosis hasta lograr el objetivo terapéutico; pero la paciente presentó manifestaciones clínicas y alteraciones electrocardiográficas compatibles con disfunción sinusal, que se resolvieron tras la reducción de la dosis del fármaco.

ABSTRACT The case of an 84-year-old female patient is presented, with a history of high blood pressure, dyslipidemia, chronic venous failure and osteoarthritis, which -due to trigeminal neuralgia- had received treatment with several drugs, without achieving neuropathic pain control; that was why the treatment with lacosamide was started in monotherapy, with an increase in dose until the therapeutic objective was achieved; but the patient presented clinical manifestations and electrocardiographic alterations compatible with sinus dysfunction, which were solved after reducing the dose of the drug.