Amplitud de distribución eritrocitaria y riesgo de mortalidad en pacientes con insuficiencia cardiaca aguda / Red cell distribution width and mortality risk in acute heart failure patients

Fundamento y objetivo: El ancho de distribución eritrocitaria (ADE) es una medida cuantitativa de la variabilidad del tamaño de los eritrocitos circulantes utilizada clásicamente para el diagnóstico diferencial de las anemias. En los últimos años, se ha sugerido que el ADE podría ser un marcador pronóstico útil en pacientes con insuficiencia cardiaca crónica. Sin embargo, es escasa la evidencia que respalda su papel en población no seleccionada con insuficiencia cardiaca aguda (ICA), de manera independiente a los factores de riesgo establecidos. El objetivo del estudio fue establecer la asociación entre el ADE y la mortalidad a largo plazo en pacientes ingresados por ICA. Pacientes y método: Se analizaron 1.190 pacientes consecutivos ingresados por ICA en nuestro centro. A todos los pacientes se les realizó una determinación de ADE durante el ingreso. Los valores del ADE se estratificaron en cuartiles (Q) y su asociación con la mortalidad total se evaluó mediante regresión de Cox. Resultados: Tras una mediana e seguimiento de 15 meses (intervalo intercuartílico 3-33 meses) se identificaron 458 (38%) muertes. Se observó un incremento progresivo de las tasas de mortalidad desde Q1 a Q4: 1,34, 1,82, 2,56 y 3,53 por 10 pacientes-año de seguimiento para Q1, Q2, Q3 y Q4, respectivamente (p de la tendencia<0,001). En el análisis multivariante, esta asociación se mantuvo independiente para los pacientes pertenecientes a Q3 (15-16%) y Q4 (>16%) frente a Q1 (≤14%): hazard ratio [HR] 1,66, intervalo de confianza del 95% [IC 95%] 1,24-2,22, p<0,01; y HR 1,80, IC 95% 1,33-2,43, p<0,01, respectivamente, en un modelo ajustado por las variables pronósticas establecidas en ICA. Conclusión: En pacientes con ICA los valores elevados del ADE se asocian a una mayor mortalidad a largo plazo (AU)

Background and objective: Red cell distribution width (RDW) is a quantitative measure of the variability in size of erythrocytes, and it is used for the differential diagnosis of anemia. Recent reports have suggested that high RDW could play a role for risk stratification in patients with chronic heart failure. However, the prognostic role of RDW in unselected population with acute heart failure (AHF), after a thoroughly multivariate adjustment, has not been well established. The aim of this study was to establish the association between RDW and long-term mortality in patients admitted for AHF. Patients and method: We analyzed 1,190 consecutive patients admitted for AHF in our center. RDW measurement was performed on admission. RDW values were stratified into quartiles (Q) and the association of RDW with total mortality was assessed using Cox regression. Results: After a median follow-up of 15 months (interquartile range 3-33 months) 458 (38%) deaths were identified. There was a progressive increase in mortal y rates from Q1 to Q4: 1.34, 1.82, 2.56 and 3.53 per 10 patients-year of follow-up (for Q1, Q2, Q3 and Q4 respectively, P for trend <.001). In the multivariate analysis, this association remained independent for patients in Q3 (15-16%) and Q4 (>16%) versus Q1 (≤14%), hazard ratio (HR): 1.66, 95% confidence interval (95% CI) 1.24-2.22, P<.01, HR: 1.80, 95% CI 1.33-2.43, p<.01, respectively, in a model adjusted for established prognostic markers in AHF. Conclusion: In patients with AHF, higher RDW values were associated with increased long-term mortality (AU)

[Red cell distribution width and mortality risk in acute heart failure patients]. / Amplitud de distribución eritrocitaria y riesgo de mortalidad en pacientes con insuficiencia cardiaca aguda.

BACKGROUND AND OBJECTIVE: Red cell distribution width (RDW) is a quantitative measure of the variability in size of erythrocytes, and it is used for the differential diagnosis of anemia. Recent reports have suggested that high RDW could play a role for risk stratification in patients with chronic heart failure. However, the prognostic role of RDW in unselected population with acute heart failure (AHF), after a thoroughly multivariate adjustment, has not been well established. The aim of this study was to establish the association between RDW and long-term mortality in patients admitted for AHF. PATIENTS AND METHOD: We analyzed 1,190 consecutive patients admitted for AHF in our center. RDW measurement was performed on admission. RDW values were stratified into quartiles (Q) and the association of RDW with total mortality was assessed using Cox regression. RESULTS: After a median follow-up of 15 months (interquartile range 3-33 months) 458 (38%) deaths were identified. There was a progressive increase in mortality rates from Q1 to Q4: 1.34, 1.82, 2.56 and 3.53 per 10 patients-year of follow-up (for Q1, Q2, Q3 and Q4 respectively, P for trend <.001). In the multivariate analysis, this association remained independent for patients in Q3 (15-16%) and Q4 (>16%) versus Q1 (≤14%), hazard ratio (HR): 1.66, 95% confidence interval (95% CI) 1.24-2.22, P<.01, HR: 1.80, 95% CI 1.33-2.43, p<.01, respectively, in a model adjusted for established prognostic markers in AHF. CONCLUSION: In patients with AHF, higher RDW values were associated with increased long-term mortality.

Implante extracardiaco de un desfibrilador en una niña de 7 años / No disponible

No disponible

La ablación transcatéter: una técnica de la cardiología práctica diaria / Transcatheter ablation. A routine cardiology technique

La ablación transcatéter, especialmente con energía de radiofrecuencia, ha sido el avance más significativo de la arritmología y uno de los de mayor impacto global en la cardiología de los últimos 25 años. Su introducción clínica en 1982 para la interrupción de la conducción auriculoventricular se siguió, a principios de los noventa, de la demostración amplia de su eficacia en el tratamiento curativo de pacientes con vías accesorias y en pacientes con taquicardias por reentrada nodal. Posteriormente se añadieron el aleteo auricular, las taquicardias auriculares y las taquicardias ventriculares idiopáticas. El abordaje de las taquicardias ventriculares asociadas a cardiopatía estructural permite en muchos casos el control total de la arritmia, mientras que en cualquier caso puede utilizarse como parte de una terapia híbrida, junto con los fármacos y los dispositivos implantables. Por último, las técnicas de ablación de la fibrilación auricular, en pleno desarrollo, han venido a completar una oferta terapéutica que el cardiólogo clínico puede y debe ofrecer a los pacientes con arritmias (AU)

Transcatheter ablation, especially with radiofrequency energy, is the most significant advance in arrhythmology and is one of the developments that has had the greatest impact on the whole field of cardiology over the last 25 years. It was introduced into clinical practice in 1982 to block atrioventricular conduction. This was followed at the beginning of the 1990s by widespread evidence that the technique was effective as curative treatment for patients with accessory pathways or atrioventricular nodal reentrant tachycardia. Subsequently, atrial flutter, atrial tachycardia and idiopathic ventricular tachycardia were added to the list. Using the technique to treat ventricular tachycardias associated with structural heart disease enables these arrhythmias to be completely controlled in many cases. In addition, the technique can also be used as part of hybrid therapy together with drugs and implantable devices. Finally, techniques for ablating atrial fibrillation, which are currently under development, complete the range of treatment choices that clinical cardiologists can and should offer to patients with arrhythmias (AU)