Empiema por Aspergillus fumigatus en pacientes con trasplante cardiaco / Aspergillus fumigatus empyema in heart transplant recipients

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Two-Dimensional Speckle Tracking Echocardiography in Heart Transplant Patients: Two-Year Follow-Up of Right and Left Ventricular Function.

BACKGROUND: Evolution of left and right ventricular (LV and RV) function after heart transplantation (HT) has not been well described. Our objective was to evaluate the evolution of echocardiographic parameters of both ventricles along the first 2 years after HT. METHODS: We followed 31 HT recipients with serial echocardiograms for up to 2 years. Echocardiograms with AR ≥2R were excluded. We analyzed LV global longitudinal strain (LV GLS) by speckle tracking in 12 segments in four- and two-chamber views and RV global longitudinal strain (RV GLS) in four-chamber view. Control group included 25 healthy volunteers. RESULTS: Even though LVEF was preserved, LV GLS was reduced early post-HT (-17.7 ± 3.0 in HT vs. -20.7 ± 2.8 in controls, P = 0.02), improving progressively until its complete normalization 2 years after HT (-20.0 ± 3.7 vs. -20.7 ± 2.8, P = 0.60). TAPSE was impaired in the early post-HT period and increased progressively (11.9 ± 2.9 mm at baseline vs. 19.0 ± 3.6 mm at 2 years, P < 0.001). RV GLS rose during follow-up as well (-17.4 ± 3.5 at baseline vs. -22.6 ± 3.3 at 2 years, P = 0.001), reaching normal values 1 year after HT. CONCLUSION: In this series of HT recipients with uneventful postoperative course, LV and RV GLS values were significantly reduced early after HT and improved progressively until their complete normalization two and 1 year after HT, respectively. This is the first study to show a full recovery of LV and RV deformation parameters and offers "normal" strain values that, if confirmed in larger studies, could be useful for monitoring the evolution of HT recipients.

Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años / Epidemiology of heart failure in Spain over the last 20 years

La insuficiencia cardiaca en un problema sanitario de primer orden en nuestro país, aunque no disponemos de cifras que permitan dimensionar su impacto con exactitud por falta de estudios con diseño apropiado. Frente a una prevalencia de insuficiencia cardiaca del 2% en otros países europeos y en Estados Unidos, los estudios en España arrojan cifras del 5%, probablemente a causa de sus limitaciones metodológicas. La insuficiencia cardiaca consume enormes recursos sanitarios: es la primera causa de hospitalización de mayores de 65 años y representa el 3% de todos los ingresos hospitalarios y el 2,5% del coste de la asistencia sanitaria. Hay dos patrones de insuficiencia cardiaca, uno con función sistólica preservada, más asociado a la hipertensión, y otro con función deprimida, más relacionado con la cardiopatía isquémica. En 2010, la insuficiencia cardiaca constituyó el 3% del total de defunciones de varones y el 10% de las de mujeres. La tasa de mortalidad por insuficiencia cardiaca ha ido reduciéndose en los últimos años. Los cambios temporales en la codificación diagnóstica podrían explicar parte del aumento en los ingresos hospitalarios y del descenso en la mortalidad por insuficiencia cardiaca, aunque hay indicios de que la adherencia a las guías de práctica clínica puede haber reducido su mortalidad (AU)

Heart failure is a major health care problem in Spain, although its precise impact is unknown due to the lack of data from appropriately designed studies. In contrast with the 2% prevalence of heart failure elsewhere in Europe and in the United States, studies in Spain report figures of 5%, probably because of methodological limitations. Heart failure consumes enormous quantities of health care resources; it is the first cause of hospitalization in persons aged 65 years or older and represents 3% of all hospital admissions and 2.5% of health care costs. There are two patterns of heart failure: one with preserved systolic function, more often associated with high blood pressure, and another with depressed systolic function, more often associated with ischemic heart disease. In 2010, heart failure accounted for 3% of all deaths in men and for 10% of all deaths in women. In recent years, the mortality rate from heart failure has gradually fallen. The rise in hospital admissions for heart failure and the decrease in mortality from this cause could partly be explained by temporary changes in diagnostic coding, but there is evidence that the reduced mortality could also be due to adherence to clinical practice guidelines (AU)

Epidemiology of heart failure in Spain over the last 20 years.

Heart failure is a major health care problem in Spain, although its precise impact is unknown due to the lack of data from appropriately designed studies. In contrast with the 2% prevalence of heart failure elsewhere in Europe and in the United States, studies in Spain report figures of 5%, probably because of methodological limitations. Heart failure consumes enormous quantities of health care resources; it is the first cause of hospitalization in persons aged 65 years or older and represents 3% of all hospital admissions and 2.5% of health care costs. There are two patterns of heart failure: one with preserved systolic function, more often associated with high blood pressure, and another with depressed systolic function, more often associated with ischemic heart disease. In 2010, heart failure accounted for 3% of all deaths in men and for 10% of all deaths in women. In recent years, the mortality rate from heart failure has gradually fallen. The rise in hospital admissions for heart failure and the decrease in mortality from this cause could partly be explained by temporary changes in diagnostic coding, but there is evidence that the reduced mortality could also be due to adherence to clinical practice guidelines.