Mid-term outcomes of rapid deployment aortic prostheses in patients with small aortic annulus.

OBJECTIVES: The Edwards Intuity valve is a rapid deployment aortic prosthesis that favours less invasive approaches. However, evidence about the clinical behaviour of their smaller sizes is scarce. Herein, we studied haemodynamic behaviours and clinical outcomes of small Intuity prostheses (19-21 mm) in comparison to larger Intuity prostheses (>21 mm). METHODS: This is an observational study including patients implanted with an Edwards Intuity rapid deployment aortic prosthesis. Patients with prosthesis sizes 19-21 and >21 mm were included. Baseline and perioperative variables, as well as adverse events during the follow-up were recorded and compared between groups. RESULTS: A total of 122 patients (37% female, mean age 75 ± 4.5 years) were included, of whom 54 (45%) were implanted with a small prosthesis and 68 (55%) with a prosthesis >21 mm. There were no significant differences between patients with small Intuity prostheses and patients with larger prostheses regarding in-hospital mortality (2% vs 4%, P = 0.43) or mortality during the follow-up (3.41 vs 2.45 per 100 patients-years; P = 0.58). Survival in the small Intuity valve group was 95% at 1 year and 83% at 6 years, whereas in the larger Intuity valve group was 96% at 1 year and 78% at 6 years. The presence of a small prosthesis did not influence mid-term survival (log-rank P-value = 0.62). CONCLUSIONS: This study showed good clinical performance of Intuity aortic prostheses with appropriate mid-term survival in patients with the small aortic annulus. Thus, the Edwards Intuity rapid deployment aortic prosthesis may be considered as a potential option in patients with the small aortic annulus.

Rendimiento de un nuevo software para la cuantificación automática de trabeculaciones en el ventrículo izquierdo / Performance of a new software tool for automatic quantification of left ventricular trabeculations

No disponible

Síndrome de Erdheim-Chester con periaortitis / Erdheim-Chester syndrome with periaortitis

No disponible

[Influence of gender on the clinical characteristics and prognosis of patients hospitalized for heart failure]. / Influencia del sexo en el perfil clínico y pronóstico de la insuficiencia cardiaca tras el alta hospitalaria.

BACKGROUND AND OBJECTIVES: The natural history of heart failure (HF) may be different in women due to their clinical characteristics, treatment and prognosis being distinct. Our aim was to describe the differential characteristics of women hospitalized with HF. METHODS: We prospectively studied consecutive patients who were discharged with a diagnosis of HF (n=412). Clinical, laboratory, echocardiographic, and therapeutic variables were recorded at discharge. During follow-up (16 [9] months), all-cause mortality and the need for rehospitalization were recorded. RESULTS: Compared with men, women (n=157, 38%) were older (75 [12] years vs. 71 [18] years, P< .001), had a higher prevalence of arterial hypertension (71% vs. 51%, P< .001), had more frequently been previously hospitalized for HF (36% vs. 25%, P=.02), had a higher prevalence of HF with a preserved left ventricular ejection fraction (LVEF) (44% vs. 21%, P<001), had less coronary disease (34% vs. 49%, P=.007), had more hypertensive cardiomyopathy (17% vs. 8%, P=.006), had worse renal function (52 [25] vs. 58 [25] mL/min per 1.73m2, P=.002), and had lower hemoglobin levels (12.1 [1.7] vs. 12.9 [1.9] g/dL, P< .001). This clinical profile resulted in less use of coronary angiography (22% vs. 37%, P=.001), antiplatelet drugs (45% vs. 62%, P=.001), and beta-blockers (39% vs. 50%, P=.03). In addition, women received statin treatment less often (31% vs. 45%, P=.003). Nevertheless, mortality (23% vs. 18%, P=.26) and the rehospitalization rate (44% vs. 46%, P=.81) were similar. In women, age (hazard ratio [HR] = 1.05, 95% confidence interval [CI] 1.01-1.09; P=.036) and anemia (HR = 2.43, 95% CI 1.16-5.12; P=.015) were independent predictors of death. CONCLUSIONS: Women hospitalized for HF had a distinct clinical profile: their LVEF was greater and they more frequently had comorbid conditions. This led to different treatment, though prognosis was similar to that in men.

Influencia del sexo en el perfil clínico y pronóstico de la insuficiencia cardiaca tras el alta hospitalaria / Influence of gender on the clinical characteristics and prognosis of patients hospitalized for heart failure

Introducción y objetivos. La historia natural de la insuficiencia cardiaca puede ser distinta en mujeres, debido a su diferente perfil clínico, terapéutico y pronóstico. Nuestro objetivo fue definir las características diferenciales de mujeres hospitalizadas por insuficiencia cardiaca. Métodos. Estudiamos prospectivamente a los pacientes consecutivos dados de alta con el diagnóstico de insuficiencia cardiaca (n = 412). Al alta, se registraron las variables clínicas, analíticas, ecocardiográficas y terapéuticas. Durante el seguimiento (16 ± 9 meses) se registraron mortalidad y reingreso hospitalario. Resultados. Respecto a los varones, las mujeres (n = 157; 38%) presentaron: mayor edad (75 ± 12 y 71 ± 18 años; p < 0,001), hipertensión arterial (el 71 y el 51%; p < 0,001) e ingresos previos por insuficiencia cardiaca (el 36 y el 25%; p = 0,02); mayor prevalencia de fracción de eyección del ventrículo izquierdo (FEVI) preservada (el 44 y el 21%; p < 0,001); menor prevalencia de cardiopatía isquémica (el 34 y el 49%; p = 0,007) y mayor de hipertensiva (el 17 y el 8%; p = 0,006); peor función renal (52 ± 25 y 58 ± 25 ml/min/1,73 m2; p = 0,002) y menos hemoglobina (12,1 ± 1,7 y 12,9 ± 1,9; p < 0,001). Este perfil clínico conllevó menos coronariografías (el 22 y el 37%; p = 0,001), antiplaquetarios (el 45 y el 62%; p = 0,001) y bloqueadores beta (el 39 y el 50%; p = 0,03); el sexo femenino tiene relación con menos uso de estatinas (el 31 y el 45%; p = 0,003). Sin embargo, su mortalidad (el 23 contra el 18%; p = 0,26) y sus reingresos hospitalarios (el 44 y el 46%; p = 0,81) fueron similares. En mujeres, los predictores independientes de muerte fueron edad (p = 0,036; hazard ratio [HR] = 1,05 [1,01-1,09]) y anemia (p = 0,015; HR = 2,43 [1,16-5,12]). Conclusiones. Las mujeres hospitalizadas por insuficiencia cardiaca presentan un perfil clínico diferente, con FEVI más preservada y mayores comorbilidades, que conlleva un manejo terapéutico distinto. Su pronóstico es similar al de los varones (AU)

Background and objectives. The natural history of heart failure (HF) may be different in women due to their clinical characteristics, treatment and prognosis being distinct. Our aim was to describe the differential characteristics of women hospitalized with HF. Methods. We prospectively studied consecutive patients who were discharged with a diagnosis of HF (n=412). Clinical, laboratory, echocardiographic, and therapeutic variables were recorded at discharge. During follow-up (16 [9] months), all-cause mortality and the need for rehospitalization were recorded. Results. Compared with men, women (n=157, 38%) were older (75 [12] years vs. 71 [18] years, P<.001), had a higher prevalence of arterial hypertension (71% vs. 51%, P<.001), had more frequently been previously hospitalized for HF (36% vs. 25%, P=.02), had a higher prevalence of HF with a preserved left ventricular ejection fraction (LVEF) (44% vs. 21%, P<001), had less coronary disease (34% vs. 49%, P=.007), had more hypertensive cardiomyopathy (17% vs. 8%, P=.006), had worse renal function (52 [25] vs. 58 [25] mL/min per 1.73m2, P=.002), and had lower hemoglobin levels (12.1 [1.7] vs. 12.9 [1.9] g/dL, P<.001). This clinical profile resulted in less use of coronary angiography (22% vs. 37%, P=.001), antiplatelet drugs (45% vs. 62%, P=.001), and beta-blockers (39% vs. 50%, P=.03). In addition, women received statin treatment less often (31% vs. 45%, P=.003). Nevertheless, mortality (23% vs. 18%, P=.26) and the rehospitalization rate (44% vs. 46%, P=.81) were similar. In women, age (hazard ratio [HR] = 1.05, 95% confidence interval [CI] 1.01­1.09; P=.036) and anemia (HR = 2.43, 95% CI 1.16­5.12; P=.015) were independent predictors of death. Conclusions. Women hospitalized for HF had a distinct clinical profile: their LVEF was greater and they more frequently had comorbid conditions. This led to different treatment, though prognosis was similar to that in men (AU)

[Impact of primary angioplasty on the indication for implantable cardiac defibrillator in patients with myocardial infarction]. / Impacto de la angioplastia primaria en la indicación de desfibrilador implantable en pacientes con infarto de miocardio.

INTRODUCTION AND OBJECTIVES: Implantable cardiac defibrillators (ICD) have been shown to improve survival in patients with myocardial infarctionand LVEF < 0.30 or LVEF < 0.40 + nonsustained ventricular tachycardia + inducible sustained arrhythmias. However, these risk stratification criteria have not been evaluated in patients who are candidates for primary percutaneous transluminal coronary angioplasty (PTCA). The objective of this study was to assess the impact of both strategies on the indication for ICD in a consecutive series of post-infarction patients treated with primary PTCA. PATIENTS AND METHOD: One hundred and two consecutive patients with myocardial infarction (80 men, mean age 63.6 11.5 years) included in a single-center-based regional program of primary PTCA were included in the study. A 24-h continuous ECG recording was obtained 2 to 6 weeks after the acute event, and LVEF was determined by 2D-echocardiography one month after the infarct. Patients with nonsustained ventricular tachycardia and LVEF < 0.40 underwent programmed ventricular stimulation using a standard protocol. RESULTS: Twenty-two patients (21.6%; 95% CI, 13.6-29.6) showed at least one episode of nonsustained ventricular tachycardia in the 24 h recording. Six of them had LVEF < or = 0.40, and sustained ventricular arrhythmia was induced in 2 out of 5. LVEF < or = 0.30 was found in 3 patients, none of whom had nonsustained ventricular tachycardia. Thus, 5 patients had an indication for ICD according to either of the two risk stratification criteria. CONCLUSIONS: The prevalence of nonsustained ventricular tachycardia in post-infarction patients treated with primary PTCA is high. However, because most of them have preserved ventricular function, primary prevention with an ICD is indicated in approximately 5% of the population.

Impacto de la angioplastia primaria en la indicación de desfibrilador implantable en pacientes con infarto de miocardio / Impact of primary angioplasty on the indication for implantable cardiac defibrillator in patients with myocardial infarction

Introducción y objetivos. El desfibrilador implantable mejora la supervivencia en pacientes postinfarto de miocardio con a) fracción de eyección <= 0,30 y b) fracción de eyección <= 0,40, taquicardias ventriculares no sostenidas y arritmias ventriculares inducibles. Estos criterios no han sido evaluados en el contexto de la angioplastia primaria. El objetivo del estudio es evaluar el impacto de ambos criterios en las indicaciones de desfibrilador en pacientes con infarto revascularizados con angioplastia primaria. Pacientes y método. Se estudió a 102 pacientes postinfarto (80 varones; edad, 63,6 ñ 11,5 años) incluidos en un programa regional de angioplastia primaria. Se realizó un registro Holter de 24 h entre las semanas 2 y 6 postinfarto, al mes, y se estimó la fracción de eyección por ecocardiografía practicando estimulación ventricular programada en el grupo con fracción de eyección <= 0,40 y taquicardia ventricular no sostenida. Resultados. Un total de 22 pacientes (21,6 por ciento; intervalo de confianza [IC] del 95 por ciento, 13,6-29,6) presentaron taquicardia ventricular no sostenida en el Holter. Seis de ellos tuvieron fracción de eyección <= 0,40, siendo inducibles 2 de 5 en el estudio electrofisiológico. La fracción de eyección fue <= 0,30 en 3 pacientes, ninguno de los cuales presentó taquicardia ventricular no sostenida. En total, 5 pacientes (4,9 por ciento) tuvieron indicación de desfibrilador aplicando alguno de los 2 criterios. Conclusiones. La prevalencia de taquicardia ventricular no sostenida en pacientes con infarto tratados con angioplastia primaria es elevada. Sin embargo, la mayoría tiene una función ventricular conservada, por lo que la prevención primaria con desfibrilador estaría indicada en un 5 por ciento aproximadamente utilizando los criterios evaluados en este estudio (AU)