Endocarditis infecciosa en pacientes con enfermedades oncológicas / Infective endocarditis in patients with oncological diseases

Introducción: Los pacientes con cáncer pueden constituir un especial grupo de riesgo para el desarrollo de endocarditis infecciosa (EI) debido a que frecuentemente están sometidos a maniobras invasivas. Nuestro objetivo es conocer cuál es el perfil diferencial y el pronóstico de los pacientes con EI y cáncer. Métodos: Estudio observacional retrospectivo de todos los pacientes con EI diagnosticados consecutivamente en un hospital entre 2005 y 2015. Se realiza un análisis comparativo entre los pacientes con enfermedad oncológica y sin ella, así como un seguimiento a largo plazo. Resultados: Se diagnosticaron 208 casos de EI, de los cuales 32 sufrían enfermedad oncológica. No hubo diferencias significativas en cuanto a la edad (67,5 [59,2-74] vs. 64 [51-74] años), y la comorbilidad estimada por el índice de Charlson fue similar cuando no se consideró el propio diagnóstico de cáncer (4 [2,2-5] vs. 3,9 [2-5]). Se relacionó principalmente con la asistencia sanitaria (59,5% vs. 24,4%, p<0,001), predominó Staphylococcus aureus como agente causal (35%) y la localización tricuspídea fue 3 veces más frecuente (18,8% vs. 6,2%). Un 18,7% de pacientes no se intervinieron quirúrgicamente a pesar de tener indicación, frente al 7,4% de pacientes sin cáncer. La mortalidad intrahospitalaria alcanzó el 45,5% en pacientes con cáncer y la probabilidad de supervivencia al año fue del 40%. Conclusiones: La EI en pacientes con cáncer está predominantemente causada por estafilococos y presenta una elevada mortalidad precoz. A pesar de que se relaciona frecuentemente con la asistencia sanitaria, los pacientes se ven limitados desde el punto de vista terapéutico (AU)

Introduction: Cancer patients may constitute a special risk group for the development of infective endocarditis (IE) because they are often subjected to invasive procedures. The aim of this study is to determine the differential clinical profile and prognosis of patients with IE and cancer. Methods: A retrospective observational study was conducted on all patients consecutively diagnosed with IE in a single centre between 2005 and 2015. A comparative analysis was performed between patients with cancer and those free of disease, as well as a long-term follow-up. Results: There were 208 IE cases, of which 32 had a cancer diagnosis. There were no significant differences in age (67.5 [59.2-74] vs. 64 [51-74] years). The Charlson comorbidity index was same whether cancer was diagnosed or not (4 [2.2-5] vs. 3.9 [2-5]). IE in cancer patients was mainly associated with health care (59.5% vs 24.4%, P<.001). Staphylococcus aureus was the main causative agent (35%), and the tricuspid location was three times more common (18.8% vs. 6.2%). Surgery was not performed in 18.7% of patients, despite having an indication, compared with 7.4% of patients without cancer. In-hospital mortality for cancer patients was 45.5%, and the probability of survival at one year was 40%. Conclusions: IE in patients with cancer is predominantly caused by staphylococci, and has high early mortality. Although it is often related to health care, patients are limited from the therapeutic point of view (AU)

Infective endocarditis in patients with oncological diseases. / Endocarditis infecciosa en pacientes con enfermedades oncológicas.

INTRODUCTION: Cancer patients may constitute a special risk group for the development of infective endocarditis (IE) because they are often subjected to invasive procedures. The aim of this study is to determine the differential clinical profile and prognosis of patients with IE and cancer. METHODS: A retrospective observational study was conducted on all patients consecutively diagnosed with IE in a single centre between 2005 and 2015. A comparative analysis was performed between patients with cancer and those free of disease, as well as a long-term follow-up. RESULTS: There were 208 IE cases, of which 32 had a cancer diagnosis. There were no significant differences in age (67.5 [59.2-74] vs. 64 [51-74] years). The Charlson comorbidity index was same whether cancer was diagnosed or not (4 [2.2-5] vs. 3.9 [2-5]). IE in cancer patients was mainly associated with health care (59.5% vs 24.4%, P<.001). Staphylococcus aureus was the main causative agent (35%), and the tricuspid location was three times more common (18.8% vs. 6.2%). Surgery was not performed in 18.7% of patients, despite having an indication, compared with 7.4% of patients without cancer. In-hospital mortality for cancer patients was 45.5%, and the probability of survival at one year was 40%. CONCLUSIONS: IE in patients with cancer is predominantly caused by staphylococci, and has high early mortality. Although it is often related to health care, patients are limited from the therapeutic point of view.

Ivabradina como modulador del nódulo auriculoventricular. ¿Promesa o realidad? / Ivabradine as an atrioventricular node modulator. Promise or reality?

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Aortic valve tethering: embryonic remnant of a common origin?

A 14-year-old asymptomatic girl without relevant medical history was referred to our department for heart murmur evaluation. The echocardiogram showed cardiac chambers with normal size and function. Noteworthy was the presence of an apparently fibrous tissue joining the ventricular surfaces of the aortic non-coronary and right coronary leaflets with the anterior mitral leaflet. Both valves were slightly thickened and there was a mild anterior mitral valve 'billowing' causing an eccentric mild-to-moderate regurgitant jet. During systole, tethering of this tissue caused the incomplete opening of both mentioned aortic leaflets, causing a turbulent flow with no significant gradient across the valve. During diastole, moderate eccentric aortic regurgitation jet was noted, probably related to incomplete coaptation at the insertion point of this anomalous tissue. We speculate that this finding may represent the remnant of some tissue during heart development that abnormally persisted in this young lady.

Marcadores pronósticos en la insuficiencia cardíaca. Situación actual / Prognostic markerts in heart failure. Current status

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Efecto del sildenafilo en un sujeto con miocardiopatía hipertrófica obstructiva candidato a trasplante cardíaco / Effect of sildenafile in patient with obstructive hypertrophic cardiomyopathy candidated to cardiac transplantation

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