Prognostic value of troponin I in atrial fibrillation.

OBJECTIVE: To evaluate whether circulating cardiac troponin I (cTnI) levels are associated with worst outcomes in patients with atrial fibrillation (AF). METHODS: Consecutive patients visiting the emergency room (ER) with a new episode of a previously diagnosed AF or a new diagnosis of AF during ER admission between January 1st, 2010 and December 31st, 2015, were enrolled in the study (n = 2617). After applying exclusion criteria and eliminating repeated episodes, 2013 patients were finally included. Of these, 1080 patients with at least one cTnI measurement in the ER were selected and classified into 4 groups according to cTnI quartiles: Q1 (n = 147) cTnI <10 ng/L (Group 1); Q2 (n = 254): 10-19 ng/L (Group 2); Q3 (n = 409): 20-40 ng/L (Group 3); and Q4 (n = 270): cTnI >40 ng/L (Group 4). The median follow-up period was 47.8 ± 32.8 months. The primary endpoint was all-cause death during the follow-up. RESULTS: A higher mortality was found in group 4 compared with the other groups (58.9% vs. 28.5%, respectively, p < 0.001), along with, hospitalizations (40.4% vs. 30.7%, p = 0.004), and readmissions due to decompensated heart failure (26.7% vs. 2.5%, p = 0.002). The probability of survival without AF recurrences was lower in the Q4 (p = 0.045). Moreover, cTnI levels >40 ng/L (Q4) were an independent risk factor of death (HR, 2.03; 95% CI, 1.64-2.51; p < 0.001). CONCLUSION: The assessment of cTnI at ER admission could be a useful strategy for risk stratification of patients diagnosed with AF by identifying a subgroup with medium-term to long-term increased risk of adverse events and mortality.

Bloqueo fascicular anterior izquierdo seudobradicardia dependiente. Presentación de un caso / Pseudobradycardia-dependent left anterior fascicular block. A case report

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Clinical benefit of cardiac resynchronization therapy with a defibrillator in patients with an ejection fraction > 35% estimated by cardiac magnetic resonance.

INTRODUCTION AND OBJECTIVES: Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35 estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance. METHODS: We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS ≥ to 120 ms, ejection fraction ≤ 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n=103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance. RESULTS: The 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function ≤ 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups. CONCLUSIONS: We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction ≤ 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis.

Beneficio clínico de la terapia de resincronización cardiaca con desfibrilador para pacientes con fracción de eyección > 35 por ciento por resonancia magnética / Clinical benefit of cardiac resynchronization therapy with a defibrillator in patients with an ejection fraction > 35 percent estimated by cardiac magnetic resonance

Introducción y objetivos. La terapia de resincronización cardiaca con desfibrilador aumenta la supervivencia y mejora la calidad de vida en insuficiencia cardiaca avanzada. Tradicionalmente, se ha excluido a los pacientes con fracción de eyección > 35% calculada por ecocardiografía. Evaluamos el impacto pronóstico de dicha terapia en un grupo de pacientes con disfunción sistólica grave por ecocardiografía pero con fracción de eyección > 35% por resonancia magnética cardiaca. Métodos. Se analizaron los ingresos por insuficiencia cardiaca entre 2004 y 2011 en clase funcional II - IV , QRS >= 120 ms, fracción de eyección por ecocardiografía <= 35% y estudio de resonancia magnética cardiaca según protocolo local. Se incluyó a los pacientes (n = 103) con implante de dispositivo en prevención primaria. Se registró la incidencia de arritmias ventriculares, reingreso por insuficiencia cardiaca y mortalidad total. La muestra se dividió según la función sistólica por resonancia magnética fuera <= 35% o > 35%. Resultados. Ambos grupos mostraron mejoras comparables en clase funcional y fracción de eyección a los 6 meses. Se encontró una tendencia no significativa hacia mayor mortalidad total entre los pacientes con fracción de eyección <= 35% en el seguimiento a largo plazo. Al dividir la muestra por función sistólica y patrón de realce, encontramos que la presencia de necrosis identificaba a los pacientes con peor pronóstico de arritmias ventriculares y mortalidad total. Conclusiones. La terapia de resincronización cardiaca con desfibrilador proporcionó un beneficio clínico similar a los pacientes con función sistólica por resonancia resonancia magnética cardiaca <=35% y > 35%. El patrón de realce tardío de gadolinio aporta información adicional sobre riesgo arrítmico y pronóstico a largo plazo de estos pacientes (AU)

Introduction and objectives. Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35 estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance. Methods. We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS >= to 120 ms, ejection fraction <= 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n=103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance. Results. The 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function <= 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups. Conclusions. We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction <= 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis (AU)