Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF).

BACKGROUND: Different variables are playing a role in prognosis of acute heart failure. OBJECTIVES: Our purpose was to create and validate a risk score to predict mortality in patients with a first episode of acute heart failure during the first 2 months after the first hospitalization. DESIGN: This was a prospective cohort study. PARTICIPANTS: We recruited patients diagnosed with a first episode of acute heart failure. MAIN MEASURES: We collected data on sociodemographic characteristics; medical history; symptoms; precipitating factors; signs and symptoms of congestion; echocardiographic parameters; aetiology; vital signs and laboratory findings; and response to initial treatment (yes/no). A Cox proportional hazard regression model was built with mortality during the first 2 months after the index episode as the dependent variable. A risk score is presented. KEY RESULTS: The mortality rate during the first 2 months after a first episode of heart failure was 5%. Age, systolic blood pressure, serum sodium, ejection fraction and blood urea nitrogen were selected in the internal validation, as was right ventricular failure. A risk score was developed. Both the model and the score showed good discrimination and calibration properties when applied to an independent cohort. CONCLUSIONS: Our ESSIC-FEHF risk score showed excellent properties in the derivation cohort and also in a cohort from a different time period. This score is expected to help decision making in patients diagnosed with heart failure for the first time.

Creation and validation of the acute heart failure risk score: AHFRS.

Our aims were to create and validate a clinical decision rule to assess severity in acute heart failure. We conducted a prospective cohort study of patients with symptoms of acute heart failure who attended the emergency departments (EDs) of three hospitals between April 2011 and April 2013. The following data were collected on arrival to or during the stay in the ED: baseline severity of symptoms; presence of decompensated comorbidities; number of hospital admissions/visits to EDs for acute heart failure during the previous 24 months; triggers of the exacerbation; clinical signs and symptoms; results of ancillary tests requested in the ED; treatments prescribed; and response to the initial treatment in the ED. The main outcome was poor course during the acute phase, in-hospital for admitted patients and during the first week following the ED visit for discharged patients, this being a composite endpoint that included death, admission to an intensive care unit, need for invasive mechanical ventilation, cardiac arrest and use of non-invasive mechanical ventilation. Multivariate logistic regression models were developed. Predictors of poor course in acute heart failure were oedema on chest radiography, visits to the ED and/or admissions in the previous two years, and levels of glycemia and blood urea nitrogen (areas under the curve of 0.83 in the derivation sample, and 0.82 in the validation sample). Four clinical predictors available in the ED can be used to create a simple score to predict poor course in acute heart failure.Clinical Trials.gov ID: NCT02437058.

Angiomixoma agresivo de pelvis con afectación cardiaca / Aggressive angiomyxoma of the pelvis with cardiac involvement

No disponible

[Diagnosis of acute myocarditis by contrast-enhanced cardiac magnetic resonance imaging]. / Diagnóstico de miocarditis aguda por cardiorresonancia magnética con contraste.

Myocarditis is defined as an inflammatory process of the heart muscle. The symptoms are often nonspecific, and it can mimic acute coronary syndrome. Although the majority of patients recover fully, in some cases myocarditis can lead to dilated cardiomyopathy and even death. Available diagnostic tools are unsatisfactory and there is a need to develop noninvasive techniques that can aid diagnosis, prognosis, and follow-up. Contrast-enhanced magnetic resonance imaging is a valuable tool for the evaluation of inflammatory heart diseases such as myocarditis. We describe a 39-year-old man presenting in the emergency department with chest pain, ST segment elevation and elevated cardiac enzymes, who was treated initially with thrombolysis. Coronary angiography showed normal coronary arteries. Magnetic resonance imaging showed focally delayed uptake of gadolinium with a patchy pattern typical of myocarditis.

Diagnóstico de miocarditis aguda por cardiorresonancia magnética con contraste / Diagnosis of acute myocarditis by contrast-enhanced cardiac magnetic resonance imaging

La miocarditis es un proceso inflamatorio del músculo cardíaco. Los síntomas suelen ser inespecíficos y pueden simular un síndrome coronario agudo. Si bien la mayoría de los pacientes presentan una recuperación completa, en ocasiones puede desarrollarse una miocardiopatía dilatada e incluso la muerte. Las técnicas diagnósticas disponibles no son satisfactorias y es necesario desarrollar técnicas no invasivas que puedan garantizar un diagnóstico, pronóstico y seguimiento. La resonancia magnética con realce tardío de contraste es una herramienta útil para la valoración de un proceso inflamatorio cardíaco como la miocarditis. Presentamos el caso de un varón de 39 años con dolor torácico, elevación del segmento ST e incremento de marcadores de daño miocárdico tratado inicialmente con trombólisis. La coronariografía mostró unas arterias coronarias angiográficamente normales. El estudio con resonancia magnética mostró captación focal tardía de gadolinio con patrón parcheado típico de miocarditis

Myocarditis is defined as an inflammatory process of the heart muscle. The symptoms are often nonspecific, and it can mimic acute coronary syndrome. Although the majority of patients recover fully, in some cases myocarditis can lead to dilated cardiomyopathy and even death. Available diagnostic tools are unsatisfactory and there is a need to develop noninvasive techniques that can aid diagnosis, prognosis, and follow-up. Contrast-enhanced magnetic resonance imaging is a valuable tool for the evaluation of inflammatory heart diseases such as myocarditis. We describe a 39-year-old man presenting in the emergency department with chest pain, ST segment elevation and elevated cardiac enzymes, who was treated initially with thrombolysis. Coronary angiography showed normal coronary arteries. Magnetic resonance imaging showed focally delayed uptake of gadolinium with a patchy pattern typical of myocarditis