[Non-valvular atrial fibrillation and completed stroke: factors determining mortality, recurrence and prognosis after a first event in the Mexican population]. / Fibrilación auricular no valvular e infarto cerebral: determinantes de mortalidad, recurrencia y pronóstico después de un primer evento en población mexicana.

AIMS: Non-valvular atrial fibrillation (NVAF) accounts for 25% of completed strokes (CS) of a cardioembolic origin in patients over 60 years old. Our aim was to define the predictors of a good and poor prognosis after a CS secondary to an NVAF in our milieu. PATIENTS AND METHODS: We evaluated the risk factors (RF) and severity of CS in relation to death, functionality and recurrence at 5 years. 81 patients between the ages of 49 and 88 were followed up consecutively for 1 to 90 months; 38 (46.9%) of them were males. Multivariate analysis was performed with the following independent variables: age, gender, smoking, hypertension, heart disease, diabetes mellitus and characteristics of the stroke. The severity of the CS was assessed by means of the modified Rankin scale, which was dichotomised into a good prognosis (0-2) and a poor prognosis (> or = 3), both basal and at the end of the clinical control. We also evaluated the secondary preventive treatment used and its relation with recurrence, prognosis, death and complications. RESULTS: No RF was linked to a poor prognosis or recurrence; 88% had a poor prognosis. Antiplatelet drugs were used in 42% of cases and 39% received anticoagulants. A good final progression was observed in 9.5% of the patients treated with antiplatelet drugs versus 35% of those receiving anticoagulation therapy (p = 0.004). Severity of the CS on admission was worse in the aspirin group, with no differences in recurrence and mortality. A better prognosis was observed in patients from urban areas. CONCLUSIONS: Use of antiplatelet drugs, living in a rural area and a Rankin score of > or = 3 on admission are factors suggesting a poor prognosis in the clinical control at 5 years.

Fibrilación auricular no valvular e infarto cerebral: determinantes de mortalidad, recurrencia y pronóstico después de un primer evento en población mexicana / Non-valvular atrial fibrillation and completed stroke: factors determining mortality, recurrence and prognosis after a first event in the Mexican population

Objetivo. La fibrilación auricular no valvular (FANV) representa el 25% de los infartos cerebrales (IC) de origen cardioembólico en mayores de 60 años. Nuestro propósito fue definir los factores de buen y mal pronósticos después de un IC secundario a FANV en nuestro medio. Pacientes y métodos. Evaluamos los factores de riesgo (FR) y la gravedad del IC en relación con muerte, funcionalidad y recurrencia a cinco años. Se siguieron 81 pacientes consecutivos de entre 49 y 88 años, durante 1-90 meses; 38 (46,9%) fueron hombres. Se realizó un análisis multivariado con las siguientes variables independientes: edad, sexo, tabaquismo, hipertensión, cardiopatía, diabetes mellitus y características del infarto. La gravedad del IC se evaluó mediante la escala modificada de Rankin, dicotomizada en buen pronóstico (0-2) y mal pronóstico 3), basal y al final del control clínico. Evaluamos también el tratamiento de prevención secundaria utilizado y su relación con recurrencia, pronóstico, muerte y complicaciones. Resultados. Ningún FR se asoció con mal pronóstico o recurrencia; el 88% tuvo mal pronóstico. En el 42% se utilizaron antiagregantes, y en el 39% anticoagulantes. Se observó una buena evolución final en un 9,5% de los pacientes con antiagregantes frente a un 35% con anticoagulación (p 0,004). La gravedad del IC al ingreso fue peor en el grupo de aspirina, sin diferencias en recurrencia y mortalidad. Se observó mejor pronóstico en los pacientes provenientes de áreas urbanas. Conclusión. El uso de antiagregantes, vivir en área rural y un Rankin 3 al ingreso son factores de mal pronóstico en el control clínico a los cinco años

Aims. Non-valvular atrial fibrillation (NVAF) accounts for 25% of completed strokes (CS) of a cardioembolic origin in patients over 60 years old. Our aim was to define the predictors of a good and poor prognosis after a CS secondary to an NVAF in our milieu. Patients and methods. We evaluated the risk factors (RF) and severity of CS in relation to death, functionality and recurrence at 5 years. 81 patients between the ages of 49 and 88 were followed up consecutively for 1 to 90 months; 38 (46.9%) of them were males. Multivariate analysis was performed with the following independent variables: age, gender, smoking, hypertension, heart disease, diabetes mellitus and characteristics of the stroke. The severity of the CS was assessed by means of the modified Rankin scale, which was dichotomised into a good prognosis (0-2) and a poor prognosis 3), both basal and at the end of the clinical control. We also evaluated the secondary preventive treatment used and its relation with recurrence, prognosis, death and complications. Results. No RF was linked to a poor prognosis or recurrence; 88% had a poor prognosis. Antiplatelet drugs were used in 42% of cases and 39% received anticoagulants. A good final progression was observed in 9.5% of the patients treated with antiplatelet drugs versus 35% of those receiving anticoagulation therapy (p = 0.004). Severity of the CS on admission was worse in the aspirin group, with no differences in recurrence and mortality. A better prognosis was observed in patients from urban areas. Conclusions. Use of antiplatelet drugs, living in a rural area and a Rankin score of 3 on admission are factors suggesting a poor prognosis in the clinical control at 5 years

[The neurological complications of infectious endocarditis]. / Complicaciones neurológicas de la endocarditis infecciosa.

We review the neurologic complications of 131 episodes of infective endocarditis, and the influences of some factors that are considered risk factors at its presentation, like the presence of vegetations detected by echocardiography, type and location of involved valve, or bacterial culture. Neurologic complications occurred in 28 patients (21.4%), 4 of them were excluded because of the absence of neuroimaging studies. In 21 patients the underlying cardiac pathology was valve disease and in the remaining 3 patients was congenital heart disease. 11 patients had native valve endocarditis and 10 prosthetic valve endocarditis. The cultured bacteria were Streptococcus viridans in 8 cases and Staphylococcus aureus in 7. The most frequent complication was cerebrovascular with incidence of cerebral embolism, and intracerebral hemorrhage of 62.5% and 8.3% respectively. Echocardiographic evidence of vegetation was seen in 18 patients, and cerebral embolism were noted in 12. Death occurred in 29% of patients with neurologic complications and 27% without. Two of nine patients who underwent open-heat surgery died. We conclude that there is no difference in the incidence of neurologic complications between mitral and aortic valve groups, neither when comparing native and prosthetic valve groups. Open-heart surgery does not increase mortality in this group of patients.