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(1) Background: The validation of new lines of therapy for the elderly is required due to the progressive ageing of the world population and scarce evidence in elderly patients with HF with reduced ejection fraction (HFrEF). The purpose of our study is to analyze the effect of SGLT2 inhibitors (SGLT2i) in this subgroup of patients. (2) Methods: A single-center, real-world observational study was performed. We consecutively enrolled all patients aged ≥ 75 years diagnosed with HFrEF and for treatment with SGLT2i, and considered the theoretical indications. (3) Results: A total of 364 patients were recruited, with a mean age of 84.1 years. At inclusion, the mean LVEF was 29.8%. Median follow-up was 33 months, and there were 122 deaths. A total of 55 patients were under SGLT2i treatment. A multivariate Cox logistic regression test for all-cause mortality was performed, and only SGLT2i (HR 0.39 [0.19-0.82]) and glomerular filtration rate (HR 0.98 [0.98-0.99]) proved to be protective factors. In parallel, we conducted a propensity-score-matched analysis, where a significant reduction in all-cause mortality was associated with the use of SGLT2i treatment (HR 0.39, [0.16-0.97]). (4) Conclusions: Treatment with SGLT2i in elderly patients with HFrEF was associated with a lower rate of all-cause mortality. Our data show that SGLT2i therapy could improve prognosis in the elderly with HFrEF in a real-world study.
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BACKGROUND: Clinical management of cardiac resynchronization therapy (CRT) non-responders is difficult, and their prognosis is poor. The aim of the present study was to evaluate whether treatment with sacubitril/valsartan can improve quality of life (QoL) parameters in these patients. METHODS: Thirty five non-responders to CRT were included (75 ± 7 years, 28% females, mean left ventricular ejection fraction 28 ± 8%, 54% non-ischemic cardiomyopathy) with maximally optimized drug therapy and New York Heart Association class II-III. They were all on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and were switched to sacubitril/valsartan. One week before and 6 months after initiation of the therapy they completed both the Minnesota Living with Heart Failure (MLWHF) and the 12-item Kansas City Cardiomyopathy Questionnaires (KCCQ-12). The primary outcome was the effect of sacubitril/valsartan on the physical, clinical, social and emotional QoL parameters and number of hospitalizations. RESULTS: The mean total scores of both questionnaires improved from baseline to the follow-up visit at 6-months (KCCQ-12 40 ± 10 to 47 ± 10; p < 0.001; MLWHF 40 ± 15 to 29 ± 15; p < 0.001). The best results were seen in the KCCQ-12 total symptom domains (77% improvement), the MLWHF physical domain (81% improvement), and the MLWHF emotional domain (71% improvement). Two patients died during follow-up. The mean number of hospitalizations reduced significantly (1 ± 0.6 vs. 0.5 ± 0.8; p = 0.003) CONCLUSIONS: In CRT non-responders, sacubitril/valsartan significantly improved overall QoL, physical limitations and emotional domains and reduced the number of hospitalizations.
Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Angiotensinas , Compostos de Bifenilo , Combinação de Medicamentos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Neprilisina , Qualidade de Vida , Sistema de Registros , Volume Sistólico , Tetrazóis/uso terapêutico , Resultado do Tratamento , Valsartana , Função Ventricular EsquerdaRESUMO
BACKGROUND: Superior vena cava (SVC) isolation with radiofrequency energy remains a challenge due to potential side effects, especially phrenic nerve (PN) or sinus node injury. The purpose of this study was to evaluate the feasibility of a novel SVC isolation technique using the third-generation cryoballoon (CB3). METHODS: Patients undergoing atrial fibrillation (AF) ablation were prospectively included. The procedure was performed with the CB3, beginning with the pulmonary veins and ending with SVC isolation. During applications in the SVC, continuous PN capture and sinus rate were monitored. Once reached SVC isolation during the application, 60 s more was applied, with no bonus application. If after 90 s the SVC was not isolated, application was stopped. A maximum number of four applications were permitted. RESULTS: Thirty patients (62 ± 9 years; 74% male, 78% paroxysmal AF) were included. No SVC activity was observed in two patients. Success rate for SVC isolation was 89%. Mean number of applications per patient was 2.3 ± 1. Mean time to SVC isolation was 37 ± 20 s. Mean duration of application was 92 ± 15 s. Mean total time of procedure for SVC isolation was 218 ± 43 s. We recorded only two complications: one transient PN palsy and one short and transient sinus arrest. After a mean follow-up of 5 ± 2 months, 89% are free from arrhythmia recurrence. CONCLUSIONS: We present a promising simple SVC-isolation technique using CB3, featuring a high success rate and very low incidence of complications.
Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Veia Cava Superior/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgiaRESUMO
Atrial fibrillation (AF) causes a substantial proportion of embolic strokes of undeterminded source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least 1 week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2 ± 1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (p <0.05). Patients with SCAF were older (77 ± 9 vs 67 ± 11 years, p <0.05), with a higher rate of left atrial enlargement (50% vs 20%, p<0.05), renal impairment (28% vs 5%; p<0.01), and a slower mean heart rate (55 ± 6 vs 70 ± 6 beats/min; p<0.001). On multivariate analysis, the presence of persistent bradycardia (≤60 beats/min) in the 21-day Holter was a powerful and significant risk factor for SCAF. In conclusion, the sooner 21-day Holter electrocardiogram monitoring is initiated after ESUS, the more likely SCAF can be detected. Sinus bradycardia is a powerful predictor of SCAF in patients with ESUS.
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Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Embolia Intracraniana/etiologia , Sistema de Registros , Idoso , Fibrilação Atrial/complicações , Feminino , Seguimentos , Humanos , Incidência , Embolia Intracraniana/epidemiologia , Masculino , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de TempoAssuntos
Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Gamopatia Monoclonal de Significância Indeterminada/complicações , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Marca-Passo ArtificialAssuntos
Falso Aneurisma/diagnóstico , Coração , Diagnóstico Diferencial , Dispneia , Ecocardiografia , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural , Taquicardia , Trombose/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Since the Spanish Society of Cardiology Clinical Practice Guidelines on Unstable Angina/Non-Q-Wave Myocardial Infarction were released in 1999, the conclusions of several studies that have been published make it advisable to update current clinical recommendations. The main findings are related to the developing role of Chest Pain Units in the management and early risk stratification of acute coronary syndromes in the emergency department; new information concerning the efficacy of glycoprotein IIb/IIIa inhibitors, clopidogrel and low-molecular-weight heparins in the pharmacological treatment of acute coronary syndromes without ST-segment elevation; and the role of early invasive strategy in improving the prognosis of these patients. The published evidence is reviewed and the corresponding clinical recommendations for the management of acute coronary syndromes without persistent ST-segment elevation are updated.
Assuntos
Angina Instável/terapia , Eletrocardiografia , Infarto do Miocárdio/terapia , Angina Instável/diagnóstico , Angina Instável/tratamento farmacológico , Dor no Peito , Clopidogrel , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Medição de Risco , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêuticoRESUMO
Desde la elaboración de las Guías de Práctica Clínica sobre angina inestable/infarto agudo de miocardio sin onda Q de la SEC en 1999, se han publicado numerosos trabajos cuyas conclusiones hacen recomendable modificar las recomendaciones vigentes hasta la fecha. Los hallazgos más importantes están relacionados con el papel emergente de las Unidades de Dolor Torácico en el manejo y la estratificación inicial de los síndromes coronarios agudos en las unidades de urgencias, los nuevos descubrimientos sobre la eficacia de los inhibidores de la glucoproteína IIb/IIIa, el clopidogrel y las heparinas de bajo peso molecular en el tratamiento farmacológico del síndrome coronario agudo sin elevación del segmento ST y el papel de la estrategia invasiva precoz para mejorar el pronóstico de estos pacientes.En este documento se revisan las evidencias publicadas en estos campos y se actualizan las recomendaciones correspondientes en el manejo de los pacientes con síndrome coronario agudo sin elevación persistente del segmento ST (AU)
Assuntos
Humanos , Eletrocardiografia , Ticlopidina , Medição de Risco , Infarto do Miocárdio , Inibidores da Agregação Plaquetária , Dor no Peito , Angina Instável , Heparina de Baixo Peso MolecularRESUMO
Este trabajo representa la actualización, por parte de la Sección de Cardiopatía Isquémica y Unidades Coronarias de la Sociedad Española de Cardiología, de las Guías de Actuación Clínica para el manejo de la Angina Inestable y del Infarto sin elevación del segmento ST. Además de las normas habituales referidas al manejo del enfermo ingresado, se ha considerado necesario ampliar estas recomendaciones al manejo extrahospitalario y en el área de urgencias, tanto porque es la fase de máxima mortalidad, como por la efectividad que un manejo adecuado tiene precisamente en esa fase inicial. La conducta en el área extrahospitalaria ante un enfermo con dolor torácico sospechoso de isquemia miocárdica debe centrarse en el traslado rápido al centro hospitalario, realización de ECG, y la administración de nitroglicerina sublingual y aspirina. El manejo en el área de urgencias se basa en la atención clínica inmediata y monitorización, así como acceso al desfibrilador. El trazado ECG determina, habitualmente en este entorno, la aplicación de un protocolo determinado de tratamiento. Si existe elevación del segmento ST debe organizarse el tratamiento de reperfusión en el menor tiempo posible (véanse Guías de infarto agudo de mioacrdio). Si no existe elevación del ST, debe valorarse primero la probabilidad de isquemia coronaria y seguidamente la estratificación de riesgo, que son esenciales para un adecuado manejo. En estas guías se propone una nueva estratificación de riesgo simplificada, que entre otras cosas determina el lugar adecuado de ingreso: ingreso en unidad coronaria, si existen factores de riesgo elevado o modificadores de riesgo; por el contrario, si existe estabilidad clínica y factores pronósticos de riesgo intermedio, ingreso en el área de hospitalización. En los casos de riesgo ligero se recomienda el tratamiento ambulatorio Manejo en la unidad coronaria. Se describen las medidas generales (monitorización, analgesia). En el tratamiento antitrombótico se añade a la antiagregación con ácido acetilsalicílico, las indicaciones de los nuevos antiplaquetarios y a la administración de heparina i.v., las heparinas de bajo peso molecular y los inhibidores directos de la trombina. El tratamiento antiisquémico se basa en: nitroglicerina i.v., betabloqueantes y antagonistas del calcio. Actualmente, el manejo de las complicaciones (angina refractaria, disfunción del ventrículo izquierdo, insuficiencia mitral, progresión a infarto agudo de miocardio, etc.) implica la indicación de coronariografía. Cuando el sustrato anatómico lo permite, la revascularización en la angina inestable, debe contemplar la intervención percutánea sobre la arteria responsable como primera opción. La utilización de stents y anti IIb-IIIa han mejorado el resultado de esta intervención. Manejo en la planta de hospitalización. En esta fase debe realizarse la instauración de tratamiento médico de mantenimiento y la estratificación de riesgo con pruebas funcionales, que pueden indicar la necesidad de coronariografía antes del alta para valorar la revascularizacion. El diseño de la estrategia en prevención secundaria debe realizarse en colaboración con asistencia primaria (AU)