Hospitalizaciones y eventos por insuficiencia cardiaca sistólica y diastólica en España entre 2016 y 2019. Un estudio de base poblacional / Hospital admissions and outcomes for systolic and diastolic heart failure in Spain between 2016 and 2019: A population-based study

Antecedentes y objetivos: En España carecemos de datos poblacionales de hospitalizaciones por insuficiencia cardiaca (IC) según sea sistólica o diastólica. Analizamos las diferencias clínicas, en mortalidad intrahospitalaria y reingresos de causa cardiovascular a los 30 días entre ambos tipos. Métodos: Estudio observacional retrospectivo de pacientes dados de alta con el diagnóstico principal de IC de los hospitales del Sistema Nacional de Salud entre 2016 y 2019, distinguiendo entre IC sistólica y diastólica. La fuente de datos fue el conjunto mínimo básico de datos del Ministerio de Sanidad. Se calcularon las razones de mortalidad intrahospitalaria y de reingreso a los 30 días estandarizadas por riesgo usando sendos modelos de regresión logística multinivel de ajuste de riesgo. Resultados: Se seleccionaron 190.200 episodios de IC. De ellos, 163.727 (86,1%) fueron por IC diastólica y se caracterizaron por presentar mayor edad, mayor proporción de mujeres, de diabetes y de insuficiencia renal que los de IC sistólica. Según los modelos de ajuste de riesgo la IC diastólica, frente a la sistólica, se comportó como un factor protector de mortalidad intrahospitalaria (odds ratio [OR]: 0,79; intervalo de confianza del 95% [IC 95%]: 0,75-0,83; p<0,001) y de reingreso de causa cardiovascular a los 30 días (OR: 0,93; IC 95%: 0,88-0,97; p0,002). Conclusiones: En España, entre 2016 y 2019, los episodios de hospitalización por IC fueron mayoritariamente por IC diastólica. Según los modelos de ajuste de riesgo la IC diastólica, con respecto a la sistólica, fue un factor protector de mortalidad intrahospitalaria y de reingreso de causa cardiovascular a los 30 días.(AU)

Background and purpose: In Spain there is a lack of population data that specifically compare hospitalization for systolic and diastolic heart failure (HF). We assessed clinical characteristics, in-hospital mortality and 30-day cardiovascular readmission rates differentiating by HF type. Methods: We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System’ acute hospital during 2016-2019, distinguishing between systolic and diastolic HF. The source of the data was the Minimum Basic Data Set. The risk-standardized in-hospital mortality ratio and risk-standardized 30-day cardiovascular readmission ratio were calculated using multilevel risk adjustment models. Results: The 190,200 episodes of HF were selected. Of these, 163,727 (86.1%) were classified as diastolic HF and were characterized by older age, higher proportion of women, diabetes mellitus, dementia and renal failure than those with systolic HF. In the multilevel risk adjustment models, diastolic HF was a protective factor for both in-hospital mortality (odds ratio [OR]: 0.79; 95% confidence interval [CI]: 0.75-0.83; P<.001) and 30-day cardiovascular readmission versus systolic HF (OR: 0.93; 95% CI: 0.88-0.97; P=.002). Conclusions: In Spain, between 2016 and 2019, hospitalization episodes for HF were mostly due to diastolic HF. According to the multilevel risk adjustment models, diastolic HF compared to systolic HF was a protective factor for both in-hospital mortality and 30-day cardiovascular readmission.(AU)

Towards the personalization of septic shock resuscitation: the fundamentals of ANDROMEDA-SHOCK-2 trial.

Septic shock is a highly lethal and prevalent disease. Progressive circulatory dysfunction leads to tissue hypoperfusion and hypoxia, eventually evolving to multiorgan dysfunction and death. Prompt resuscitation may revert these pathogenic mechanisms, restoring oxygen delivery and organ function. High heterogeneity exists among the determinants of circulatory dysfunction in septic shock, and current algorithms provide a stepwise and standardized approach to conduct resuscitation. This review provides the pathophysiological and clinical rationale behind ANDROMEDA-SHOCK-2, an ongoing multicenter randomized controlled trial that aims to compare a personalized resuscitation strategy based on clinical phenotyping and peripheral perfusion assessment, versus standard of care, in early septic shock resuscitation.

Diastolic function assessment with left atrial strain in long-term survivors of childhood acute lymphoblastic leukemia.

INTRODUCTION AND OBJECTIVES: Survivors of childhood cancer might be at increased risk of diastolic dysfunction at follow-up due to exposure to cardiotoxic treatment. Although assessment of diastolic function is challenging in this relatively young population, left atrial strain might provide a novel insight in this evaluation. Our aim was to examine diastolic function in a cohort of long-term survivors of childhood acute lymphoblastic leukemia by using left atrial strain and conventional echocardiographic parameters. METHODS: Long-term survivors who were diagnosed at a single center between 1985 and 2015 and a control group of healthy siblings were recruited. Conventional diastolic function parameters and atrial strain were compared, and the latter was measured during the 3 atrial phases: reservoir (PALS), conduit (LACS) and contraction (PACS). Inverse probability of treatment weighting was used to account for differences between the groups. RESULTS: We analyzed 90 survivors (age, 24.6±9.7 years, time since diagnosis 18 [11-26] years) and 58 controls. PALS and LACS were significantly reduced compared with the control group: 46.4±11.2 vs 52.1±11.7; P=.003 and 32.5±8.8 vs 38.2±9.3; P=.003, respectively. Conventional diastolic parameters and PACS were similar between the groups. The reductions in PALS and LACS were associated with exposure to cardiotoxic treatment in age- and sex-adjusted analysis (≥ moderate risk, low risk, controls): 45.4±10.5, 49.5±12.9, 52.1±11.7; Padj=.003, and 31.7±9.0, 35.2±7.5, 38.2±9.3; Padj=.001, respectively. CONCLUSIONS: Long-term childhood leukemia survivors showed a subtle impairment of diastolic function that was detected with atrial strain but not with conventional measurements. This impairment was more pronounced in those with higher exposure to cardiotoxic treatment.

[Hospital admissions and outcomes for systolic and diastolic heart failure in Spain between 2016 and 2019: A population-based study]. / Hospitalizaciones y eventos por insuficiencia cardiaca sistólica y diastólica en España entre 2016 y 2019. Un estudio de base poblacional.

BACKGROUND AND PURPOSE: In Spain there is a lack of population data that specifically compare hospitalization for systolic and diastolic heart failure (HF). We assessed clinical characteristics, in-hospital mortality and 30-day cardiovascular readmission rates differentiating by HF type. METHODS: We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospital during 2016-2019, distinguishing between systolic and diastolic HF. The source of the data was the Minimum Basic Data Set. The risk-standardized in-hospital mortality ratio and risk-standardized 30-day cardiovascular readmission ratio were calculated using multilevel risk adjustment models. RESULTS: The 190,200 episodes of HF were selected. Of these, 163,727 (86.1%) were classified as diastolic HF and were characterized by older age, higher proportion of women, diabetes mellitus, dementia and renal failure than those with systolic HF. In the multilevel risk adjustment models, diastolic HF was a protective factor for both in-hospital mortality (odds ratio [OR]: 0.79; 95% confidence interval [CI]: 0.75-0.83; P<.001) and 30-day cardiovascular readmission versus systolic HF (OR: 0.93; 95% CI: 0.88-0.97; P=.002). CONCLUSIONS: In Spain, between 2016 and 2019, hospitalization episodes for HF were mostly due to diastolic HF. According to the multilevel risk adjustment models, diastolic HF compared to systolic HF was a protective factor for both in-hospital mortality and 30-day cardiovascular readmission.

Association between diastolic dysfunction and fluid balance in critically ill patients during weaning from mechanical ventilation / Asociación entre la disfunción diastólica y el balance de hídrico en pacientes críticos durante el destete de la ventilación mecánica

Objective: To assess the role of diastolic dysfunction and fluid balance in weaning failure. Design: Prospective, observational, single center. Setting: Intensive care unit of a university hospital. Patients: Adult patients on mechanical ventilation for more than 48 h who underwent a spontaneous breathing trial (SBT). Interventions: Echocardiography was performed immediately before and at the end of SBT. Patients were classified into two groups according to weaning outcome. Main variable of interest: Weaning failure. Results: Among 89 patients included, weaning failure occurred in 33 patients (37%). Isolated diastolic dysfunction at the end of the SBT was more frequent in the failure group (39.3% vs. 17.8%, p = 0.025). Average daily fluid balance from ICU admission until first SBT was less negative in patients who failed than in those who succeed in the weaning (−648 mL [−884 to -138] vs. −893 mL [−1284 to −501], p = 0.007). Average daily fluid balance from the first SBT until the ICU discharge was more negative in the weaning failure than in the success group (−973 mL [−1493 to −201] vs. −425 mL [−1065 to 12], p = 0.034). Cox regression analysis showed that diastolic dysfunction was not an independent factor related to weaning failure but needed the association of positive fluid balance and age. Conclusions: Weaning failure due to diastolic dysfunction is highly related to fluid balance, and the deleterious effect of fluid balance on diastolic function is associated with age The timing of fluid removal could play a key role in this scenario. (AU)

Objetivo: Evaluar el papel de la disfunción diastólica (DD) y el balance hídrico en el fracaso del destete de la ventilación mecánica. Diseño: Prospectivo, observacional.Ámbito: Unidad de cuidados intensivos hospital universitario. Pacientes: Pacientes adultos con ventilación mecánica más de 48 h sometidos a una prueba de respiración espontánea (SBT).Intervenciones: Ecocardiografía antes y al final del SBT. Los pacientes se clasificaron en dos grupos según el resultado del destete. Variable de interés principal: Fracaso del destete. Resultados: Se incluyeron 89 pacientes, el fracaso del destete ocurrió en 33 (37%). La DD al final de la SBT fue más frecuente en el grupo de fracaso (39,3% vs 17,8%, p = 0,025). El balance hídrico diario desde el ingreso en UCI hasta la SBT fue menos negativo en los pacientes que fracasaron que en los que tuvieron éxito del destete (−648 mL [-884 a -138] vs −893 mL [-1284 a -501], p = 0,007). El balance hídrico diario desde el primer SBT hasta el alta de UCI fue más negativo en el grupo de fracaso que en el de éxito (−973 ml [−1493 a −201] vs. −425 ml [−1065 a 12], p = 0,034). La regresión de Cox mostró que la DD no era un factor independiente relacionado con el fracaso, necesitando la asociación del balance hídrico y la edad. Conclusiones: El fracaso del destete debido a DD se relaciona con el balance hídrico, incrementando su efecto nocivo con la edad. El momento de inicio del balance hídrico negativo puede jugar un papel clave en el fracaso. (AU)

Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury.

BACKGROUND AND AIM: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. MATERIAL AND METHODS: This is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ±â€¯28 months, cardiovascular events (CVE) were collected, and associated factors were analysed. RESULTS: 1255 patients were included (55% male, age 75 ±â€¯13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. CONCLUSION: Diastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.

Association between diastolic dysfunction and fluid balance in critically ill patients during weaning from mechanical ventilation.

OBJECTIVE: To assess the role of diastolic dysfunction and fluid balance in weaning failure. DESIGN: Prospective, observational, single center. SETTING: Intensive care unit of a university hospital. PATIENTS: Adult patients on mechanical ventilation for more than 48 h who underwent a spontaneous breathing trial (SBT). INTERVENTIONS: Echocardiography was performed immediately before and at the end of SBT. Patients were classified into two groups according to weaning outcome. MAIN VARIABLE OF INTEREST: Weaning failure. RESULTS: Among 89 patients included, weaning failure occurred in 33 patients (37%). Isolated diastolic dysfunction at the end of the SBT was more frequent in the failure group (39.3% vs. 17.8%, p = 0.025). Average daily fluid balance from ICU admission until first SBT was less negative in patients who failed than in those who succeed in the weaning (-648 mL [-884 to -138] vs. -893 mL [-1284 to -501], p = 0.007). Average daily fluid balance from the first SBT until the ICU discharge was more negative in the weaning failure than in the success group (-973 mL [-1493 to -201] vs. -425 mL [-1065 to 12], p = 0.034). Cox regression analysis showed that diastolic dysfunction was not an independent factor related to weaning failure but needed the association of positive fluid balance and age. CONCLUSIONS: Weaning failure due to diastolic dysfunction is highly related to fluid balance, and the deleterious effect of fluid balance on diastolic function is associated with age The timing of fluid removal could play a key role in this scenario.

La disfunción diastólica es un predictor independiente de eventos cardiovasculares tras un fracaso renal agudo / Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury

Antecedente y objetivo: El desarrollo de un fracaso renal agudo (FRA) condiciona complicaciones a corto, medio y largo plazo. El objetivo de nuestro estudio fue analizar el impacto de las alteraciones cardiacas en el pronóstico cardiovascular de pacientes que presentan un episodio de FRA. Materiales y métodos: Realizamos un estudio observacional de cohortes retrospectivo incluyendo a todos los pacientes con FRA en 2013 y 2014. Basalmente recogimos variables epidemiológicas, comorbilidades y parámetros ecocardiográficos. Seguimos a los pacientes tras el ingreso durante una media de 49 ± 28 meses, recogiendo la incidencia de eventos cardiovasculares (ECV) y los factores asociados a los mismos. Resultados: Se incluyeron 1.255 pacientes (55% varones, edad 75 ± 13 años). De los 676 (54%) pacientes que disponían de un ecocardiograma previo, el 46% tenían hipertrofia de ventrículo izquierdo, el 38% hipertensión pulmonar, el 38% disfunción diastólica y el 22% disfunción sistólica. Tras la hospitalización por FRA, 484 (39%) tuvieron un ECV. Los factores asociados a presentar un ECV fueron el sexo (varón), la edad, diabetes mellitus, hipertensión arterial, dislipidemia, cardiopatía isquémica, insuficiencia cardiaca, fibrilación auricular, neoplasia previa y enfermedad renal crónica (y el filtrado glomerular estimado basal y tras el FRA). El análisis de supervivencia demostró que todos los parámetros ecocardiográficos se asociaban a ECV. Un modelo de regresión de Cox ajustado demostró que la edad (HR 1,017), la diabetes mellitus (HR 1,576) y la disfunción diastólica (HR 1,358) eran predictores independientes de ECV. Conclusiones: La disfunción diastólica es un predictor independiente de ECV a largo plazo tras un episodio hospitalario de FRA. (AU)

Background and aim: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. Materials and methods: This is an observational retrospective cohorts study including all in-hospital AKI episoes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ± 28 months, cardiovascular events (CVEs) were collected, and associated factors were analysed. Results: 1255 patients were included (55% male, age 75 ± 13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to CVE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. Conclusion: Diastolic dysfunction is an independent predictor for long-term CVEs after an in-hospital AKI episode. (AU)

Progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en adultos jóvenes / Progression of blood pressure components and correlation with anthropometric and laboratory measurements in young adults

Introducción: La presencia de hipertensión arterial en población joven aumenta el riesgo de eventos cardiovasculares en la mediana edad y como consecuencia una morbimortalidad prematura. El propósito de este estudio es evaluar la progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en estudiantes de la Universidad Nacional de Asunción- Paraguay. Materiales y métodos: Se realizó un estudio descriptivo correlacional, longitudinal, prospectivo, desde el año 2013 hasta el año 2017 evaluando al inicio 284 universitarios y 240 al final de las carreras. Se midieron variables sociodemográficas, antropométricas, presión arterial, determinaciones bioquímicas. La progresión de los componentes de la presión arterial, de las variables antropométricas y clínicas se calcularon mediante la prueba T de muestras relacionadas. La correlación de la presión arterial sistólica y presión arterial diastólica con las variables antropométricas y laboratoriales con la correlación de Pearson. Resultados: La progresión de los componentes de la presión arterial presentó una diferencia estadísticamente significativa en la presión arterial sistólica, presión arterial diastólica y presión de pulso. En relación con las características antropométricas y clínicas de los estudiantes se encontró una diferencia estadísticamente significativa entre la medición inicial y final en el peso, perímetro abdominal, glicemia, insulina, colesterol total, colesterol de alta densidad, colesterol de baja densidad, triglicéridos y proteína C reactiva. La correlación más importante encontrada entre las medidas antropométricas con la presión arterial sistólica y presión arterial diastólica fue la circunferencia abdominal. Conclusión: Se encontró aumento de la tendencia de la presión arterial y de otros factores de riesgo cardiovascular en universitarios.

Introduction: The presence of arterial hypertension in young population increases the risk of cardiovascular events in middle age and as a consequence premature morbimortality. The purpose of this study was to evaluate the progression of blood pressure components and the correlation with anthropometric and laboratory measurements in students of the National University of Asuncion, Paraguay. Materials and methods: A descriptive correlational, longitudinal, prospective, descriptive study was conducted from 2013 to 2017 evaluating at the beginning 284 undergraduates and 240 at the end of the careers. Sociodemographic variables, anthropometric variables, blood pressure, biochemical determinations were measured. The progression of blood pressure components, anthropometric and clinical variables were calculated using the related samples t-test. The correlation of systolic blood pressure and diastolic blood pressure with anthropometric and laboratory variables was correlated with Pearson's correlation. Results: The progression of blood pressure components presented a statistically significant difference in systolic blood pressure, diastolic blood pressure and pulse pressure. In relation to the anthropometric and clinical characteristics of the students, a statistically significant difference was found between the initial and final measurements in weight, abdominal perimeter, glycemia, insulin, total cholesterol, high-density cholesterol, low-density cholesterol, triglycerides, and C-reactive protein. The most important correlation found between anthropometric measurements with systolic blood pressure and diastolic blood pressure was abdominal circumference. Conclusion: An increase in the trend of blood pressure and other cardiovascular risk factors was found in university students.

Dilemas de la insuficiencia cardíaca con fracción de eyección preservada / Dilemmas of heart failure with preserved ejection fraction / Dilemas da insuficiência cardíaca com fração de ejeção preservada

La insuficiencia cardíaca con fracción de eyección preservada (ICFEp) y reducida presentan marcadas diferencias. Mientras que la última tiene un algoritmo diagnóstico y terapéutico desde hace años, con guías y fármacos que mejoran su pronóstico, la ICFEp no solo presenta dificultades para llegar al diagnóstico, sino que tampoco hay fármacos que hayan demostrado disminuir la mortalidad. En esta revisión se hace un abordaje amplio de la ICFEp, comenzando por definirla y distinguirla de la disfunción diastólica. Se describe el gold standard para su diagnóstico invasivo y se analizan los scores no invasivos recientemente desarrollados que estiman la probabilidad de tener la enfermedad. A través del análisis de las comorbilidades frecuentemente asociadas, se describen los mecanismos fisiopatológicos implicados. Asimismo, se detallan los fenotipos propuestos para agrupar pacientes y diseñar ensayos clínicos con fármacos que prueben disminuir la mortalidad. Por último, se reseñan las medidas terapéuticas no farmacológicas y farmacológicas recomendadas.

Heart failure with preserved and reduced ejection fraction have significant differences. While the latter has had a diagnostic and therapeutic algorithm for years, with guidelines and drugs that improve its prognosis, heart failure with preserved ejection fraction (HFpEF) not only presents difficulties in reaching a diagnosis, but also there are no drugs that have been proven to be effective in reducing mortality. In this review, a broad approach to HFpEF is made, beginning by defining it and distinguishing it from diastolic dysfunction. The gold standard for its invasive diagnosis is described and recently developed non-invasive scores that estimate the probability of having the disease are analyzed. Through the analysis of the frequently associated comorbidities, the pathophysiological mechanisms involved are described. Likewise, the phenotypes proposed to group patients and design clinical trials with drugs that try to reduce mortality are detailed. Finally, the recommended non-pharmacological and pharmacological therapeutic measures are outlined.

A insuficiência cardíaca com fração de ejeção preservada (ICFEp) e reduzida apresentam diferenças marcantes. Enquanto esta última conta com um algoritmo diagnóstico e terapêutico há anos, com diretrizes e medicamentos que melhoram seu prognóstico, a ICFEp não só apresenta dificuldades no diagnóstico, mas nenhum há medicamentos que tenham demonstrado reduzir a mortalidade. Nesta revisão, é feita uma abordagem ampla da ICFEp, começando por defini-la e distinguindo-a da disfunção diastólica. O padrão ouro para seu diagnóstico invasivo é descrito e são analisados os escores não invasivos recentemente desenvolvidos que estimam a probabilidade de ter a doença. Através da análise de comorbidades frequentemente associadas, são descritos os mecanismos fisiopatológicos envolvidos. Da mesma forma, são detalhados os fenótipos propostos para agrupar pacientes e desenhar ensaios clínicos com medicamentos que podem ser mostradas para reduzir a mortalidade. Por fim, são delineadas as medidas terapêuticas não farmacológicas e farmacológicas recomendadas.

Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil / Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort

Resumo Fundamento vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. Objetivo Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). Métodos A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. Resultados Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62-3,00). Conclusão Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Abstract Background Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. Objective This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. Methods The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). Conclusion Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

Impacto del tratamiento con metilfenidato sobre las propiedades funcionales y estructurales del ventrículo izquierdo a medio plazo en el trastorno por déficit de atención e hiperactividad / The impact of methylphenidate treatment on the functional and structural properties of the left ventricle: A medium-term prospective study

Introducción: El metilfenidato (MTF) es un psicoestimulante que aumenta frecuencia cardiaca (FC) y presión arterial (PA), lo cual a largo plazo podría modificar la geometría del ventrículo izquierdo (VI) y alterar sus propiedades funcionales, principalmente la diastólica. Material y métodos: Estudio prospectivo, longitudinal y comparativo tipo caso-caso en niños y adolescentes sanos diagnosticados de trastorno por déficit de atención e hiperactividad (TDAH) tratados con MTF durante 3 años. Se valoró pre y postratamiento PAS/PAD, geometría ventricular, función sistólica y diastólica. Resultados: Incluimos a 112 pacientes, completando 73. El 75,3% varones, entre 4-15 años (9±2,6), con índice de masa corporal de 18,27±3,75 y una dosis media de MTF de 0,9±0,17mg/kg/día. Objetivamos aumento de PAS/PAD de 3,7±9mmHg (p = 0,004) y 2±11,5mmHg, respectivamente. No tuvimos ningún evento cardiovascular grave, cambios estructurales ni variación en los parámetros de función sistólica estudiados. Sin embargo, encontramos un aumento discreto, pero progresivo y significativo del tiempo de relajación isovolumétrica del VI (p = 0,046) y del tiempo de desaceleración (p = 0,016) indicativos de alteración en la relajación. No observamos variación en los parámetros relacionados con la distensibilidad ni con las presiones diastólicas tempranas y ningún paciente cumplió criterios de disfunción diastólica. Conclusiones: El incremento de PAS/PAD y las alteraciones de la relajación del VI objetivadas podrían ser un indicador precoz de una posible disfunción diastólica y riesgo cardiovascular a largo plazo.(AU)

Introduction: Although methylphenidate (MPH) used for treatment of Attention deficit hyperactivity disorder (ADHD) are considered safe in healthy children and adolescents in the short and medium term, there is a widespread concern about long-term cardiovascular safety. Material and methods: Interventional, prospective, longitudinal and comparative study with a crossover design to evaluate the cardiovascular impact of the treatment with MPH in healthy children and adolescents diagnosed with ADHD. A protocol for the cardiovascular evaluation was established at a basal point, after the first and the second year of the beginning with treatment based on the monitoring of Blood pressure (BP) and echocardiographic follow-up of the systolic and diastolic functions, and structural cardiac properties. Results: 73 patients completed the study, with an average age of 9+/- 2.6 years, 75.3% were male and the majority were thin (64.4%). We found an increase in Systolic and Diastolic BP of 3.7±9mmHg (P).004) and 2±11,5mmHg respectively. There were no severe cardiovascular events. We didn’t find any echocardiographic alterations namely on the structural properties or parameters of systolic function. Regarding diastolic function, a significant increase in the isovolumic relaxation time (IVRT) (P=.046) and deceleration time (P=.016) was observed. However, no significant alterations in the parameters related to distensibility of the LV neither in the early diastolic pressure were found. Conclusion: Further studies are needed to evaluate the impact of psychostimulants as a modifiable long-term Cardiovascular Risk Factor.(AU)

The impact of methylphenidate treatment on the functional and structural properties of the left ventricle: A medium-term prospective study.

INTRODUCTION: Although methylphenidate (MPH) used for treatment of attention deficit hyperactivity disorder (ADHD) are considered safe in healthy children and adolescents in the short and medium term, there is a widespread concern about long-term cardiovascular safety. MATERIAL AND METHODS: Interventional, prospective, longitudinal and comparative study with a crossover design to evaluate the cardiovascular impact of the treatment with MPH in healthy children and adolescents diagnosed with ADHD. A protocol for the cardiovascular evaluation was established at a basal point, after the first and the second year of the beginning with treatment based on the monitoring of blood pressure (BP) and echocardiographic follow-up of the systolic and diastolic functions, and structural cardiac properties. RESULTS: 73 patients completed the study, with an average age of 9 ±â€¯2.6 years, 75.3% were male and the majority were thin (64.4%). We found an increase in Systolic and Diastolic BP of 3.7 ±â€¯9 mmHg (P = 0.004) and 2 ±â€¯11,5 mmHg respectively. There were no severe cardiovascular events. We didn't find any echocardiographic alterations namely on the structural properties or parameters of systolic function. Regarding diastolic function, a significant increase in the isovo-lumic relaxation time (IVRT) (P = 0.046) and deceleration time (P = 0.016) was observed. However, no significant alterations in the parameters related to distensibility of the LV neither in the early diastolic pressure were found. CONCLUSION: Further studies are needed to evaluate the impact of psychostimulants as a modifiable long-term Cardiovascular Risk Factor.

Factores asociados con mortalidad intrahospitalaria en falla cardíaca aguda: un estudio de cohorte retrospectiva / Factors Associated with in-hospital Mortality in Acute Heart Failure: A Retrospective Cohort Study / Fatores associados à mortalidade intra-hospitalar na insuficiência cardíaca aguda: estudo retrospectivo

Introducción: La falla cardiaca es una enfermedad de alta prevalencia mundial y de gran interés para la salud pública. En Colombia constituye una de las principales causas de mortalidad de origen cardiovascular, por lo cual es importante determinar los factores de riesgo asociados con la mortalidad intrahospitalaria en estos pacientes. Materiales y métodos: Estudio de cohorte retrospectiva que incluyó a 260 pacientes con diagnóstico de falla cardiaca aguda atendidos en el Hospital Universitario San Rafael de Tunja (Colombia) entre enero de 2019 y enero de 2022. Con un análisis univariado y bivariado se construyó un modelo de regresión de Cox para determinar los factores asociados con mortalidad intrahospitalaria, y como desenlaces secundarios se determinó la incidencia de mortalidad intrahospitalaria a 10 días, el reingreso y el tiempo de estancia hospitalaria. Resultados: La incidencia de mortalidad intrahospitalaria a los 10 días fue del 10 %, el reingreso hospitalario se presentó en el 21,2 % de los pacientes, la media de estancia hospitalaria fue de 9,31 días. Los factores de riesgo para mortalidad intrahospitalaria estadísticamente significativos fueron la clasificación clínica de Stevenson C o L (HR: 3,2; IC: 1,12-9,39; p = 0,03) y la clase funcional del paciente a su ingreso NYHA III o IV (HR: 2,76; IC: 1,02-7,53; p = 0,04). Conclusiones: La clasificación clínica de Stevenson C o L y la clase funcional según NYHA III o IV demostraron ser factores de riesgo independientes de mortalidad intrahospitalaria. Se sugiere identificar tempranamente a estos pacientes, ya que podría asegurar una mayor supervivencia

Introduction: Heart failure is an illness of high prevalence at world level, and therefore one of great interest for public health. In Colombia, it is one of the leading causes of death from cardiovascular cause. For this reason, it is important to determine the risk factors associated to intrahospital morta-lity in these patients. Materials and methods: Retrospective cohort study that included 260 patients diagnosed with acute heart failure treated in San Rafael University Hospital in Tunja between January 2019 and January 2022. A univariate and a bivariate analysis were carried out calculating Hazard Ratio and p values. With these results, a Cox regression model was made to determine the associated factors in intrahos-pital mortality; in addition, the incidence of intrahospital mortality 10 days after admission; readmis-sions; and length of hospital stay were determined as secondary outcomes. Results: The incidence of intrahospital mortality 10 days after admission was of 10%; hospital read-missions occurred for 21.2% of the patients; the mean in hospital stay was of 9.31 days; the statis-tically significant risk factors for intrahospital mortality were Stevenson's clinical classification C or L (HR: 3.2; IC: 1.12-9.39; p = 0.03] and the patient's functional class at the time of admission NYHA III or IV (HR: 2.76; IC: 1.02-7.53; p = 0.04]. Conclusion: Stevenson's clinical classification C or L and the functional class NYHA III or IV emerge as independent risk factors for intrahospital mortality. Early identification of these patients is suggested for an increased rate of survival.

Introdução: a insuficiência cardíaca é uma doença de elevada prevalência em todo o mundo e que suscita grades preocupações em termos de saúde pública. Na Colômbia, esta é uma das principais causas de mortalidade cardiovascular, pelo que é importante determinar os fatores de risco associados à mortalidade intra-hospitalar nestes pacientes. Materiais e métodos: Estudo retrospectivo que inclui 260 pacientes com diagnostico de insuficiência cardíaca aguda tratados no Hospital Universitário San Rafael da cidade de Tunja (Colômbia) entre janeiro de 2019 e janeiro de 2022. Foi construído um modelo de regressão de Cox utilizando análises univariada e bivariada para determinar os fatores associados à mortalidade intra-hospitalar. A inci-dência de mortalidade intra-hospitalar aos 10 dias, a readmissão e a duração do internamento foram determinados como resultados secundários. Resultados: A incidência de mortalidade intra-hospitalar aos 10 dias foi de 10%, a readmissão ocorreu em 21,2% dos pacientes e o tempo médio de internamento foi de 9,31 dias. Os fatores de risco estatis-ticamente significativos para a mortalidade intra-hospitalar foram a classificação clínica de Stevenson C ou L (HR: 3,2; IC: 1,12-9,39; p = 0,03) e a classe funcional do paciente na admissão NYHA III ou IV (HR: 2,76; IC: 1,02-7,53; p = 0,04). Conclusões: A classificação clínica C ou L de Stevenson e a classe funcional III ou IV da NYHA provaram ser fatores de risco independentes para a mortalidade intra-hospitalar. A identificação precoce destes pacientes é sugerida, uma vez que pode assegurar uma sobrevivência mais longa

Insuficiência Cardíaca com Fração de Ejeção Ventricular Esquerda Supranormal - Estado da Arte / Heart Failure with Supra-normal Left Ventricular Ejection Fraction - State of the Art

Resumo Em 2019, um artigo publicado no European Heart Journal reconheceu pela primeira vez a insuficiência cardíaca (IC) com fração de ejeção do ventrículo esquerdo (FEVE) ≥ 65% como um novo fenótipo de IC, ou a insuficiência cardíaca com fração de ejeção supranormal (ICFEsn), com o objetivo principal de promover a investigação desta nova categoria. Eles analisaram a mortalidade em pessoas com IC e descobriram que havia uma relação em forma de U entre a mortalidade e a FEVE. Sendo assim, os pacientes com ICFEsn tinham uma mortalidade geral mais alta em comparação com outros pacientes diagnosticados com IC com fração de ejeção preservada (ICFEp). Este artigo descreve a situação atual da ICFEsn e discute as perspectivas futuras com base nos resultados preliminares de nosso grupo. Para melhor tratar os pacientes com ICFEsn, é fundamental que cardiologistas e médicos entendam as diferenças e semelhanças desse novo fenótipo.

Abstract In 2019, an article published in the European Heart Journal recognized for the first time heart failure (HF) with left ventricular ejection fraction (LVEF)≥ 65% as a new HF phenotype, heart failure with supra-normal left ventricular ejection fraction (HFsnEF), with the main purpose of promoting research on this new category. They analyzed mortality in people with HF and found that there was a u-shaped relationship between mortality and LVEF. Accordingly, HFsnEF patients had a higher all-cause mortality compared with other patients diagnosed with HF with preserved ejection fraction (HFpEF). This article describes the current situation of HFsnEF and discusses future perspectives based on the preliminary results of our group. To better treat patients with HFsnEF, it is fundamental that cardiologists and physicians understand the differences and similarities of this new phenotype.

Evaluación del riesgo de alteración de presión diastólica en las variables metabólicas en el embarazo

OBJETIVO: Evaluar la asociación de la presión diastólica (PAD) y variables metabólicas en embarazadas. METODOLOGÍA: Estudio retrospectivo, transversal en embarazadas de término, mayores de 25 años, con embarazo único, agrupadas por Índice de Masa Corporal (IMC). A todas se les midieron lípidos, glucosa y PAD. Se calculó Odds Ratio (IC 95 %), correlación de Spearman entre variables y Kruskal Wallis utilizando SPSS v21.0. RESULTADOS: Se incluyeron 60 embarazadas normoevolutivas, edad promedio 30.9 ± 4.5 años, obteniendo una prevalencia de 41.6 % para sobrepeso y 31.6 % para obesidad. Los valores de glucemia en ayuno fueron de 102.2 ± 49.8 mg/dL en obesidad, 89.8 ± 28.7 mg/dL en sobrepeso y 84.5 ± 12.3 mg/dL en normopeso. Los valores medios de la PAD y PAS mostraron una correlación positiva con el valor medio de IMC pregestacional y gestacional. Mientras que, para las concentraciones de glucosa y lípidos, se obtuvo una correlación positiva con el valor medio de la PAD. CONCLUSIÓN: Se confirma asociación de la PAD con el IMC pregestacional. (provisto por Infomedic Intl)

OBJECTIVE: To evaluate the association of diastolic pressure (DBP) and metabolic variables in pregnant women. METHODOLOGY: Retrospective, cross-sectional study in full-term pregnant women, older than 25 years, with a single pregnancy, grouped by Body Mass Index (BMI). Lipids, glucose and DBP were measured in all of them. Odds Ratio (95% CI), Spearman's correlation between variables and Kruskal Wallis were calculated using SPSS v21.0. RESULTS: 60 normodevelopmental pregnant women were included, mean age 30.9 ± 4.5 years, obtaining a prevalence of 41.6% for overweight and 31.6% for obesity. Fasting blood glucose values ​​were 102.2 ± 49.8 mg / dL in obesity, 89.8 ± 28.7 mg / dL in overweight, and 84.5 ± 12.3 mg / dL in normal weight. The following ORs were obtained for DBP> 80 mmHg with SBP> 130 mmHg (1,571; 95% CI: 0.490-5.037), glucose> 90 mg/dL (1.052; 95% CI: 0.451-2.453), cholesterol > 200 mg / dL (1.667; 95% CI: 0.694-4.004), triglycerides> 150 mg/dL (1.2; 95% CI: 0.243-1.832), platelets <150 thousand / µL (1.072; 95% CI: 0.220-2.974) and lymphocytes <1000 /µL (1.145; 95% CI: 0.168-2.405). CONCLUSION: The association of DBP disorders with pre-pregnancy BMI is confirmed. (provided by Infomedic Intl)

Epidemiología de la insuficiencia cardiaca con fracción de eyección preservada: resultados del Registro RICA / Epidemiology of heart failure with preserved ejection fraction: Results from the RICA Registry

Introducción y objetivos: La caracterización de los pacientes con insuficiencia cardiaca (IC) con fracción de eyección preservada (IC-FEp) sigue teniendo interés. El objetivo fue conocer la prevalencia, las características clínicas y epidemiológicas de la IC-FEp, y sus cambios en los últimos años.MétodosAnalizamos el Registro RICA, de la Sociedad Española de Medicina Interna; estudio de cohorte multicéntrico y prospectivo de pacientes ingresados por IC, consecutivamente en servicios de medicina interna, durante un periodo de 11 años (2008-2018).ResultadosSe incluyeron 4.752 pacientes, 2957 (62,2%) con IC-FEp, proporción que se mantuvo constante durante todo el periodo. En comparación con los pacientes con IC y fracción de eyección reducida (IC-FEr), los pacientes con IC-FEp tienen: mayor edad, predominio de sexo femenino, etiología hipertensiva y valvular, distinto perfil de comorbilidades y peor capacidad funcional (menor índice de Barthel). La mayoría de pacientes recibía un tratamiento similar al de la IC-FEr (inhibidores del sistema renina-angiotensina-aldosterona y betabloqueantes). La mortalidad global al año de seguimiento fue del 24% en la IC-FEp y del 30% en la IC-FEr. En el análisis multivariante el riesgo de muerte fue superior en los pacientes con IC-FEr (HR: 1,84; IC 95%: [1,43-2,36]); la estancia hospitalaria fue inferior en la IC-FEp y no hubo diferencias en las re-hospitalizaciones. (AU)

Introduction and objectives: There is great interest in better characterizing patients with heart failure (HF) with preserved ejection fraction (HF-PEF). The objective of this study is to determine the prevalence, progression over time and to describe the clinical and epidemiological characteristics of patients with HF-PEF.MethodsFrom the National Registry of Heart Failure (RICA, prospective multicentre cohort study) we analysed patients consecutively admitted for HF in Internal Medicine wards over a period of 11 years (2008-2018).Results4752 patients were included, 2957 (62.2%) with preserved ejection fraction. This prevalence remained constant from 2008 to 2019. Compared to patients with HF and reduced ejection fraction (HF-REF) patients with HF-PEF are older, more are female, there is a higher prevalence of hypertensive and valvular aetiology, they have a profile of different comorbidities and worse functional status. A high proportion of patients receive disease-modifying treatment for IC-REF (renin-angiotensin-aldosterone system inhibitors and beta-blockers). The overall mortality after one-year follow-up was 24% and 30% in the HF-PEF and the HF-REF, respectively. In the multivariate analysis, the risk of death was higher in patients with HF-REF compared to HF-PEF (OR: 1.84; 95% CI: [1.43-2.36]). The length of hospital stay was also lower in the HF-PEF patients but there were no differences in re-hospitalizations. (AU)

Importancia de estilos de vida en adultos mayores hipertensos: centro de adulto mayor "Renata Luque" 2019 / Importance of lifestyles in hypertensive older adults. Senior Center"Renta Luque". 2019

La Hipertensión Arterial es una enfermedad de etiología múltiple, caracterizada por la elevación persistente de la tensión arterial sistólica, diastólica o ambas cifras. Objetivo: Determinar los estilos de vida de los adultos mayores hipertensos del Centro del Adulto Mayor "Renta Luque" 2019. Siendo las variables del estudio estilos de vida el cual consta de tres dimensiones, nutrición, actividad física y hábitos nocivos. Materiales y métodos: La investigación se llevó a cabo mediante el método descriptivo de tipo cuantitativo. La muestra de este estudio se constituyó por 100 adultos mayores de ambos sexos con edades comprendidas entre los 60 y 80 años, con patología de base hipertensión arterial. Para conocer los estilos de vida se aplicó el cuestionario validado por expertos en metodología de investigación y especialistas médicos que consiste en 21 ítems de distintos criterios relacionados con el estilo de vida. Resultados: Con la información de los cuestionario se realizó un análisis, presentándose una síntesis gráfica de los resultados más relevantes de esta información. Los resultados de este estudio servirán como base para fomentar, con fundamentos reales, la práctica de actividad física, nutrición y los hábitos nocivos en la adquisición de hábitos saludables de la población nacional, generando el aporte para estudios posteriores sobre la relación de estas mismas variables en diversas poblaciones. Conclusión: Mantener un estilo de vida saludables es vital para garantizar la calidad de vida de este grupo etario. Es importante que cuenten con apoyo psicológico permanente, además de un estricto control nutricional, realización de ejercicios pasivos como yoga para evitar el alto nivel de stress que suelen presentar los adultos mayores en especial con comorbilidades como la hipertensión arterial(AU)

Arterial Hypertension is a disease of multiple etiology, characterized by persistent elevation of systolic blood pressure, diastolic blood pressure or both figures. Objective: To determine the lifestyles of hypertensive older adults at the "Renta Luque" Senior Center 2019. Being the variables of the study lifestyles that consists of three dimensions, nutrition, physical activity and harmful habits. Materials and methods: The research was carried out using the quantitative descriptive method. The sample of this study consisted of 100 older adults of both sexes aged between 60 and 80 years, with arterial hypertension. The questionnaire validated by experts in research methodology and medical specialists, consisting of 21 items of different criteria related to lifestyle, was applied to learn about lifestyles. Results: With the information from the results of the questionnaire, an analysis was made, presenting a graphic synthesis of the most relevant results of this information. The results of this study will serve as a basis to promote, with real foundations, the practice of physical activity, nutrition and harmful habits in the acquisition of healthy habits in the national population, generating the contribution for subsequent studies on the relationship of these same variables in different populations. Conclusion: Maintaining a healthy lifestyle is vital to ensure the quality of life of this age group. It is important that they have permanent psychological support, in addition to strict nutritional control and passive exercises such as yoga to avoid the high level of stress that older adults usually present, especially with comorbidities such as arterial hypertension(AU)