Asociación de los polimorfismos rs2200733 y rs7193343 con la fibrilación auricular en población española y metanálisis de la evidencia existente / Association Between rs2200733 and rs7193343 Genetic Variants and Atrial Fibrillation in a Spanish Population, and Meta-analysis of Previous Studies

Introducción y objetivos Los objetivos del estudio son analizar en población española la asociación entre dos variantes genéticas (rs2200733 y rs7193343) y el riesgo de sufrir fibrilación auricular y realizar una revisión sistemática y un metanálisis de estas asociaciones. Métodos Estudio de casos y controles con 257 casos de fibrilación auricular y 379 controles. Los casos eran donantes del Banco Nacional de ADN; los controles participaron en un estudio transversal de base poblacional. La genotipificación se realizó mediante pruebas TaqMan. Se realizó una búsqueda bibliográfica sistemática, dos revisores independientes extrajeron la información necesaria. Se realizó un metanálisis, un análisis de heterogeneidad y de metarregresión para identificar las variables que explicaran la heterogeneidad entre estudios. Resultados En nuestra población se observa una asociación entre el rs2200733 y la presencia de fibrilación auricular (odds ratio = 1,87; intervalo de confianza del 95%, 1,30-2,70), pero no con el rs7193343 (odds ratio = 1,18; intervalo de confianza del 95%, 1,11-1,25) para el rs7193343. En la asociación entre el rs2200733 y la fibrilación auricular se observó heterogeneidad entre estudios, parcialmente relacionada con el diseño del estudio, con mayor magnitud de asociación en estudios de casos y controles (odds ratio = 1,83) que en cohortes (odds ratio = 1,41). Conclusiones: Las variantes rs2200733 y rs7193343 se asocian con mayor riesgo de fibrilación auricular. Los estudios de casos y controles tienden a sobrestimar la magnitud de la asociación entre estas variantes genéticas y la fibrilación auricular

Introduction and objectives The objectives of this study were to analyze the association between two genetic variants (rs2200733 and rs7193343) in a Spanish population and the risk of developing atrial fibrillation, and to carry out a systematic review and meta-analysis of these associations. Methods We performed a case-control study involving 257 case patients with atrial fibrillation and 379 controls. The case patients were individuals who had donated samples to the Spanish National DNA Bank; the controls were participating in a population-based cross-sectional study. Genotyping was carried out using a TaqMan assay. We conducted a systematic literature search in which 2 independent reviewers extracted the necessary information. The study involved a meta-analysis, a heterogeneity analysis, and a meta-regression analysis to identify the variables that explain the heterogeneity across studies. Results In our population, the presence of atrial fibrillation was found to be associated with rs2200733 (odds ratio = 1.87; 95% confidence interval, 1.30-2.70), but not with rs7193343 (odds ratio = 1.18; 95% confidence interval, 0.80-1.73). In the meta-analysis, we observed an association between atrial fibrillation and both variants: odds ratio = 1.71 (95% confidence interval, 1.54-1.90) for rs2200733 and odds ratio = 1.18 (95% confidence interval, 1.11-1.25) for rs7193343. We observed heterogeneity among the studies dealing with the association between rs2200733 and atrial fibrillation, partially related to the study design, and the strength of association was greater in case-control studies (odds ratio = 1.83) than in cohort studies (odds ratio = 1.41). Conclusions: Variants rs2200733 and rs7193343 are associated with a higher risk of atrial fibrillation. Case-control studies tend to overestimate the strength of association between these genetic variants and atrial fibrillation

Association between rs2200733 and rs7193343 genetic variants and atrial fibrillation in a Spanish population, and meta-analysis of previous studies.

INTRODUCTION AND OBJECTIVES: The objectives of this study were to analyze the association between two genetic variants (rs2200733 and rs7193343) in a Spanish population and the risk of developing atrial fibrillation, and to carry out a systematic review and meta-analysis of these associations. METHODS: We performed a case-control study involving 257 case patients with atrial fibrillation and 379 controls. The case patients were individuals who had donated samples to the Spanish National DNA Bank; the controls were participating in a population-based cross-sectional study. Genotyping was carried out using a TaqMan assay. We conducted a systematic literature search in which 2 independent reviewers extracted the necessary information. The study involved a meta-analysis, a heterogeneity analysis, and a meta-regression analysis to identify the variables that explain the heterogeneity across studies. RESULTS: In our population, the presence of atrial fibrillation was found to be associated with rs2200733 (odds ratio = 1.87; 95% confidence interval, 1.30-2.70), but not with rs7193343 (odds ratio = 1.18; 95% confidence interval, 0.80-1.73). In the meta-analysis, we observed an association between atrial fibrillation and both variants: odds ratio = 1.71 (95% confidence interval, 1.54-1.90) for rs2200733 and odds ratio = 1.18 (95% confidence interval, 1.11-1.25) for rs7193343. We observed heterogeneity among the studies dealing with the association between rs2200733 and atrial fibrillation, partially related to the study design, and the strength of association was greater in case-control studies (odds ratio = 1.83) than in cohort studies (odds ratio = 1.41). CONCLUSIONS: Variants rs2200733 and rs7193343 are associated with a higher risk of atrial fibrillation. Case-control studies tend to overestimate the strength of association between these genetic variants and atrial fibrillation.

Relationship between adiponectin and left atrium size in uncomplicated obese patients: adiponectin, a link between fat and heart.

BACKGROUND: It is well known that obesity is a risk factor for severe cardiovascular complications, such as coronary heart disease, heart failure, stroke, venous thromboembolic disease, and atrial fibrillation. Left ventricle (LV) and left atrium (LA) enlargement is a characteristic feature of these patients with the consequent cardiovascular risk. Factors other than hemodynamic may influence LA remodeling. The aim of the study is to evaluate the relationship between adiponectin and LA size in uncomplicated obese patients. METHODS: Seventy-four asymptomatic obese patients and an age- and sex-matched control group (N = 70) were recruited. A detailed clinical, echocardiographic, and analytical study was performed. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR) method. Insulin sensitivity was assessed measuring serum total adiponectin concentrations. RESULTS: Adiponectin levels were lower in the obese group (P < 0.001) and particularly so in those obese participants with enlarged LA (32%; P < 0.0005). LA sizes were higher in the obese group (P < 0.0005). Adiponectin displayed significant correlations with body mass index, glucose, insulin, high-density lipoprotein cholesterol, and triglyceride concentrations as well as HOMA-IR (P < 0.001 for all). Adiponectin displayed significant correlations with LV mass and LA size, diastolic and systolic cardiac volumes and diameters, and cardiac output (P < 0.001 for all). Adiponectin correlations with LA size (r = -0.429; P < 0.001) persisted after adjustment for HOMA-IR, age, sex, and LV mass. CONCLUSIONS: A novel inverse relationship between adiponectin and LA size independent of age, sex, insulin resistance, and LV mass appears in our series. Adiponectin could be a link between adipose tissue and the heart, having an influence on cardiac remodeling.

Association between sleep-disordered breathing, aminoterminal pro-brain natriuretic peptide (NT-proBNP) levels and insulin resistance in morbidly obese young women.

OBJECTIVE: Sleep-disordered breathing (SDB) is often encountered in morbid obesity (MO) in conjunction with insulin resistance (IR) and several cardio-vascular risk factors. Aminoterminal pro-brain natriuretic peptide (NT-proBNP) is a promising marker for left ventricular dysfunction (LVD) in MO. The aim of this study was to look for possible correlations between SDB, IR, heart structure and function indexes and NT-proBNP levels in MO female subjects. MATERIALS AND METHODS: Cross-sectional study involving 110 MO (44.5+/-0.7 kg m(-2)) apparently healthy, young (37.8+/-1.0 y.o.) female patients. NT-proBNP was measured using an ELISA kit (Roche). Echo-cardiograms were performed to quantify left ventricular ejection fraction values (LVEF), cardiac output (CO), left ventricular mass (LVM), left atria size (LA) and left ventricular filling pressures (the E/Em ratio). The Berlin Questionnaire (BQ) was used to assess the risk of SDB. IR and sensitivity were assessed using the HOMA index and adiponectin measurements, respectively. RESULTS: All patients had a normal LVEF (>50%). Hypertension and Type 2 diabetes mellitus prevalences were 34.5 and 4.5% (respectively). Log-transformed NT-proBNP levels correlated with BQ categories (P<0.0005), creatinine (P<0.001), age (P<0.05), LVM (P<0.001), CO (P<0.001), LA (P<0.0005) and E/Em (P<0.01). NT-proBNP levels, LVD and LVM increased significantly along with BQ scores (P<0.0001). Stepwise multiple regression analysis identified BQ and log-transformed HOMA as independent variables predicting as much as 48.0% of log-transformed NT-proBNP's variability (dependent variable). CONCLUSIONS: NT-proBNP levels are independently predicted by SDB and IR in asymptomatic MO women. Additionally, SDB worsens along with LVH and diastolic dysfunction. Larger prospective studies are warranted.

Aminoterminal pro-brain natriuretic peptide (NT-proBNP) and sleep-disordered breathing in morbidly obese females: a cross-sectional study.

Sleep-disordered breathing (SDB) is often encountered in morbid obesity (MO) in conjunction with insulin resistance (IR). Aminoterminal pro-brain natriuretic peptide (NT-proBNP) is a promising marker for left ventricular dysfunction (LVD) in MO. We sought to explore the factors that may influence the relationships of SDB and IR with NT-proBNP in MO women. We performed a cross-sectional pilot study involving 110 asymptomatic MO (44.5+/-0.7 kg/m2) young women. SDB risk was assessed using a modified version of the Berlin Questionnaire (BQ). IR was assessed using the homeostasis model assessment (HOMA) index and adiponectin levels. LVD was assessed using NT-proBNP and echocardiograms. In this study, NT-proBNP levels and LVD increased significantly along the BQ strata. Multiple regression analysis identified BQ and log-transformed HOMA as the independent variables predicting as much as 48.0% of the variability of logNT-proBNP. In conclusion, NT-pro-BNP levels are independently predicted by SDB and IR in asymptomatic MO women. Larger prospective studies are warranted.

Correlation between insulin resistance surrogates and echocardiographic findings in asymptomatic patients with morbid obesity: a cross-sectional study.

OBJECTIVE: To assess the relationship between insulin resistance (IR) and left ventricular diastolic dysfunction (LVDD) in asymptomatic patients with morbid obesity (MO). METHODS: The study cohort consisted of 231 patients (165 women and 66 men) with MO (mean body mass index [BMI] of 46.0 kg/m2) and a control group of 93 age-and sex-matched apparently healthy control subjects (56 women and 37 men; mean BMI of 24.1 kg/m2). Tissue Doppler imaging echocardiography was used to provide measurements of ejection fraction, LVDD (peak early tissue Doppler velocity/peak late tissue Doppler velocity or Em/Am ratio), left ventricular mass (LVM), and left ventricular hypertrophy (LVH). Adiponectin levels, the homeostasis model assessment index, and the ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL) were used as surrogate markers of IR. RESULTS: The ejection fraction was normal and similar in the patient and control groups. LVDD (Em/Am ratio <1.0) and LVH prevalences were 52% and 30%, respectively, in the group with MO (significantly higher than in the control group; P<0.0005). The patients with MO displayed higher IR on the basis of all 3 surrogate markers (P<0.0005, respectively). Log-transformed adiponectin showed the strongest correlations with LVM and Em/Am ratios; log-transformed homeostasis model assessment index and TG/HDL ratio displayed less robust yet significant correlations. Stepwise multiple linear regression analysis identified hypertension and the TG/HDL ratio as independent predictors of 35.5% of the variance of LVDD. In contrast, LVM was mainly predicted by BMI, hypertension, and sex. CONCLUSION: LVH and LVDD are highly prevalent in asymptomatic patients with MO. IR is significantly correlated with both variables. Furthermore, LVDD is independently predicted by the presence of hypertension and the TG/HDL ratio. The prognostic implications of these findings warrant further studies.

Idiopathic dilated cardiomyopathy exhibits defective vascularization and vessel formation.

BACKGROUND: Ultrastructural findings of idiopathic dilated cardiomyopathy (IDCM) include myocyte atrophy and myofilament loss, yet little is known about the vascular abnormalities present in IDCM. METHODS AND RESULTS: Patients with IDCM and controls underwent multi-slice CT to examine length and diameter of epicardial vasculature. The levels of mobilizing cytokines and circulating EPCs were assessed by endothelial colony formation assay and flow cytometry. Immunohistochemistry and Western blot were used to examine microvessel density and expression of HIF-1alpha and beta-catenin. Main epicardial coronary arteries were shorter and smaller, and microvascular density was reduced in the epicardium in IDCM. Epicardial vessel paucity was associated with increased numbers of HIF-1alpha(+) cells (46.8+/-13.1% vs. 19.4+/-9.4%, p=0.006) indicating local epicardial hypoxia and elevation of circulating VEGF-A (394 pg/mL vs. 22 pg/mL, p=0.001). The number of mobilized progenitors CD133(+)/VEGF-R2(+) was 21-fold higher in IDCM compared with controls (6.5+/-3.3% vs. 0.3+/-0.2%; p<0.001). Moreover, this defective vascularization was associated with reduced myocardial expression of vascular beta-catenin, an important angiogenic regulator. CONCLUSIONS: This study shows defective vascularization and impaired vasculogenesis (the de novo vascular organization of mobilized endothelial progenitors) and angiogenesis (by which new blood vessels are formed from pre-existing mature endothelial cells) in human IDCM.

Electrocardiographic findings in patients with cryptogenic ischemic stroke and patent foramen ovale.

BACKGROUND: A characteristic electrocardiogram (ECG) pattern called crochetage has been described in patients with atrial septal defects. Nevertheless, there are discrepancies regarding its frequency in patients with patent foramen ovale (PFO). OBJECTIVE: We analyzed the ECGs of patients who had cryptogenic stroke to study crochetage and other possible patterns in relation to PFO. METHODS: We prospectively included consecutive patients who have had a cryptogenic stroke and are undergoing a right-to-left shunt (RLS) study with transesophageal echocardiography and simultaneous transcranial Doppler. Two blinded and independent cardiologists analyzed the ECGs for crochetage, defined as a notch near the apex of the R wave in inferior limb leads, P wave abnormalities, and right bundle branch block (RBBB). RESULTS: We studied 104 patients whose mean age was 55.1 +/- 12.7 years; 60.6% were men. PFO was detected in 40.4% of patients. Cardiologists recorded crochetage in 26.2% of patients with PFO and 14.5% of patients without PFO (P = .204) and RBBB in 19% and 8% of patients, respectively (P = .132). P wave abnormalities were also detected in 54.8% of patients with PFO and 35.5% of patients without PFO (P = .070). In patients with PFO, biphasic P waves were more frequent in small RLS (P = .006). Although higher frequencies of crochetage in small RLS and RBBB in moderate RLS were detected, these differences did not reach statistical significance (P = .067 and P = .05, respectively). CONCLUSION: There is no characteristic ECG pattern to identify the patients with cryptogenic stroke.

Serial NT-proBNP monitoring and outcomes in outpatients with decompensation of heart failure.

BACKGROUND: NT-proBNP is useful for heart failure (HF) diagnosis and prognosis. We examined the value of serial NT-proBNP monitoring to predict outcomes in decompensated HF patients attending a structured HF clinic. METHODS: Patients with decompensation of established optimally treated HF, not requiring emergency hospital admission, were enrolled in the study. Patients received intensive follow-up weekly during 4 weeks and at 3 months in specialist HF clinics. Serial NT-proBNP concentrations were measured at each visit. Primary endpoint was cardiovascular death and hospital admission for HF at 3 months. RESULTS: Fifty-nine patients were enrolled (60+/-14 years, LVEF 27+/-9%) and 39% had a primary endpoint during follow-up. Baseline NT-proBNP concentration (in ng/L) was 7050+/-6620, and did not differ significantly in patients with and without events (p=0.22). Patients without events showed marked NT-proBNP reduction at week-1 (30% reduction), week-2 (36% reduction), week-3 (34% reduction) and week-4 (37% reduction). By contrast, patients with events showed no significant NT-proBNP reduction during follow-up. Using a general linear model, the relative NT-proBNP reductions (%) at weeks 1-4 were predictors of adverse events (p=0.004, p<0.001, p=0.001 and p=0.03, respectively). In a stepwise multiple Cox regression analysis, NT-proBNP relative reduction (in %) at week 2 was a strong predictor of no events during follow-up (OR 0.79, 95% CI 0.70-0.88, p<0.001). CONCLUSIONS: Serial NT-proBNP monitoring in decompensated HF patients seen in a structured in-hospital HF clinic predicts cardiovascular events during follow-up. NT-proBNP may be useful in an outpatient basis to identify patients at high risk needing more aggressive therapy.

[Natural history of and risk factors for idiopathic atrial fibrillation recurrence (FAP Registry)]. / Historia natural y factores de riesgo de recurrencia de la fibrilación auricular primaria (Registro FAP).

INTRODUCTION AND OBJECTIVES: The natural history of idiopathic atrial fibrillation is not well understood. The aim of this study was to investigate the frequency of and risk factors for disease recurrence. METHODS: The study involved 115 patients with a first episode of paroxysmal atrial fibrillation of unknown origin who were included the FAP registry, which contains data from 11 district hospitals in Catalonia, Spain. All patients underwent comprehensive clinical, laboratory, electro-cardiographic and echocardiographic investigations at baseline and were followed up periodically every 6 months to identify the occurrence of new symptomatic episodes and their complications. RESULTS: During a mean follow-up period of 912 (445) days, 32 (27.8%) patients experienced recurrence of atrial fibrillation. Those who experienced recurrence had a significantly higher left ventricular ejection fraction (P=.023) and smaller end-systolic volume (P<.001), and they were more likely to consume alcohol regularly (P=.013). Cox regression analysis confirmed that these variables had independent prognostic value. In contrast, the occurrence of syncope during the initial episode was associated with a lower likelihood of recurrence (P=.017). CONCLUSIONS: The risk of recurrence of idiopathic atrial fibrillation was high, and was enhanced by moderate alcohol consumption and increased left ventricular activity, probably of sympathetic origin. This trend was less marked in paroxysmal atrial fibrillation of vagal origin.

Historia natural y factores de riesgo de recurrencia de la fibrilación auricular primaria (Registro FAP) / Natural history of and risk factors for idiopathic atrial fibrillation recurrence (FAP Registry)

Introducción y objetivos. La historia natural de la fibrilación auricular (FA) primaria o idiopática tiene aspectos poco conocidos. El objeto del estudio fue describir la frecuencia y los factores determinantes de las recurrencias. Métodos. Se estudió a 115 pacientes atendidos en su primera crisis de FA paroxística sin causa conocida incluidos en el «registro FAP», en el que participan 11 centros comarcales de Cataluña. Se les practicó un estudio clínico, analítico, electrocardiográfico y ecocardiográfico exhaustivo y fueron seguidos periódicamente cada 6 meses para detectar la aparición de nuevas crisis sintomáticas y sus complicaciones. Resultados. Durante el seguimiento de 912 ± 445 días de promedio, 32 (27,8%) pacientes presentaron una recidiva de la fibrilación auricular. Los pacientes con recurrencias tenían una fracción de eyección más elevada (p = 0,023), un menor volumen telesistólico (p < 0,001) y eran con mayor frecuencia consumidores habituales de alcohol (p = 0,013). El análisis de regresión de Cox confirmó el valor predictivo independiente de estas variables. En cambio, la presencia de lipotimias en el episodio agudo se asoció con una menor tendencia a recidivar (p = 0,017). Conclusiones. La fibrilación auricular idiopática mostró una notable tendencia a las recidivas, favorecida por el consumo moderado de alcohol y el aumento de la actividad ventricular, probablemente de origen simpático. La tendencia fue menor en la fibrilación paroxística de origen vagal

Introduction and objectives. The natural history of idiopathic atrial fibrillation is not well understood. The aim of this study was to investigate the frequency of and risk factors for disease recurrence. Methods. The study involved 115 patients with a first episode of paroxysmal atrial fibrillation of unknown origin who were included the FAP registry, which contains data from 11 district hospitals in Catalonia, Spain. All patients underwent comprehensive clinical, laboratory, electro-cardiographic and echocardiographic investigations at baseline and were followed up periodically every 6 months to identify the occurrence of new symptomatic episodes and their complications. Results. During a mean follow-up period of 912 (445) days, 32 (27.8%) patients experienced recurrence of atrial fibrillation. Those who experienced recurrence had a significantly higher left ventricular ejection fraction (P=.023) and smaller end-systolic volume (P<.001), and they were more likely to consume alcohol regularly (P=.013). Cox regression analysis confirmed that these variables had independent prognostic value. In contrast, the occurrence of syncope during the initial episode was associated with a lower likelihood of recurrence (P=.017). Conclusions. The risk of recurrence of idiopathic atrial fibrillation was high, and was enhanced by moderate alcohol consumption and increased left ventricular activity, probably of sympathetic origin. This trend was less marked in paroxysmal atrial fibrillation of vagal origin

[Predictive factors for readmission in heart failure patients]. / Morbimortalidad de los pacientes ingresados por insuficiencia cardíaca. Factores predictores de reingreso.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a prevalent and increasing disease and represents one of the main causes of hospital admission. It is associated with an important morbi-mortality and a high rate of readmission. The objective of this study was to know the clinical characteristics of admitted patients with HF and to detect any valuable prognosis factors. PATIENTS AND METHOD: Prospective study of admitted HF patients between May'99 and May'00. Readmission rate was evaluated six months later. RESULTS: 204 patients were included with an average age of 78 (9.9) years. 66% were women. Diabetes mellitus (DM) (36.4%) and chronic obstructive pulmonary disease (COPD) (23.4%) were the most outstanding associated pathologies. Ischemic heart disease (IHD) was the most frequent etiology in 33.4% cases. Mean time of admission was 10 days. 34% patients had systolic dysfunction (SD). Men with IHD presented a higher rate of SD (p < 0.001). Mortality was 12.4%, especially in COPD patients (p < 0.011). IECAs were prescribed in 71.2% in the SD group. Readmission rate at 6 months was about 43%. Patients with renal failure (p < 0.04) and those with a more impaired functional class (p < 0.02) displayed a higher readmission rate. CONCLUSIONS: Several clinical factors determine the morbi-mortality and prognosis including an older age, associated comorbility, type of cardiopathy and presence of systolic dysfunction. All these factors are detected at the time of hospital admission.

Morbimortalidad de los pacientes ingresados por insuficiencia cardíaca: factores predictores de reingreso / Predictive factors for readmission in heart failure patients

FUNDAMENTO Y OBJETIVO: La insuficiencia cardíaca (IC) es una enfermedad de prevalencia creciente que constituye una de las principales causas de hospitalización. Se asocia con una notable morbimortalidad y un elevado índice de reingreso. El objetivo de este estudio es conocer las características clínicas de los pacientes ingresados por IC y detectar factores con valor pronóstico en esta enfermedad. PACIENTES Y MÉTODO: Estudio prospectivo de los pacientes ingresados por IC entre mayo de 1999 y mayo de 2000. A los 6 meses se valoró la tasa de rehospitalización. RESULTADOS: Se incluyeron 204 pacientes con una edad media (DE) de 78 (9,9) años. El 66% eran mujeres. La diabetes (36,4%) y la enfermedad pulmonar obstructiva crónica (EPOC)(23,4%) fueron las enfermedades asociadas más destacadas. La cardiopatía isquémica (CI) fue la etiología más frecuente (33,4%). La estancia media fue de 10 días. Se detectó disfunción sistólica (DS) en el 34%. Los varones y la CI presentaron más DS (p < 0,001). La tasa de fallecimientos fue del 12,4%; los pacientes con EPOC presentaron mayor mortalidad (p < 0,011). Los inhibidores de la enzima conversiva de la angiotensina (IECA) se pautaron en el 71,2% en el grupo con DS. La tasa de reingreso a los 6 meses fue del 43%. Los pacientes con insuficiencia renal (p < 0,04), con IC previa (p < 0,02) y con clase funcional más deteriorada (p < 0,02) tuvieron mayor índice de reingreso. CONCLUSIONES: La edad avanzada, el sexo, la cormorbilidad asociada, el tipo de cardiopatía y la presencia de disfunción sistólica son factores clínicos que determinan el pronóstico de morbimortalidad. Todos ellos son detectables en el momento de la hospitalización

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a prevalent and increasing disease and represents one of the main causes of hospital admission. It is associated with an important morbimortality and a high rate of readmission. The objective of this study was to know the clinical characteristics of admitted patients with HF and to detect any valuable prognosis factors. PATIENTS AND METHOD: Prospective study of admitted HF patients between May’99 and May’00. Readmission rate was evaluated six months later. RESULTS: 204 patients were included with an average age of 78 (9.9) years. 66% were women. Diabetes mellitus (DM) (36.4%) and chronic obstructive pulmonary disease (COPD) (23.4%) were the most outstanding associated pathologies. Ischemic heart disease (IHD) was the most frequent etiology in 33.4% cases. Mean time of admission was 10 days. 34% patients had systolic dysfunction (SD). Men with IHD presented a higher rate of SD (p < 0.001). Mortality was 12.4%, especially in COPD patients (p < 0.011). IECAs were prescribed in 71.2% in the SD group. Readmission rate at 6 months was about 43%. Patients with renal failure (p < 0.04) and those with a more impaired functional class (p < 0.02) displayed a higher readmission rate. CONCLUSIONS: Several clinical factors determine the morbimortality and prognosis including an older age, associated comorbility, type of cardiopathy and presence of systolic dysfunction. All these factors are detected at the time of hospital admission

[Immediate and long-term outcome after angioplasty with stenting of the left main coronary artery]. / Resultados inmediatos y a largo plazo de la angioplastia con stent del tronco común.

INTRODUCTION AND OBJECTIVES: Coronary artery bypass graft surgery is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. The aim of the present study was to analyze the immediate and long-term results of angioplasty with stenting of the left main coronary artery, and to identify factors predictive of death. PATIENTS AND METHOD: A total of 38 nonconsecutive patients (mean age 69 [8] years) with a severe lesion in the left main coronary artery were treated with angioplasty and stenting between November 1997 and March 2003. The procedure was elective in 27 patients and urgent in the remaining 11. In 23 patients (60.5%) the left main coronary artery was not protected by aortocoronary bypass. All patients underwent clinical follow-up examination at 25 (20) months. RESULTS: Angiographically documented success was obtained in all patients. However, one patient died from acute occlusion one hour after the operation. Four patients (10%) had a non-Q-wave myocardial infarction. In-hospital mortality was 15.8% (6/38 patients). Five of the 11 patients (45.4%) who underwent emergency angioplasty and stenting died in the hospital from acute myocardial infarction complicated by severe (Killip grade III-IV) heart failure. However, only one of 27 patients (3.7%) in the elective surgery group died (P=.007). Major clinical cardiac events during follow-up occurred in 5 patients (13%); 3 died and the other 2 had recurrent angina. All patients who died had an unprotected left main coronary artery. Cumulative survival rates for the elective group were 92 (0.5)% at 6 months, 88 (0.6)% at 1 year and 86 (0.7)% at 3 years, respectively. For the emergency surgery group cumulative survival rate was 54 (0.2)% at 6 months (P<.05). CONCLUSIONS: Elective angioplasty and stenting of the left main coronary artery in selected patients was associated with a high immediate success rate. In patients who underwent elective angioplasty and stenting, the incidence of major cardiac events during follow-up was relatively low. Emergency angioplasty and signs of left ventricular dysfunction were the main predictors of in-hospital mortality.

[Usefulness of hand-held echocardiography in emergency room]. / Utilidad de un equipo de ecocardiografía portátil en un servicio de urgencias generales.

BACKGROUND AND OBJECTIVE: Handheld echocardiography may be a powerful diagnostic tool in the emergency room. However, its usefulness in this environment when it is performed by medical personnel with a basic training in echocardiography remains to be clarified. PATIENTS AND METHOD: A cardiologist with expertise in echocardiography and a cardiology fellow with basic training evaluated 33 patients admitted in emergency using a handheld device. RESULTS: The echocardiogram led to a change in the diagnosis and treatment in 27% and 46% of patients, respectively, allowing an early discharge in 49% of cases. The agreement between the two observers was acceptable. CONCLUSIONS: Portable echocardiography is a useful tool in emergency rooms and may be reliably performed by medical personnel with basic training in echocardiography.

Utilidad de un equipo de ecocardiografía portátil en un servicio de urgencias generales / Usefulness of hand-held echocardiography in emergency room

FUNDAMENTO Y OBJETIVO: La ecocardiografía con equipos portátiles se plantea como una potente herramienta diagnóstica del área de urgencias, aunque deben aclararse su utilidad en este entorno y su capacidad diagnóstica cuando es realizada por personal médico con entrenamiento ecocardiográfico básico. PACIENTES Y MÉTODO: Un ecocardiografista experto y un médico no cardiólogo con entrenamiento ecocardiográfico básico estudiaron a 33 pacientes de urgencias utilizando un ecocardiógrafo portátil. RESULTADOS: La concordancia interobservador fue aceptable y no existieron discrepancias relevantes que afectaran a la utilidad práctica del estudio. El ecocardiograma condujo al cambio del diagnóstico y del tratamiento en el 27 y el 46 por ciento de los pacientes, respectivamente, y facilitó el alta en el 49 por ciento de los casos. CONCLUSIONES: La ecocardiografía portátil es útil en urgencias y puede ser realizada de forma fiable por personal médico con entrenamiento ecocardiográfico básico (AU)