Diálisis peritoneal en pericarditis constrictiva: a propósito de 3 casos

High-sensitivity troponin T and the risk of recurrent readmissions after hospitalization for acute heart failure

Abstract Objectives High-sensitivity troponin is a biomarker of myocardial damage and is associated with a greater risk of mortality and disease progression in patients with acute heart failure (AHF). However, its relationship with the risk of future readmissions is less known. The aim of this study was to assess the association between ultrasensitive troponin T (TnT-us) values in patients with AHF and the risk of recurrent readmissions in the follow-up. Methods We prospectively included a cohort of 621 consecutive patients with AHF, excluding those patients with acute coronary syndrome. We measured the TnT-us levels obtained during the first medical contact in the emergency department. The…

International Normalized Ratio and Mortality Risk in Acute Heart Failure and Nonvalvular Atrial Fibrillation Patients Receiving Vitamin K Antagonists

Introduction and objectives: Heart failure patients with nonvalvular atrial fibrillation (NVAF) on treatment with vitamin K antagonists (VKA) often have suboptimal international normalized ratio (INR) values. Our aim was to evaluate the association between INR values at admission due to acute heart failure and mortality risk during follow-up. Methods: In this observational study, we retrospectively assessed INR on admission in 1137 consecutive patients with acute heart failure and NVAF who were receiving VKA treatment. INR was categorized into optimal values (INR = 2-3, n = 210), subtherapeutic (INR 3, n = 267). Because INR did not meet the proportional hazards assumption for mortality, res…

Prediction of long-term major events soon after a first ST-segment elevation myocardial infarction by cardiovascular magnetic resonance.

Cardiovascular magnetic resonance (CMR) predicts combined clinical events in post-ST-segment elevation myocardial infarction (STEMI) patients. However, its contribution to predicting long-term major events (ME: cardiac death and non-fatal myocardial infarction [MI]) is unknown. We aimed to assess whether CMR predicts long-term MEs when performed soon after STEMI.We prospectively recruited 546 STEMI patients between 2004 and 2012. The Left ventricular (LV) ejection fraction (LVEF,%), infarct size (IS), edema, hemorrhage, microvascular obstruction, and myocardial salvage were quantified by CMR at pre-discharge. During a mean follow-up of 840 days, 57 ME events (10%; 23 cardiac deaths, 34 non-…

Diuretic Strategies in Acute Heart Failure and Renal Dysfunction: Conventional vs Carbohydrate Antigen 125-guided Strategy. Clinical Trial Design

Abstract Introduction and objectives The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic str…

Razón internacional normalizada y mortalidad de los pacientes con insuficiencia cardiaca y fibrilación auricular tratados con antagonistas de la vitamina K

Resumen Introduccion y objetivos Los pacientes con insuficiencia cardiaca en tratamiento con antagonistas de la vitamina K (AVK) por fibrilacion auricular no valvular (FANV) a menudo presentan valores alterados de la razon internacional normalizada (INR). El objetivo es evaluar la asociacion entre la INR al ingreso por insuficiencia cardiaca y el riesgo de mortalidad en el seguimiento. Metodos Estudio observacional retrospectivo en el que se evaluo la INR al ingreso de 1.137 pacientes consecutivos con insuficiencia cardiaca aguda en tratamiento con AVK por FANV. Esta se categorizo en: INR en rango optimo (INR = 2-3, n = 210), infraterapeutica (INR 3, n = 267). La asociacion independiente en…

Prognostic Value of Strain by Tissue Tracking Cardiac Magnetic Resonance After ST-Segment Elevation Myocardial Infarction

The aim of this study was to evaluate the prognostic value of strain as assessed by tissue tracking (TT) cardiac magnetic resonance (CMR) soon after ST-segment elevation myocardial infarction (STEMI).The prognostic value of myocardial strain as assessed post-STEMI by TT-CMR is unknown.The authors studied the prognostic value of TT-CMR in 323 patients who underwent CMR 1 week post-STEMI. Global (average of peak segmental values [%]) and segmental (number of altered segments) longitudinal (LS), circumferential, and radial strain were assessed using TT-CMR. Global and segmental strain cutoff values were derived from 32 control patients. CMR-derived left ventricular ejection fraction, microvasc…

Estrategias diuréticas en insuficiencia cardiaca aguda con disfunción renal: terapia convencional frente a guiada por el antígeno carbohidrato 125. Diseño de ensayo clínico

Resumen Introduccion y objetivos El tratamiento optimo de pacientes con insuficiencia cardiaca aguda (ICA) y sindrome cardiorrenal tipo 1 (SCR-1) no esta bien definido. La hipoperfusion arterial y la congestion venosa tienen un papel fundamental en la fisiopatologia del SCR-1. El antigeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diuretico de pacientes con SCR-1. Metodos Ensayo clinico multicentrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a)  estrategia convencional: titulacion ba…

Functional Mitral Regurgitation Predicts Short-Term Adverse Events in Patients With Acute Heart Failure and Reduced Left Ventricular Ejection Fraction

Functional mitral regurgitation (FMR) is a common finding in patients with acute heart failure (AHF) and reduced left ventricular ejection fraction (heart failure and reduced ejection fraction [HFrEF]). However, its clinical impact remains unclear. We aimed to evaluate the association between the severity of FMR after clinical stabilization and short-term adverse outcomes after a hospitalization for AHF. We prospectively included 938 consecutive patients with HFrEF discharged after a hospitalization for AHF, after excluding those with organic valve disease, congenital heart disease, or aortic valve disease. FMR was assessed semiquantitatively by color Doppler analysis of the regurgitant jet…

Peritoneal Dialysis in Constrictive Pericarditis: A Report of Three Cases

Use of acetazolamide in the treatment of patients with refractory congestive heart failure

Aims Optimal diuretic treatment of patients with refractory congestive heart failure (CHF) remains to be elucidated. In this work, we aimed to evaluate the serial changes of functional class and surrogates of fluid overload (weight and antigen carbohydrate 125) after addition of oral acetazolamide in patients with refractory CHF. Likewise, serial changes in renal function, serum electrolytes and pH were evaluated. Method This is an observational retrospective study in which 25 ambulatory patients with refractory CHF that received acetazolamide in addition to standard intensive diuretic strategy were evaluated. Longitudinal assessment of New York Heart Association (NYHA) functional class and…

Troponina T de alta sensibilidad y riesgo de hospitalizaciones recurrentes tras un ingreso por insuficiencia cardíaca aguda

Resumen Objetivos La troponina de alta sensibilidad es un biomarcador de dano miocardico que se asocia a un mayor riesgo de mortalidad y progresion de la enfermedad en pacientes con insuficiencia cardiaca aguda (ICA). Sin embargo, su relacion con el riesgo de futuras rehospitalizaciones es menos conocido. El objetivo de este estudio fue evaluar la asociacion entre los valores de troponina T ultrasensible (TnT-us) en pacientes con ICA y el riesgo de hospitalizaciones recurrentes en el seguimiento. Metodos Se incluyo prospectivamente una cohorte de 621 pacientes consecutivos con ICA, excluyendose pacientes con sindrome coronario agudo. Se determino la TnT-us obtenida en el primer contacto med…