Deterioro agudo de la función renal en una Unidad Coronaria en España / Acute renal function deterioration in a coronary unit in Spain

Objetivo. Valorar la incidencia y el valor pronóstico del deterioro agudo de la función renal (DAFR) en pacientes cardiológicos agudos. Ámbito. Unidad Coronaria de un hospital universitario terciario. Diseño. Estudio retrospectivo. Pacientes. Cien pacientes consecutivos ingresados durante 2004. Intervenciones. No hubo intervenciones aleatorizadas. Los procedimientos diagnósticos y terapéuticos se realizaron de acuerdo con protocolos locales y las Guías de Práctica Clínica en uso. Variables principales. El objetivo primario del estudio fue analizar la incidencia de DAFR y su relación con la mortalidad por cualquier causa durante el ingreso. Se definió DAFR como el aumento de la creatinina sérica respecto a la basal mayor de 0,5 mg/dl y/o mayor del 50%. Resultados. La incidencia de DAFR fue del 26%, con un incremento medio de la creatinina sérica de 1,5 ± 0,9 mg/dl. El DAFR se asoció de forma significativa con la edad y los antecedentes de hipertensión e insuficiencia renal crónica. Los pacientes con DAFR tuvieron un curso más complicado, mayores estancias hospitalarias y recibieron menos cateterismos. El empeoramiento agudo de la función renal se asoció con mayor mortalidad hospitalaria (33% frente a 6%, p = 0,002). Conclusiones. El DAFR es frecuente en el paciente cardiópata agudo y su presencia se asocia con alta mortalidad (AU)

Objective. To assess the incidence and prognostic value of acute renal function deterioration (ARFD) in patients with acute heart disease. Setting. Coronary Care Unit in a tertiary university hospital. Design. Retrospective study. Participants. One hundred consecutive patients admitted during 2004. Interventions. No randomized interventions were done. Diagnostic and therapeutic procedures were performed according to local protocols and current Clinical Practice Guidelines. Primary variables. The primary aim of the study was to analyze the incidence of acute renal function deterioration and its effect in mortality during hospitalization. ARFD was defined as the increase of serum creatinine by 0.5 mg/dl and/or by 50% over baseline. Results. Incidence of ARFD was 26%, with a mean increase of serum creatinine of 1.5 ± 0.9 mg/dl. ARFD was significantly associated with age, background of hypertension and chronic kidney disease. Patients with ARFD had a more complicated course, longer hospitalizations, and received fewer catheterisms. Acute renal function deterioration was associated with higher mortality during hospitalization (33% versus 6%, p = 0.002). Conclusions. Acute renal function deterioration is frequent in patients with acute heart disease and its presence is linked with higher mortality (AU)

[Acute renal function deterioration in a Coronary Unit in Spain]. / Deterioro agudo de la función renalen una Unidad Coronaria en España.

OBJECTIVE: To assess the incidence and prognostic value of acute renal function deterioration (ARFD) in patients with acute heart disease. SETTING: Coronary Care Unit in a tertiary university hospital. DESIGN: Retrospective study. PARTICIPANTS: One hundred consecutive patients admitted during 2004. INTERVENTIONS: No randomized interventions were done. Diagnostic and therapeutic procedures were performed according to local protocols and current Clinical Practice Guidelines. PRIMARY VARIABLES: The primary aim of the study was to analyze the incidence of acute renal function deterioration and its effect in mortality during hospitalization. ARFD was defined as the increase of serum creatinine by 0.5 mg/dl and/or by 50% over baseline. RESULTS: Incidence of ARFD was 26%, with a mean increase of serum creatinine of 1.5 +/- 0.9 mg/dl. ARFD was significantly associated with age, background of hypertension and chronic kidney disease. Patients with ARFD had a more complicated course, longer hospitalizations, and received fewer catheterisms. Acute renal function deterioration was associated with higher mortality during hospitalization (33% versus 6%, p = 0.002). CONCLUSIONS: Acute renal function deterioration is frequent in patients with acute heart disease and its presence is linked with higher mortality.

Criterios terapéuticos en el síndrome coronario agudo / Therapeutic criteria in acute coronary syndrome

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Manejo de la miocardiopatía dilatada / Management of dilated cardiomypathy

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Native valve endocarditis due to Candida parapsilosis: a late complication after bone marrow transplantation-related fungemia.

A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient, a 35-year-old female with CML, suffered from Candida parapsilosis fungemia on day +22 after BMT. In spite of treatment with amphotericin B, fluconazole and catheter withdrawal, the same yeast was isolated > 1 year later from a vegetation on an old rheumatic mitral valve. Although the patient remained in complete cytogenetical and hematological remission, in vitro tests showed reduced phagocytic and chemotactic capacity of neutrophils and monocytes. This case stresses the need of prolonged therapy for patients with candidemia after BMT.

[Peripartum cardiomyopathy with normal endomyocardial biopsy and positive antimyosin-In 111 study for myocarditis]. / Miocardiopatía periparto con biopsia endomiocárdica normal y estudio con antimiosina-In 111 positivo para miocarditis.

Peripartum cardiomyopathy is a rare manifestation of heart disease which accounts for less than 1% of the cardiovascular problems associated to pregnancy, with a variable incidence of myocarditis ranging from 29 to 100%. We present a patient with peripartum cardiomyopathy in whom endomyocardial biopsy was normal, but the studies with anti-myosin antibodies suggested the presence of myocarditis. Clinical signs and controversies between anatomopathologic and isotopic studies are discussed.

[Guide-wire rupture as a complication of coronary angioplasty. Apropos 2 cases and a review of the literature]. / Rotura de guía como complicación de la angioplastia coronaria. A propósito de 2 casos y revisión de la literatura.

Percutaneous transluminal coronary angioplasty is a useful therapeutic tool in the treatment of ischemic heart disease. Nowadays this procedure presents acute complications of different severity in 10% of the cases. The rupture of the guide wire is a very uncommon complication that may produce important consequences as occlusion of the artery of systemic embolism. The management of this event may be interventional or conservative, depending on the clinical situation of the patient and the position of the guide wire inside the vessel. We report the 2 cases of rupture of the guide wire observed in our center in 1,000 consecutive procedures; in one case it was decided to leave the fragment in the distal portion of the artery, and in the other case the fragment was extracted surgically. We review the literature about this rare complication.

[Rupture of the intraventricular septum and free wall of the left ventricle secondary to non-penetrating thoracic injury. Doppler echocardiography diagnosis]. / Rotura de septo interventricular y pared libre de ventrículo izquierdo secundaria a traumatismo torácico no penetrante. Diagnóstico por ecocardiografía Doppler.

The heart is often injured in the setting of blunt chest trauma with a broad spectrum of cardiac lesions. We present a twenty-nine years old man with interventricular septal and rupture and left ventricular free wall rupture following chest trauma. Doppler echocardiography was essential in the diagnostic and therapeutic procedure. We concluded that Doppler-echocardiography must be performed in all patients with suspicion of cardiac affectation after blunt chest trauma.

Regression of left ventricular hypertrophy after partial correction of anemia with erythropoietin in patients on hemodialysis: a prospective study.

Myocardial effects of recombinant human erythropoietin (rhEPO) treatment were prospectively investigated in 15 hemodialysis (HD) patients with severe anemia (hematocrit [Ht] 19.7 +/- 2.5%). Echocardiographic studies were performed after a midweek HD session just before and after a year of rhEPO. At the end of the study period, Ht had improved to 32.2 +/- 3.5% and cardiac index significantly decreased (5.48 +/- 1.54 vs 3.97 +/- 0.94 l/min/m2, p less than 0.001). Left ventricular mass index (LVMi) decreased with rhEPO (210.7 +/- 48.3 vs 139 +/- 50 g/m2, p less than 0.05). This decrease was concomitant with a decrease of LV end-diastolic diameter (4.89 +/- 0.44 vs 4.57 +/- 0.64 cm, p less than 0.05), interventricular septum thickness (IVST, 1.42 +/- 0.33 vs 1.07 +/- 0.13 cm, p less than 0.01) and LV posterior wall thickness (LVPWT, 1.28 +/- 0.21 vs 1.01 +/- 0.11 cm, p less than 0.01). Eight patients were hypertensive well controlled with hypotensive drugs (group I) and 7 normotensive (group II). LVMi was higher in group I than in group II before rhEPO (235.2 +/- 40 vs 182.7 +/- 43.1 g/m2, p less than 0.05) and significantly decreased after rhEPO in both groups (28.5% and 41.4% respectively). LVMi remained higher in group I than in group II at the end of the study (168.5 +/- 0.9 vs 106.7 +/- 24 g/m2, p less than 0.025). A moderately elevated IVST/LVPWT was reduced with a year of rhEPO (1.14 +/- 0.40 vs 1.05 +/- 0.15, p less than 0.05), disclosing correction of asymmetric septal hypertrophy. We conclude that left ventricular hypertrophy (LVH) regression is obtained after partial correction of anemia with rhEPO. Previous hypertension with current need of antihypertensive treatment has also a significant effect in the development of LVH. Whether this regression would improve outcome in HD patients remains to be established.

[Anomalous origin of the left coronary artery from the right sinus of Valsalva with retro-aortic path]. / Origen anómalo de la arteria coronaria izquierda del seno de Valsalva derecho con trayecto retroaórtico.

We present the case of a patient with a dilated cardiomyopathy in which an anomaly in the origin of the left coronary artery, that arose from the right sinus of Valsalva through an own ostium and followed a retro aortic course, was recognized as an angiographic finding. The possible pathways the anomalous artery may follow, and their different clinical significances are reviewed. The angiographic sign of the aortic root, described for the identification of the anomalous origin of circumflex artery, is reviewed and its utility in the case of anomalous left coronary artery is demonstrated. In our case, Thallium-201 didn't show myocardial ischemia with the exercise and that justified, beside the doubtful efficacy of surgery as prophylaxis of sudden death when the anomalous course is retro-aortic, to maintain a conservative attitude.