Belén Redondo

Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients

To study the long‐term prognostic value of red blood cell distribution width (RDW) in patients hospitalized with acute heart failure (AHF) and to compare the value of this measurement with haemoglobin levels and anaemia status.

Hyperuricaemia and long-term outcome after hospital discharge in acute heart failure patients

Uric acid (UA) may be involved in chronic heart failure (HF) pathogenesis, entailing a worse outcome. The purpose of this study was to examine the role of hyperuricaemia as a prognostic marker after hospital discharge in acute HF patients.

Emergency Percutaneous Coronary Intervention in Unprotected Left Main Coronary Arteries. Predictors of Mortality and Impact of Cardiogenic Shock

INTRODUCTION AND OBJECTIVES Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease may be essential following acute myocardial infarction (AMI). However, few data are available on the use of emergency PCI in unprotected LMCAs outside of clinical trials. The objective of this study was to determine the frequency of in-hospital mortality, its predictors and its association with cardiogenic shock, and long-term outcomes in patients with unprotected LMCA disease who undergo emergency PCI because of AMI. METHODS The study included 71 consecutive patients who underwent emergency angioplasty of the LMCA and who were followed up clinically. RESULTS Overall, 42 patients (59%) had ST-elevation AMI and 47 (66%) had cardiogenic shock or developed it during PCI. Eleven patients (16%) died in the catheterization laboratory and 33 (47%) died during hospitalization. Inhospital mortality was similar in those with and without evidence of ST-segment elevation on ECG (48% vs. 45%; P=1). Multivariate analysis showed that the predictors of in-hospital mortality were cardiogenic shock (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.1-18) and incomplete revascularization (OR=5.1; 95% CI, 1.0-26). After discharge, 39 patients were followed up for a median of 32 months. Mortality in the first year was 10%. CONCLUSIONS Emergency PCI is a viable therapeutic option for AMI due to unprotected LMCA disease. However, in-hospital mortality is high, regardless of ST-segment elevation, particularly if there is cardiogenic shock or complete revascularization has not been achieved.

Unusual presentation of acute coronary syndrome. Bilateral coronary dissection after car accident

Dissection of large and small vessels can be caused by deceleration trauma. Management of dissections is often difficult technically, and invasive interventions are associated with complications. We report the case of a 45-year-old woman admitted with acute coronary syndrome after a car accident and deceleration trauma. The coronary angiogram showed a focal stenotic dissection of the left main and a long nonstenotic dissection of the right coronary artery. Aortography was normal. After a complicated but finally successful angioplasty, the patient developed an abdominal hemorrhagic complication due to her previous trauma, which required urgent laparotomy; spleen was then removed and laceration on liver surface was surgically repaired. The patient developed a severe coagulopathy after surgery, which led to an irreversible stage and death within 24 hours.

Comparison of Late Mortality in Hospitalized Patients >70 Years of Age With Systolic Heart Failure Receiving Beta Blockers Versus Those Not Receiving Beta Blockers

Beta blockers are underprescribed to elderly patients with systolic heart failure (HF). We studied whether the prescription of a beta blocker is associated with a survival benefit in a nonselected population of patients >70 years of age hospitalized with acute HF and systolic dysfunction. We studied 272 consecutive patients >70 years (median 77.0, interquartile range 73.4 to 81.1) hospitalized with acute HF (left ventricular ejection fraction 34 +/- 8%) during a 2-year period. At discharge, beta-blocker therapy was prescribed in 139 patients (51.1%). A propensity score for the likelihood of receiving beta-blocker therapy was developed and showed a good performance (c-statistic = 0.825 and Hosmer-Lemeshow p = 0.820). After discharge, 120 patients (44.1%) died during the follow-up (median 31 months, interquartile range 12 to 46). Cox regression analysis showed a lower risk of death associated with beta-blocker prescription (p <0.001, hazard ratio [HR] 0.450, 95% confidence interval [CI] 0.310 to 0.655), which persisted after risk adjusting for the propensity score (HR 0.521, 95% CI 0.325 to 0.836, p = 0.007). In a propensity-matched cohort of 130 patients, there was a significantly lower mortality in patients receiving beta blockers (log rank 0.009, HR 0.415, 95% CI 0.234 to 0.734, p = 0.003). Risk reduction associated with beta blockade was observed with both high doses (HR 0.472, 95% CI 0.300 to 0.742, p = 0.001) and low doses (HR 0.425, 95% CI 0.254 to 0.711, p = 0.001). In conclusion, beta-blocker prescription at discharge in a nonselected population >70 years of age hospitalized with systolic HF is associated with a significantly lower risk of death even at low doses. This benefit remains consistent after adjustment for potential confounders.

Valor pronóstico del BNP y la prueba de esfuerzo cardiopulmonar en la insuficiencia cardiaca sistólica en tratamiento con bloqueadores beta

Introduccion y objetivos En pacientes con insuficiencia cardiaca y tratamiento con bloqueadores beta, el valor pronostico a largo plazo del peptido natriuretico tipo B (BNP) y la prueba de esfuerzo cardiopulmonar no esta bien establecido. Metodos Se estudio a 80 pacientes ambulatorios con insuficiencia cardiaca estable (el 78% varones; media de edad, 50 ± 11 anos), disfuncion ventricular severa (FEVI, 25% ± 9%), deterioro funcional intermedio (NYHA, 2,4 ± 0,6) y tratamiento optimizado que incluyera bloqueadores beta. Se midio el BNP (pg/ml) y se realizo una prueba de esfuerzo cardiopulmonar, en la que se midio el consumo maximo de oxigeno (VO2max) y la ineficiencia ventilatoria (pendiente VE/VCO2). El seguimiento fue de 2,7 ± 0,8 anos y se estudio la muerte cardiovascular, el trasplante y el ingreso hospitalario por insuficiencia cardiaca. Resultados La concentracion de BNP y la pendiente VE/VCO2 fueron mayores en los pacientes que fallecieron (n = 7) (211 [51-266] contra 46 [16-105], p = 0,017; 39 ± 3 contra 33,8 ± 5,5, p = 0,018) o presentaron cualquier evento adverso (n = 19) (139 [88-286] contra 40 [13-81], p 102 pg/ml (p = 0,002; hazard ratio [HR] = 5,2; intervalo de confianza [IC] del 95%, 1,8-14,8) y la pendiente VE/VCO2>35 (p = 0,012; HR = 4,3; IC del 95%, 1,4-13,2) fueron los mejores predictores de complicaciones. En presencia de ninguno, alguno o ambos predictores, la incidencia acumulada de eventos a 36 meses fue del 2, el 25 y el 63% respectivamente (log rank Conclusiones En pacientes con insuficiencia cardiaca, deterioro funcional intermedio y tratamiento optimizado con bloqueadores beta, la persistencia de un BNP elevado (> 102 pg/ml) y la ineficiencia ventilatoria (pendiente VE/VCO2 > 35) identifican a los pacientes con peor pronostico a largo plazo.

Prognostic Value of BNP and Cardiopulmonary Exercise Testing in Patients With Systolic Heart Failure on Beta-Blocker Therapy

INTRODUCTION AND OBJECTIVES The long-term prognostic value of the B-type natriuretic peptide (BNP) level and cardiopulmonary exercise testing in patients with heart failure (HF) who are receiving beta-blocker therapy is not well established. METHODS The study involved 80 outpatients (78% male, age 50 [11] years) with stable HF, severe systolic dysfunction (left ventricular ejection fraction 25 [9]%), and intermediate functional impairment (New York Heart Association functional class 2.4 [0.6]) who were receiving optimum therapy, including beta-blockers. Their BNP levels (pg/mL) were measured and cardiopulmonary exercise testing was carried out to determine maximal oxygen uptake (VO2max) and ventilatory efficiency (VE/VCO2 slope). Patients were followed up for 2.7 (0.8) years. The study endpoints were cardiovascular death, heart transplantation, and HF hospitalization. RESULTS The BNP level and VE/VCO2 slope were greater in patients who died (n=7), at 211 pg/mL (51-266 pg/mL) vs. 46 pg/mL (16-105 pg/mL) (P=.017) and 39 (3) vs. 33.8 (5.5) (P=.018), respectively, or who had an adverse event (n=19), at 139 pg/mL (88-286 pg/mL) vs. 40 pg/mL (13-81 pg/mL) (P< .001) and 38.7 (4.3) vs. 32.9 (5.2) (P< .001), respectively. Only the combined endpoint was associated with a significant difference in VO2max (19.7 [5.4] vs. 16.8 [3.9] mL/kg per min, P=.016). On multivariate analysis, BNP >102 pg/mL (P=.002; hazard ratio [HR]=5.2; 95% confidence interval [CI], 1.8-14.8) and VE/VCO2 slope >35 (P=.012; HR =4.3; 95% CI, 1.4-13.2) were the best predictors of an adverse event. In patients who satisfied neither, one or both criteria, 36-month cumulative adverse event rates were 2%, 25% and 63%, respectively (log rank, P< .001). CONCLUSIONS In ambulatory HF patients with intermediate functional impairment who are receiving optimum beta-blocker therapy, the persistence of a high BNP level (>102 pg/mL) combined with poor ventilatory efficiency (VE/VCO2 slope >35) identify those with a poor long-term prognosis.