Sacubitril-valsartan in heart failure and multimorbidity patients.

AIMS: The poor control of symptoms in patients with advanced heart failure with reduced ejection function (HFrEF) can limit the functionality of patients. Sacubitril-valsartan, compared with enalapril, has been shown to reduce mortality and hospitalization, and nowadays, there is still little evidence about the improvement on functionality. The aim of our study is to analyse the improvement of the functional class and the 6 min walking test (6MWT) in patients with multiple pathologies and advanced heart failure. METHODS AND RESULTS: From September 2016 to March 2018, 65 multimorbidity patients with severe symptomatic HFrEF were initiated to receive sacubitril-valsartan. Mean age was 78.6 ± 7.4 years, and 68% were male. The Charlson co-morbidity index was 8 points. Seventy-four per cent had New York Heart Association (NYHA) Functional Class IV. After the treatment, patients were able to achieve 55.68 m or more on 6MWT, and 91% presented an improvement in the NYHA functional class. CONCLUSIONS: Sacubitril-valsartan relieves symptoms and improves functional class prognostic risk of patients with advanced HFrEF and co-morbidity.

Calcifilaxia. Estudio de 9 casos / Calciphylaxis. A review of 9 cases

Fundamento y objetivo: La calcifilaxia es una vasculopatía cutánea isquémica de vasos de pequeño tamaño con una alta morbimortalidad. Hasta el momento actual han sido publicadas muy pocas series de pacientes con esta enfermedad, ninguna procedente de un hospital español. Los principales objetivos de este trabajo son analizar el perfil demográfico, clínico e histológico de los pacientes diagnosticados de calcifilaxia en nuestro servicio, para identificar posibles factores de riesgo y potenciales estrategias terapéuticas. Material y método: Estudio retrospectivo de los casos vistos en el Servicio de Dermatología con diagnóstico de calcifilaxia con una biopsia confirmatoria, en el periodo de enero de 2010 a agosto de 2015. Resultados: Se estudiaron 9 pacientes, con edades de 76-86 años. Todos tenían comorbilidades cardiovasculares y el 67% tenía insuficiencia renal. Se observó un 33% de mortalidad. Conclusiones: Ante el posible diagnóstico de calcifilaxia debe realizarse una analítica sanguínea completa para descartar otras causas de úlceras cutáneas. El tratamiento de estos pacientes debe llevarse a cabo por un equipo multidisciplinar. Resaltamos el papel del tiosulfato sódico en el tratamiento de esta entidad (AU)

Background and objective: Calciphylaxis is a cutaneous ischaemic vascular disease of small vessels with high morbidity and mortality. To date very few series of patients with this disease have been published, none from a Spanish hospital. The main objectives of this work are to analyze the demographic, clinical and histological profile of patients diagnosed in our department to identify risk factors and potential therapeutic strategies. Material and method: We made a retrospective study of the cases seen in the dermatology department with a diagnosis of calciphylaxis and who had a confirmatory biopsy in the period between January 2010 to August 2015. Results: Nine patients were studied, with an age range of 76-86 years. All had cardiovascular comorbidities and 67% had renal failure. A 33% mortality was observed. Conclusions: Faced with a possible diagnosis of calciphylaxis, a complete blood analysis is mandatory to rule out other causes of skin ulcers. The management of these patients should be undertaken by a multidisciplinary team. We emphasize the role of sodium thiosulfate in the treatment of this condition (AU)

[Calciphylaxis. A review of 9 cases]. / Calcifilaxia. Estudio de 9 casos.

BACKGROUND AND OBJECTIVE: Calciphylaxis is a cutaneous ischaemic vascular disease of small vessels with high morbidity and mortality. To date very few series of patients with this disease have been published, none from a Spanish hospital. The main objectives of this work are to analyze the demographic, clinical and histological profile of patients diagnosed in our department to identify risk factors and potential therapeutic strategies. MATERIAL AND METHOD: We made a retrospective study of the cases seen in the dermatology department with a diagnosis of calciphylaxis and who had a confirmatory biopsy in the period between January 2010 to August 2015. RESULTS: Nine patients were studied, with an age range of 76-86 years. All had cardiovascular comorbidities and 67% had renal failure. A 33% mortality was observed. CONCLUSIONS: Faced with a possible diagnosis of calciphylaxis, a complete blood analysis is mandatory to rule out other causes of skin ulcers. The management of these patients should be undertaken by a multidisciplinary team. We emphasize the role of sodium thiosulfate in the treatment of this condition.