Insuficiencia cardíaca y disfunción diastólica en pacientes en hemodiálisis: factores asociados / Cardiac failure and diastoli disfunction in hemodialysis patients: associated factors

La prevalencia de insuficiencia cardíaca (ICC) en hemodiálisis (HD) es elevada,se ha relacionado con disfunción sistólica, pero su relación con disfuncióndiastólica (DD) no ha sido estudiada.Objetivos: Analizar la incidencia de ICC en una población prevalente en HD yfactores asociados, incluyendo DD.Pacientes y metodo: 79 pacientes en HD; edad: 48 ± 15 años; tiempo en HD:83 ± 62 meses; 55,7% tenía calcificaciones arteriales (CVP) (series radiológicas)y 26% Cardiopatía isquémica (CIsq). Se recogieron parámetros analíticos y clínicosde riesgo cardiovascular, y mediante ecocardiografía se estudiaron: calcificacionesvalvulares (CV), hipertrofia ventricular izquierda (HVI), dilatación VI, disfunciónsistólica y diastólica (DD). Los pacientes se siguieron prospectivamentedos años, recogiendo: incidencia de CIsq, ICC y mortalidad de origen cardíaco.Resultados: Hallazgos ecocardiográficos más frecuentes: HVI (93%) y DD (relajaciónmiocárdica alterada (RMA): 63,5%). El 38,3% presentó ICC, asociándosea mayor tiempo en HD (130/72 meses), mayores niveles de CaxP (74/65), PTH(677/376), fosfatasa alcalina ósea (27/16), aluminio (35/25) y PA sistólica(145/130 mmHg) (p < 0,05), así como a la presencia de CIsq, CVP, CV, HVI yRMA (p < 0,01). La fracción de eyección era normal en ambos grupos. El estudiode regresión logística identificó como factores predictores de ICC: RMA (OR:9,5), CIsq (OR: 15) y PA sistólica (OR: 2,2).Los pacientes con RMA tenían mayor edad (55/37), más tiempo en HD (76/60meses), CVP y CV (p < 0,001). Edad (OR: 2,13) y CVP (OR: 3,9) se comportaroncomo factores predictores de RMA.Conclusiones: Los pacientes en HD presentan elevada incidencia de ICC. La cardiopatíaisquémica, la DD (relajación ventricular alterada) y la PA sistólica se comportancomo factores predictores de su aparición. La DD tiene muy alta prevalencia,y se relaciona con la edad y con la presencia de CVP

Heart failure (CHF) and diastolic dysfuction (DD) relationship has received poorattention in hemodialysis patients (HD).Objetive: To analyse the incidence of CHF in our HD patients, the relationshipwith DD and impact on mortality.Methods: We studied 79 patients: 48 ± 15 years old, mean time on HD 83 ±63 months. Vascular calcification (PVC) was evaluated by radiologic series(55.7%). We analyzed the presence of clinical and analytical cardiovascular factors.All patients underwent M-mode, two-dimensional, Doppler echocardiography.Patients were followed for two years. Clinical information collected: incidence ofischemic heart disease (IHD), CHF, and mortality due to cardiovascular events.Results: Most frequent finding was Left Ventricular Hypertrophy (LVH) (93%),followed by DD (63.5% had anormal LV relaxation) (ALVR). Incidence of CHFwas 38.3%; and was significantly associated with higher: time on HD (130/72months), Ca x P (74/65), PTH (677/376), bone alkaline phosphatase (27/16), andsystolic BP (145 vs 130 mmHg); IHD, PVC, valvular calcification (VC), LVH andALVR (p < 0.01). Systolic function was normal in both groups (with/without CHF).Logistic regression identified as risk factors for CHF: ALVR (OR: 9.5), IHD (OR:15) and systolic BP (OR: 2.2).ALVR was associated with greater age (55/37), longer time on HD (76/60), PVCand VC (p < 0.001). Predictor factors identified were age (OR: 2.13) and PVC(OR: 3.9).Conclusions: HD patients showed a high incidence of CHF. IHD, systolic BPand DD (ALVR) have behave as risk factors for CHF. Vascular calcifications wereintimately related to these findings and, therefore, they contribute to the greatermortality of these patients

[Cardiac failure and diastolic disfunction in hemodialysis patients: associated factors]. / Insuficiencia cardíaca y disfunción diastólica en pacientes en hemodiálisis: factores asociados.

UNLABELLED: Heart failure (CHF) and diastolic dysfuction (DD) relationship has received poor attention in hemodialysis patients (HD). OBJECTIVE: To analyse the incidence of CHF in our HD patients, the relationship with DD and impact on mortality. METHODS: We studied 79 patients: 48 +/- 15 years old, mean time on HD 83 +/- 63 months. Vascular calcification (PVC) was evaluated by radiologic series (55.7%). We analyzed the presence of clinical and analytical cardiovascular factors. All patients underwent M-mode, two-dimensional, Doppler echocardiography. Patients were followed for two years. Clinical information collected: incidence of ischemic heart disease (IHD), CHF, and mortality due to cardiovascular events. RESULTS: Most frequent finding was Left Ventricular Hypertrophy (LVH) (93%), followed by DD (63.5% had anormal LV relaxation) (ALVR). Incidence of CHF was 38.3%; and was significantly associated with higher: time on HD (130/72 months), Ca x P (74/65), PTH (677/376), bone alkaline phosphatase (27/16), and systolic BP (145 vs 130 mmHg); IHD, PVC, valvular calcification (VC), LVH and ALVR (p < 0.01). Systolic function was normal in both groups (with/without CHF). Logistic regression identified as risk factors for CHF: ALVR (OR: 9.5), IHD (OR: 15) and systolic BP (OR: 2.2). ALVR was associated with greater age (55/37), longer time on HD (76/60), PVC and VC (p < 0.001). Predictor factors identified were age (OR: 2.13) and PVC (OR: 3.9). CONCLUSIONS: HD patients showed a high incidence of CHF. IHD, systolic BP and DD (ALVR) have behave as risk factors for CHF. Vascular calcifications were intimately related to these findings and, therefore, they contribute to the greater mortality of these patients.

[A right atrial thrombus in transit: its echocardiographic diagnosis 72 hours before a pulmonary embolism]. / Trombo en tránsito en aurícula derecha: diagnóstico ecocardiográfico 72 horas antes de un embolismo pulmonar.

We report a case of a 72-year-old woman with coronary artery disease in whom a thrombus in transit in the right atrium was diagnosed accidentally. After 72 hours of treatment with intravenous anticoagulants she developed a pulmonary thromboembolism resolved with systemic fibrinolysis. This is a rare case in which such a diagnosis preceded an embolic event. This fact raises the controversy about the best therapeutic management of this unusual form of thromboembolic illness.

[Regression of cardiac hypertrophy in hypertensive patients treated with captopril]. / Regresión de la hipertrofia cardiaca en pacientes hipertensos tratados con Captopril.

We studied the echographic LVH indexes early detected in recent AHT. We analyzed the LVH regression after 12 months of treatment with Captopril. We describe the modifications observed in the lipidic metabolism. We studied 25 patients with an average age of 40 years and maximum essential arterial hypertension with 15 months of evolution. Septal thickness showed a reduction in systole and diastole at 6 months (p < 0.01). The posterior wall thickness decreased 3 mm in systole and diastole at 12 months (p < 0.001). Afterload diastolic diameter improved at 6 months. LV mass decreased from 321 gr to 279 gr at 6 months and to 268 at 12 months (p < 0.001); the same reduction was observed in mass index. At six months, total cholesterol and LDL had decreased (p < 0.05) and HDL-cholesterol had increased, although without statistical significance. Triglycerides showed a significant decrease at 12 months (p < 0.001). Seventy per cent of the patients were controlled with Captropil 100 mg/day and the remainder, with 50 mg.