Development and validation of a risk stratification model for prediction of disability and hospitalisation in patients with heart failure: a study protocol.

BACKGROUND: Chronic heart failure (CHF) reduces quality of life and causes hospitalisation and death. Identifying predictive factors of such events may help change the natural history of this condition. AIM: To develop and validate a stratification system for classifying patients with CHF, according to their degree of disability and need for hospitalisation due to any unscheduled cause, over a period of 1 year. METHODS AND ANALYSIS: Prospective, concurrent, cohort-type study in two towns in the Madrid autonomous region having a combined population of 1 32 851. The study will include patients aged over 18 years who meet the following diagnostic criteria: symptoms and typical signs of CHF (Framingham criteria) and left ventricular ejection fraction (EF)<50% or structural cardiac lesion and/or diastolic dysfunction in the presence of preserved EF (EF>50%).Outcome variables will be(a) Disability, as measured by the WHO Disability Assessment Schedule V.2.0 Questionnaire, and (b) unscheduled hospitalisations. The estimated sample size is 557 patients, 371 for predictive model development (development cohort) and 186 for validation purposes (validation cohort). Predictive models of disability or hospitalisation will be constructed using logistic regression techniques. The resulting model(s) will be validated by estimating the probability of outcomes of interest for each individual included in the validation cohort. ETHICS AND DISSEMINATION: The study protocol has been approved by the Clinical Research Ethics Committee of La Princesa University Teaching Hospital (PI-705). All results will be published in a peer-reviewed journal and shared with the medical community at conferences and scientific meetings.

Situacion actual: lo nuevo en tecnicas de imagen cardiaca / State of the art: new developments in cardiac imaging

La imagen cardiaca sigue desentrañando aspectos anatómicos y funcionales relacionados con la enfermedad de la víscera. La ecocardiografía desarrolla y optimiza la visualización tridimensional tanto transesofagica como transtoracica, consolida el valor de técnicas que permiten entender mejor la mecánica cardiaca y la función ventricular, y al tiempo la industria saca al mercado nuevos equipos más manejables aunque limitados e incompletos para un estudio estándar. La tomografía mantiene e incrementa su valor diagnostico y predictivo en el campo de la enfermedad coronaria a coste radiactivo cada vez menor. La cardiorresonancia permite valorar exquisitamente el daño y la recuperación miocárdica en cardiopatía isquémica y tras el síndrome coronario agudo. La aparición de nuevas tomogamma cámaras exclusivas para cardiología nuclear mejora la calidad del estudio y reduce la radiación. Las imágenes hibridas o de fusión entre diferentes tecnologías, como las nucleares y la tomografía, son prometedoras e ilusionantes (AU)

Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiacmechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restricttheir use for routine assessment. Tomography’s diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future (AU)

[Progress on cardiac imaging techniques]. / Novedades en técnicas de imagen cardiaca.

The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by cardiac multislice CT and cardiac magnetic resonance. However, the new radiological techniques that have helped to reduce radiation exposure to patients and that have improved image acquisition could restore CT to the heart of general cardiac diagnosis. At the moment, it is not possible to displace the echocardiography from its central role in cardiac imaging. This article contains a review of the most important publications on echocardiography, magnetic resonance imaging and cardiac CT that have appeared recently in cardiology journals, mainly during 2010.

Novedades en técnicas de imagen cardiaca / Progress on cardiac imaging techniques

Las pruebas diagnósticas no invasivas siguen una cronología típica: descripción, entusiasmo, evaluación y aplicabilidad clínica y epidemiológica. La ecocardiografía es una técnica sin efectos lesivos, altamente disponible y barata, por lo que su aplicabilidad clínica se difunde antes que su asentamiento y su evaluación. Los avances se están desarrollando con nuevas herramientas para el estudio de la deformación miocárdica y las aplicaciones clínicas del ecocardiograma tridimensional. La ecocardiografía transesofágica tridimensional ha vuelto a situar al ecocardiograma en el centro del diagnóstico cardiaco moderno que durante los últimos años había sido desplazado por la tomografía computarizada y la resonancia magnética. No obstante, nuevas tecnologías radiológicas que contribuyan a disminuir la irradiación de los pacientes y mejorar la adquisición de imágenes pueden llevar a la tomografía al eje capital del diagnóstico cardiológico global. Actualmente no podemos desplazar a la ecocardiografía como principal área de interés en imagen cardiaca. En este artículo revisamos las publicaciones más relevantes en las revistas de cardiología aparecidas principalmente durante 2010 en ecocardiografía, resonancia magnética y tomografía computarizada cardiaca (AU)

The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by (..) (AU)

[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance and computed tomography]. / Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada.

This article contains a review of the most important contributions made by echocardiography, magnetic resonance imaging and computed tomography to the field of cardiology in 2009. During this period, we helped establish values for myocardial deformation parameters in a number of different clinical settings that have enabled us to achieve better understanding of systolic and diastolic function in both ventricles. Real-time three-dimensional echocardiography has provided new ways to improve the selection and monitoring of potential candidates for an increasing number of noncoronary interventions, such as percutaneous aortic valve implantation and percutaneous mitral valve repair. Magnetic resonance imaging has clearly become the technique of choice for studying a range of different conditions, such as myocarditis and various forms of cardiomyopathy, and is now established as the reference standard in clinical practice for determining the sizes of infarcts and myocardial areas at risk. The diagnostic potential of computed tomography for assessing heart disease has been confirmed in large multicenter trials.

Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada / Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance and computed tomography

En este artículo se realiza una revisión de las aportaciones más relevantes del ecocardiograma, la resonancia magnética y la tomografía computarizada a la cardiología que han sido publicadas durante 2009. En este periodo, hemos asistido a la consolidación, en distintos contextos clínicos, de parámetros de deformación miocárdica que nos han permitido comprender mejor tanto la función sistólica como la diastólica de ambos ventrículos. La ecocardiografía tridimensional en tiempo real ha abierto nuevas vías para seleccionar y monitorizar mejor a los candidatos a un creciente número de procedimientos intervencionistas no coronarios, tales como el implante percutáneo de prótesis valvulares aórticas o la reparación mitral percutánea. La resonancia magnética se ha convertido definitivamente en la técnica de elección para el estudio de entidades diferentes, como la miocarditis y varios tipos de miocardiopatías, y se ha asentado como el patrón de referencia en la práctica clínica para la determinación del tamaño del infarto y el área de miocardio en riesgo. Las posibilidades diagnósticas de la tomografía computarizada en el diagnóstico cardiológico se ven confirmadas en grandes ensayos multicéntricos (AU)

This article contains a review of the most important contributions made by echocardiography, magnetic resonance imaging and computed tomography to the field of cardiology in 2009. During this period, we helped establish values for myocardial deformation parameters in a number of different clinical settings that have enabled us to achieve better understanding of systolic and diastolic function in both ventricles. Real-time three-dimensional echocardiography has provided new ways to improve the selection and monitoring of potential candidates for an increasing number of no coronary interventions, such aspercutaneous aortic valve implantation and percutaneous mitral valve repair. Magnetic resonance imaging has clearly become the technique of choice for studying arange of different conditions, such as myocarditis and various forms of cardiomyopathy, and is now established as the reference standard in clinical practice for determining the sizes of infarcts and myocardial areas at risk. The diagnostic potential of computed tomography for assessing heart disease has been confirmed in large multicenter trials (AU)

[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance, and multidetector computed tomography]. / Actualización en técnicas de imagen cardiaca: ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores.

This article contains a review of the most important publications on cardiac imaging that have appeared during 2008. During the year, we assisted with the clinical implementation of three-dimensional real-time transesophageal echocardiography, with the use of echocardiography for selecting patients for and monitoring those who underwent percutaneous aortic valve replacement (the majority of centers performing the technique were still in the learning phase), and with the emergence in the clinic of techniques for studying myocardial deformation. Also reviewed are the most significant developments in the application of echocardiography to coronary heart disease and cardiac resynchronization therapy and in 2 other techniques whose use is constantly increasing: cardiac magnetic resonance and multidetector cardiac computed tomography. The review ends with a description of the current state of the art in contrast echocardiography, with particular emphasis on safety in the context of recommendations made by the US Food and Drug Administration at the end of 2007.

Actualización en técnicas de imagen cardiaca: ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores / Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance, and multidetector computed tomography

En este artículo se revisan las publicaciones más relevantes sobre la imagen cardiaca que han aparecido en2008. Hemos asistido a la introducción en la clínica de la ecocardiografía transesofágica tridimensional en tiempo real a la selección de casos y la monitorización ecocardiográfica de pacientes sometidos a sustitución percutánea de la válvula aórtica, aún en fase de aprendizaje para la mayoría de los centros que la practican, y a la irrupción en el campo clínico de las técnicas de estudio de deformación miocárdica. Se realiza también un resumen de lo más relevante en el ecocardiograma de la cardiopatía isquémica y la resincronización y de dos técnicas en expansión constante: la cardiorresonancia magnética y la tomografía computarizada cardiaca con multidetectores. Este trabajo de revisión termina con la descripción del estado de los contrastes ecocardiográficos, con especial énfasis en cuanto a su seguridad, tras las recomendaciones realizadas a finales de 2007 por la Food and Drug Administration (AU)

This article contains a review of the most importantpublications on cardiac imaging that have appearedduring 2008. During the year, we assisted with theclinical implementation of three-dimensional realtimetransesophageal echocardiography, with the useof echocardiography for selecting patients for andmonitoring those who underwent percutaneous aorticvalve replacement (the majority of centers performingthe technique were still in the learning phase), andwith the emergence in the clinic of techniques forstudying myocardial deformation. Also reviewed arethe most significant developments in the application ofechocardiography to coronary heart disease and cardiacresynchronization therapy and in 2 other techniqueswhose use is constantly increasing: cardiac magneticresonance and multidetector cardiac computedtomography. The review ends with a description of thecurrent state of the art in contrast echocardiography,with particular emphasis on safety in the context ofrecommendations made by the US Food and DrugAdministration at the end of 2007 (AU)

[Update on cardiac imaging techniques. Echocardiography, cardiac magnetic resonance imaging, and multidetector computed tomography]. / Actualización en técnicas de imagen cardiaca. Ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores.

This article contains a review of the most significant publications on non-invasive recent cardiac imaging techniques in 2005. The increasing importance of technological innovation in echocardiography is reflected in the sections on three dimensional echocardiography, contrast echocardiography, and myocardial deformation measurement techniques (i.e., strain echocardiography). The most important developments affecting cardiology in the techniques of magnetic resonance imaging and multidetector computed tomography are also summarized. This review ends with a detailed description of the contributions made by imaging techniques to the diagnosis of aortic disease.

Actualización en técnicas de imagen cardiaca. Ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores / Update on cardiac imaging techniques. Echocardiography, cardiac magnetic resonance imaging, and multidetector computed tomography

En este artículo realizamos una selección de las publicaciones más relevantes en técnicas de imagen cardiaca recientes. La creciente importancia de las nuevas tecnologías en ecocardiografía queda reflejada en los apartados de ecocardiografía tridimensional (ECO 3D), en la ecocardiografía de contraste y en el estudio de la deformación (strain) para el análisis de la función miocárdica. En un breve resumen se mencionan las aportaciones más significativas de la resonancia magnética (cardio-RM) y de la tomografía computarizada con multidetectores (cardio-TC) en el terreno cardiológico. Esta revisión concluye con una detallada descripción de la contribución de las técnicas de imagen al diagnóstico de las enfermedades de la aorta

This article contains a review of the most significant publications on non-invasive recent cardiac imaging techniques in 2005. The increasing importance of technological innovation in echocardiography is reflected in the sections on three dimensional echocardiography, contrast echocardiography, and myocardial deformation measurement techniques (i.e., strain echocardiography). The most important developments affecting cardiology in the techniques of magnetic resonance imaging and multidetector computed tomography are also summarized. This review ends with a detailed description of the contributions made by imaging techniques to the diagnosis of aortic disease

Dilated cardiomyopathy as a presenting feature of Cushing's syndrome.

Patients with Cushing's syndrome can rarely present with systolic heart failure as the mainstay feature. In these patients, heart failure is usually secondary to left ventricular hypertrophy (LVH) and not to dilated cardiopathy. We herewith report a patient with Cushing's syndrome, who presented with systolic ventricular failure secondary to dilated myocardiopathy and signs of proximal myopathy as predominant features. All symptoms regressed after successful treatment.

Utilidad del registrador implantable subcutáneo en el diagnóstico del síncope recurrente de etiología no filiada en pacientes sin cardiopatía estructural con test de tabla basculante y estudio electrofisiológico negativos / Usefulness of the Implantable Loop Recorder in the Diagnosis of Recurrent Syncope of Unknown Etiology in Patients without Structural Heart Disease and Negative Tilt Test and Electrophysiological Study

Introducción y objetivos. La etiología del síncope es, hasta en un 38 por ciento de los casos, difícil de determinar. El principal obstáculo para el diagnóstico de la causa del síncope radica en la frecuencia impredecible de los episodios. El desarrollo de registradores implantables permite la monitorización electrocardiográfica a largo plazo. El objetivo de este estudio fue evaluar la utilidad del registrador implantable subcutáneo en el diagnóstico de síncope recurrente de causa no aclarada. Pacientes y método. Entre mayo de 1991 y abril de 1999 se estudió prospectivamente una cohorte de 176 pacientes con síncopes recurrentes. Las pruebas realizadas, incluyendo monitorización de Holter, test de tabla basculante y estudio electrofisiológico, permitieron determinar la etiología en 161 casos (91 por ciento). Los restantes 15 pacientes, sin cardiopatía estructural, fueron seleccionados para monitorización continua electrocardiográfica mediante un registrador de ECG implantable. Resultados. Durante el seguimiento de 15 ñ 2 meses (X- ñ EE) realizado tras el implante, 9 pacientes presentaron recurrencia de síntomas concordantes con episodios previos (tiempo: 105 ñ 30 días). En 7 ocasiones el registro obtenido permitió el diagnóstico (47 por ciento; IC del 95 por ciento: 2173 por ciento), en 3 casos se realizó un diagnóstico de certeza con causa arrítmica documentada y en los otros cuatro se estableció un diagnóstico de presunción de causa no arrítmica. En 8 pacientes no fue posible alcanzar un diagnóstico, en seis de ellos por no presentar recurrencias. No hubo complicaciones relacionadas con el uso del sistema. Conclusiones. La estrategia de monitorización prolongada con el registrador implantable es efectiva y segura en pacientes con síncopes recurrentes de etiología no filiada (AU)