Supportive treatment of COVID 19 patients with mild respiratory failure in a primary hospital / Tratamiento conservador en pacientes COVID 19 con insuficiencia respiratoria ligera en un Hospital de primer nivel

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TUSARC: Prognostic Value of High-Sensitivity Cardiac Troponin T Assay in Asymptomatic Patients with High Cardiovascular Risk.

BACKGROUND: Prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) assays have been assessed in selected populations in different studies and in registries of members of the general population with low cardiovascular risk. The aim of this study was to determine the prognostic value of hs-cTnT in an asymptomatic very-high cardiovascular risk Spanish population. METHODS: From a previous prospective cohort of the TUSARC (troponina T UltraSensible en pacientes Asintomáticos de alto Riesgo Cardiovascular) registry, follow-up was conducted in 602 patients (93.18%). The association of high hs-cTnT (≥99th percentile value) and incidence of primary event was studied. A primary event was defined as a combined major cardiovascular event (incidence of cardiovascular death, decompensated heart failure, non-fatal cerebrovascular event, non-fatal myocardial infarction, or coronary revascularization). The association between high hs-cTnT and incidence of secondary events was studied as well. RESULTS: In patients with high hs-cTnT, the incidence of primary event during follow-up was significantly higher (18.30% vs 3.67% P < .001): heart failure (6.25% vs 0.73% P < .001), cardiovascular death (7.29% vs 0.00% P < .001), and death from any cause (7.81% vs 0.98% P < .001). CONCLUSIONS: In an asymptomatic very-high cardiovascular risk Spanish population, elevated hs-cTnT was significantly associated with incident major cardiovascular combined end point and incidence of heart failure, cardiovascular death, and death from any cause.

Detección de troponina T ultrasensible en pacientes con riesgo cardiovascular. Respuesta / Detection of high-sensitivity troponin T in patients with cardiovascular risk. Response

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Troponina T ultrasensible en pacientes asintomáticos de muy alto riesgo cardiovascular. Registro TUSARC / High-sensitivity troponin T assay in asymptomatic high cardiovascular risk patients. The TUSARC Registry

Introducción y objetivos: La troponina T ultrasensible (TnT-us) se ha cuantificado en poblaciones de ensayos clínicos y en registros poblacionales de bajo riesgo cardiovascular (RCV). El objetivo del estudio es determinar en qué proporción de la población española asintomática de muy alto RCV se puede cuantificar la TnT-us, qué proporción presenta TnT-us elevada y qué variables se asocian con la presencia de TnT-us elevada. Métodos: Se incluyó a 690 pacientes. Se analizó la detección de la TnT-us y de la TnT-us elevada (≥ percentil 99 de referencia) y su asociación con las diferentes variables recogidas. Resultados: Se analizó la TnT-us en 646 pacientes y se detectó en 645. Presentaron TnT-us elevada 212 pacientes (32,9%). En el análisis multivariable, la TnT-us elevada se asoció al sexo masculino (OR = 2,81; IC95%, 1,67-4,73; p < 0,001), mayor edad (OR = 1,06; IC95%, 1,04-1,09; p < 0,001) mayor índice de masa corporal (OR = 1,07; IC95%, 1,02-1,12; p < 0,002), tratamiento con insulina (OR = 1,99; IC95%, 1,15-3,46; p = 0,01), insuficiencia cardiaca previa (OR = 3,92; IC95%, 1,24-12,39; p = 0,02) y filtrado glomerular estimado calculado por la fórmula CKD-EPI (OR = 0,96; IC95%, 0,95-0,97; p < 0,001). Conclusiones: En una población española asintomática de muy alto RCV, la TnT-us se detectó prácticamente en todos los pacientes, y estaba elevada en un tercio de ellos. La TnT-us elevada se asoció a mayor edad, el sexo masculino, el índice de masa corporal, la insuficiencia cardiaca previa, el tratamiento con insulina y un menor filtrado glomerular (AU)

Introduction and objectives: High-sensitivity troponin T assays (Hs-TnT) have been carried out in selected populations in clinical trials and in registries of the general population with low cardiovascular risk (CVR). The aim of this study was to determine the proportion of individuals with detectable Hs-TnT and the proportion of individuals with elevated Hs-TnT in a Spanish population of asymptomatic individuals with very high CVR, as well as the parameters associated with Hs-TnT elevation. Methods: The study included 690 patients. Hs-TnT detection and Hs-TnT elevation (≥99th percentile value), as well the association of elevated Hs-TnT and clinical, analytical, and treatment data were analyzed. Results: Hs-TnT was analyzed in 646 patients and was detected in 645. Elevated TnT was detected in 212 patients (32.9%). On multivariate analysis, elevated TnT was independently associated with male sex (OR, 2.81; 95%CI, 1.67-4.73; P < .001), older age (OR, 1.06; 95%CI, 1.04-1.09; P < .001), a higher body mass index (OR, 1.07; 95%CI, 1.02-1.12; P < .002), insulin therapy (OR, 1.99; 95%CI, 1.15-3.46; P = .01), history of heart failure (OR, 3.92; 95%CI, 1.24-12.39; P = .02), and estimated glomerular filtration rate calculated by CKD-EPI (OR, 0.96; 95%CI, 0.95-0.97; P < .001). Conclusions: In a Spanish population of asymptomatic individuals at very high CVR, Hs-TnT was associated with older age, male sex, higher body mass index, insulin therapy, history of heart failure, and lower glomerular filtration rate (AU)

High-sensitivity Troponin T Assay in Asymptomatic High Cardiovascular Risk Patients. The TUSARC Registry.

INTRODUCTION AND OBJECTIVES: High-sensitivity troponin T assays (Hs-TnT) have been carried out in selected populations in clinical trials and in registries of the general population with low cardiovascular risk (CVR). The aim of this study was to determine the proportion of individuals with detectable Hs-TnT and the proportion of individuals with elevated Hs-TnT in a Spanish population of asymptomatic individuals with very high CVR, as well as the parameters associated with Hs-TnT elevation. METHODS: The study included 690 patients. Hs-TnT detection and Hs-TnT elevation (≥99th percentile value), as well the association of elevated Hs-TnT and clinical, analytical, and treatment data were analyzed. RESULTS: Hs-TnT was analyzed in 646 patients and was detected in 645. Elevated TnT was detected in 212 patients (32.9%). On multivariate analysis, elevated TnT was independently associated with male sex (OR, 2.81; 95%CI, 1.67-4.73; P < .001), older age (OR, 1.06; 95%CI, 1.04-1.09; P < .001), a higher body mass index (OR, 1.07; 95%CI, 1.02-1.12; P < .002), insulin therapy (OR, 1.99; 95%CI, 1.15-3.46; P = .01), history of heart failure (OR, 3.92; 95%CI, 1.24-12.39; P = .02), and estimated glomerular filtration rate calculated by CKD-EPI (OR, 0.96; 95%CI, 0.95-0.97; P < .001). CONCLUSIONS: In a Spanish population of asymptomatic individuals at very high CVR, Hs-TnT was associated with older age, male sex, higher body mass index, insulin therapy, history of heart failure, and lower glomerular filtration rate.

Short-term metabolic changes achieved by weight loss in hypertensive patients.

INTRODUCTION: Glucose and lipid metabolism abnormalities of hypertensive patients are highly relevant due to its increase in cardiovascular risk; moreover, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) have a high risk of new-onset diabetes mellitus (DM) development. The objective of the study was to describe glucose metabolism abnormalities and the impact of mid-term weight loss. METHODS: A six-month prospective, observational and multicentre study of patients with hypertension was conducted. Clinical antecedents, physical examination, blood test and treatments were collected in two separated visits; conventional advice was the only intervention planned. RESULTS: A total of 1957 patients were included, mean age 66.3 (10.9) years and 59.9% males. A previous diagnosis of glucose metabolism alteration was present in 43.9% (25.5% type-2 DM, 14.8% IFG, 1.6% IFG and IGT, 1.0% IGT and 1.0% type-1 DM). An increasing pattern of cardiovascular risk and target organ damage was observed according to the categories of fasting glucose. Oral glucose tolerance test (OGTT) was carried out in 234 patients (11.9%) patients and yielded the diagnosis of IGT in 44.7% or DM in 22.4% of patients with fasting glucose >100mg/dl. Six months follow-up was achieved in 85.9% patients. A slight reduction in fasting glucose was observed in the whole cohort and patients who achieved ≥ 5% weight loss experienced the highest reduction in fasting glucose, LDL-c and triglycerides; moreover, 15.8% normalized their IFG. CONCLUSIONS: Glucose and lipid metabolism abnormalities are highly prevalent in hypertensive patients and improve with 5% of weight lost at 6 months follow-up. OGTT is not currently extended in daily clinical practise.

Usefulness of plasma cardiotrophin-1 in assessment of left ventricular hypertrophy regression in hypertensive patients.

OBJECTIVE: We investigated whether regression of left ventricular hypertrophy (LVH) in response to antihypertensive treatment is associated with plasma cardiotrophin-1 (CT-1) in hypertensive patients. METHODS: The study was performed in 47 patients with mild to moderate essential hypertension, and LVH was assessed echocardiographically. The family doctor gave antihypertensive treatment and followed all patients. LVH regression was diagnosed if the baseline left ventricular mass index (LVMI) decreased to normal values after 1 year of treatment. Plasma CT-1 was determined by an enzyme-linked immunosorbent assay. RESULTS: The LVMI was normalized in 23 patients (49%) and persisted at an abnormally increased level in 24 patients (51%) after 1 year of treatment, whereas the reduction in clinic and home blood pressure was similar in the two groups: CT-1 decreased (-48%, P < 0.005) and increased (+35%, P < 0.05) in patients in whom LVH regressed and LVH persisted, respectively. Final values of CT-1 were inversely correlated (r = 0.534, P < 0.001) with the decrease in LVMI after treatment in all patients. A significant association (chi2 = 16.87, P < 0.001) was found between normalization of CT-1 and regression of LVH with treatment. A cut-off value of 41 fmol/ml for CT-1 provided a relative risk of 43.13 (95% confidence interval, 4.88-380.48) for detecting LVH regression. CONCLUSION: These results show an association between treatment-induced decrease of plasma CT-1 and LVH regression in essential hypertension. Although preliminary, these findings suggest that the determination of plasma CT-1 may be useful for the follow-up of hypertensive heart disease in routine clinical practice.

[Characteristics of hypertensive cardiomyopathy in a population of hypertensive patients never treated]. / Características de la cardiopatía hipertensiva en pacientes con hipertensión arterial no tratados previamente.

BACKGROUND AND OBJECTIVE: Although impaired diastolic function is frequently found in systemic hypertension, the diagnosis of hypertensive heart disease (HHD) is based on the demonstration of left ventricular (LV) growth. The aim of the current work was to investigate the potential interactions between diastolic function and LV growth in patients with arterial hypertension. PATIENTS AND METHOD: One hundred and sixteen never-treated asymptomatic hypertensives underwent an echocardiographic evaluation. Classification of diastolic dysfunction (DD) was based on alterations in parameters assessing transmitral inflow, Doppler tissue imaging of mitral annular motion, and color M-mode propagation velocity. Classification of LV growth was based on alterations in left ventricular mass index and/or relative will thickness. RESULTS: Ninety-four patients (81%) exhibited DD and 22 (19%) exhibited normal diastolic function. Amongst patients with DD, 79 (84%) exhibited a pattern of impaired relaxation and 15 (16%) a pseudonormal pattern. The presence of LV growth was documented in 41% of patients without DD and 75% of patients with DD (p < 0.05). None of the studied patients exhibited echocardiographic signs of systolic dysfunction. CONCLUSIONS: These findings indicate that DD is an early and highly frequent cardiac alteration in arterial hypertension. In addition, our data show that one fifth of hypertensive patients have DD in the absence of LV growth. It is thus suggested that the diagnosis of HHD can not be further based exclusively on morphologic criteria and should include also the evaluation of alterations in LV filling.

Características de la cardiopatía hipertensiva en pacientes con hipertensión arterial no tratados previamente / Characteristics of hypertensive cardiomyopathy in a population of hypertensive patients never treated

Fundamento y objetivo: Aunque la hipertensión arterial se suele asociar con alteraciones del llenado del ventrículo izquierdo (VI), el diagnóstico de cardiopatía hipertensiva se basa en la demostración del crecimiento del VI. El objetivo del presente trabajo ha sido analizar la relación existente entre la función diastólica y el crecimiento del VI en la hipertensión. Pacientes y método: En 116 pacientes con hipertensión arterial esencial nunca tratados se efectuó un estudio ecocardiográfico (modo M, Doppler transmitral, Doppler tisular y M color). El diagnóstico de disfunción diastólica (DD) se basó en alteraciones de la velocidad del flujo transmitral, de la velocidad tisular del anillo mitral y de la velocidad de propagación del flujo ventricular. El diagnóstico de crecimiento del VI se basó en alteraciones del índice de masa ventricular izquierda y/o del grosor relativo de la pared. Resultados: Noventa y cuatro pacientes (81%) presentaban DD y 22 (19%) presentaban una función diastólica normal. De los pacientes con DD, 79 (84%) presentaban un patrón de relajación retrasada y 15 (16%) un patrón de llenado seudonormal. El crecimiento del VI estaba presente en el 41% de los pacientes sin DD y en el 75% de los pacientes con DD, diferencia que fue significativa (p < 0,05). Un 25% de los pacientes presentaban DD en ausencia de crecimiento del VI. Ningún paciente tenía signos ecocardiográficos de disfunción sistólica. Conclusiones: Estos resultados indican que la DD está presente en una gran proporción de pacientes hipertensos. Una cuarta parte de los hipertensos presentan DD en ausencia de crecimiento del VI. Se apunta que el diagnóstico de la cardiopatía hipertensiva no puede basarse exclusivamente en criterios morfológicos y ha de incluir también las alteraciones del llenado ventricular

Background and objective: Although impaired diastolic function is frequently found in systemic hypertension, the diagnosis of hypertensive heart disease (HHD) is based on the demonstration of left ventricular (LV) growth. The aim of the current work was to investigate the potential interactions between diastolic function and LV growth in patients with arterial hypertension. Patients and method: One hundred and sixteeen never-treated asymptomatic hypertensives underwent an echocardiographic evaluation. Classification of diastolic dysfunction (DD) was based on alterations in parameters assessing transmitral inflow, Doppler tissue imaging of mitral annular motion, and color M-mode propagation velocity. Classification of LV growth was based on alterations in left ventricular mass index and/or relative will thickness. Results: Ninety-four patients (81%) exhibited DD and 22 (19%) exhibited normal diastolic function. Amongst patients with DD, 79 (84%) exhibited a pattern of impaired relaxation and 15 (16%) a pseudonormal pattern. The presence of LV growth was documented in 41% of patients without DD and 75% of patients with DD (p < 0.05). None of the studied patients exhibited echocardiographic signs of systolic dysfunction. Conclusions: These findings indicate that DD is an early and highly frequent cardiac alteration in arterial hypertension. In addition, our data show that one fifth of hypertensive patients have DD in the absence of LV growth. It is thus suggested that the diagnosis of HHD can not be further based exclusively on morphologic criteria and should include also the evaluation of alterations in LV filling