[Infectious endocarditis: prognostic factors of mortality in 131 cases]. / Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos.

BACKGROUND: Global hospital mortality for infective endocarditis ranges from 13 to 40%. AIM: To compare clinical, microbiological, echocardiographic factors and complications between patients that died during an episode of infective endocarditis and those who survived. PATIENTS AND METHODS: We followed during their hospital stay, 129 patients, aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. RESULTS: Thirty three patients died during hospital stay (25.2%). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occurred with higher frequency in deceased patients (57.1 and 24.3% respectively). Blood cultures were positive in 55% in survivors and 48% in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65% respectively) and embolic episodes (77 and 46% respectively) than survivors. Antimicrobial treatment was successful in 94% of survivors and 15% of those who died. Forty percent of survivors and 54% of deceased patients were subjected to surgical procedures. CONCLUSIONS: The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure.

Ventricular mass in hypertensive and normotensive obese subjects.

Two-dimensional echocardiography was performed in 29 normotensive obese subjects and 21 hypertensive obese subjects representative of the Chilean population. The left ventricular mass (LVM) did not correlate with height or body surface area (BSA) in these patients, but positively correlated with body mass index (BMI), tricipital skinfold thickness and blood pressure (BP). The LVM/BSA ratio was significantly higher in the hypertensive subjects and was correlated with BP only. Left ventricular hypertrophy (LVM/BSA > 120 or 150 g/m2 in women or men, respectively) was found in 28% of normotensive and 58% of hypertensive subjects (P = 0.036). No statistical differences were found in relative wall thickness (RWT) between both groups. Posterior wall thickness was independently associated with BP while interventricular septum thickness was positively associated with the waist/hip ratio. Systolic function, evaluated through fractional shortening and end systolic diameters, was negatively and independently associated with body fat area. Left ventricular hypertrophy is a prevalent condition in these obese subjects. Hypertension seems to exert an additive effect, mainly increasing posterior wall thickness. Fat accumulation was negatively related to systolic function in this sample, irrespective of blood pressure.

Effect of celiprolol on large and small arteries of the forearm circulation in hypertensive patients.

Celiprolol, a new highly cardioselective beta blocker, also has direct vasodilating properties. Since the noninvasive echo Doppler technique applied to the forearm circulation (brachial artery) allows the differentiation of arteriolar vasodilation (revealed by the increasing arterial blood flow velocity) from vasodilation of large arteries (shown by an increase in arterial diameter), it seems important to study the site of celiprolol's vasodilating effect. Thirty-five hypertensive patients, (21 male, 14 female; mean age, 59 +/- 11, range 42-79 years) were treated with increasing doses of celiprolol, 200 and 400 mg, over 15 days. The duplex echo Doppler technique (Aloka 7.5 M Hz probe) was used before and during each celiprolol dose period. Statistical analysis was performed by Student's paired t test. It was observed that celiprolol significantly increases the brachial artery diameter in a dose-dependent manner, and also increases the blood flow velocity (not being direct dose-related). Since the increase in diameter was clear with a higher dose, a dose-dependent increase in blood volume, a decrease in peripheral resistance, and an increase in compliance followed. Since the higher dose of celiprolol did not further reduce blood pressure (BP) in comparison to the lower dose, and a dose-dependent increase in arterial diameter and compliance occurred and a vasodilating effect of celiprolol on arterial wall ensued that was not related to BP. In conclusion, in the doses used, celiprolol dilates both arterioles and large arteries, but the mechanism of action needs to be clarified.

[Infectious endocarditis: clinical and echocardiographic initial follow-up]. / Endocarditis infecciosa: seguimiento inicial clínico-ecocardiográfico.

We analyzed the clinical and echocardiographic features of 24 patients with infective endocarditis followed for a mean of 20.2 month (range 3-84) after discharge. Mean age was 38 years, male to female ratio was 2:1 and 87% of cases had a subacute clinical course; 17% of patients had late prosthetic endocarditis. Positive blood cultures were obtained in only 50% of patients. Vegetations were detected by echocardiography in 88%, 66% of them located at the aortic valve. Heart failure (62%) was the main complication, leading to valve replacement in 4 patients. Four patients died during follow up, 3 males due to heart failure and a female from systemic emboli. Twenty patients survive at the end of follow up (84%), 50% of them in FC I or II, 40% in FC III or IV (2 lost to follow up). Eleven patients had a late echocardiogram at a mean of 12 months after discharge: 6 of them showed persistence of vegetations (55%).

Cardiac rehabilitation after acute myocardial infarction. 9-year controlled follow-up study.

Since the effect of cardiac rehabilitation (CR) on morbidity and mortality due to myocardial infarction on a long-term basis appears controversial, a controlled follow-up survey was conducted from 1973 to 1981 in 193 patients suffering a first acute myocardial infarction (AMI). The admission criteria included absence of contraindications to CR during the acute phase of AMI. Patients were divided into two matched groups: 93 patients followed a CR program, exercising 30 min three times a week (means 42; range 6-108 months) and the remaining 100 patients served as controls. Age, sex, location and extension of the myocardial damage, frequency of coronary risk factors and complications during the acute phase were comparable. At 9 years, there were 24 cardiac deaths (15 AMI, 7 sudden deaths and 2 heart failures) among the controls and 13 deaths in the CR group (7 AMI, 4 sudden deaths, 2 heart failures), mortality rates being 5.2 and 2.9% per year (p less than 0.1 greater than 0.05; NS), respectively. There were 23 recurrent AMI in the control versus 16 in the CR patients, the corresponding rates being 4.9 and 3.6% per year, respectively (NS). Nor were any differences observed in the incidence of myocardial ischemia, severe arrhythmias or cerebrovascular strokes between both groups, but the appearance of angina was significantly lower in the CR group compared with the controls (5.1 and 10.2% per year, respectively, p less than 0.005). It is concluded that CR on a long-term basis seems to improve the mortality rate of AMI and to reduce the frequency of anginal pain.

Physical training program in arterial hypertension. A long-term prospective follow-up.

A long-term training program was performed on 30 chronic hypertensive female patients, stages I-II, WHO criteria. The effect on blood pressure (BP) and other physiological parameters, as exercise BP, heart rate, physical working capacity, VO2max, double product, were studied. Four phases were outlined throughout the trial: (1) 3 months training at 70% of the maximal heart rate; (2) 3 months without training; (3) 1 year training at the same level as phase I, and (4) 12 or more months with increasing intensity training over 70% of the maximal heart rate. Serial ergometric work tests were performed every 3 months. We observed a close relationship between physical working capacity and VO2max increases with training intensity. Resting BP fell significantly with training (182/114-161/97 mm Hg; p less than 0.001) but increased again when training was discontinued (161/97-179/115 mm Hg; p less than 0.001). BP persisted low throughout the trial, but there was a tendency to a further but not significant decrease when training intensity was raised over 70% of the maximal heart rate. Both the submaximal and maximal exercise BP showed similar changes to those found in the resting BP throughout the trial. The submaximal heart rate and the double product (BP X heart rate) also fell significantly with training but with maximal values not changing significantly throughout the whole follow-up period.