José F. Rodríguez Palomares

Predictors of Moderate-to-Severe Pericardial Effusion, Cardiac Tamponade, and Electromechanical Dissociation in Patients With ST-Elevation Myocardial Infarction

Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden electromechanical dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p<0.001). In patients treated without reperfusion therapy, thrombolysis, and PPCI, incidence of PE (12.0%, 5.7%, and 4.3%), CT (6.0%, 3.0%, and 2.2%), and EMD (4.1%, 2.2%, and 0.8%) was different as was mortality (14.4%, 8.3%, and 5.9%; all p<0.001). Independent predictors of PE were lateral infarction (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57 to 6.49), increasing age (OR 1.05, 95% CI 1.04 to 1.07), number of electrocardiographic leads involved (OR 1.34, 95% CI 1.23 to 1.45), and admission delay (OR 1.01, 95% CI 1.01 to 1.02). Increasing ejection fraction (OR 0.97, 95% CI 0.96 to 0.98), thrombolysis (OR 0.53, 95% CI 0.37 to 0.75), and PPCI (OR 0.35, 95% CI 0.25 to 0.50), however, were protectors (all p<0.001). Lateral infarction, age, number of leads involved, ejection fraction, thrombolytic therapy, and PPCI were also predictors/protectors of CT and EMD. In conclusion, PE, CT, and EMD rates in patients with ST-elevation myocardial infarction have objectively fallen in the last 2 decades, and their predictors are lateral site, increasing age, number of leads involved, and lack of reperfusion therapy. Late hospital admission is also a relevant predictor of PE.

Hospital and 4-Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease.

Background Long‐term prognosis of acute pulmonary edema (APE) remains ill defined. Methods and Results We evaluated demographic, echocardiographic, and angiographic data of 806 consecutive patients with APE with (CAD) and without coronary artery disease (non‐CAD) admitted from 2000 to 2010. Differences between hospital and long‐term mortality and its predictors were also assessed. CAD patients (n=638) were older and had higher incidence of diabetes and peripheral vascular disease than non‐CAD (n=168), and lower ejection fraction. Hospital mortality was similar in both groups (26.5% vs 31.5%; P=0.169) but APE recurrence was higher in CAD patients (17.3% vs 6.5%; P<0.001). Age, admission systolic blood pressure, recurrence of APE, and need for inotropics or endotracheal intubation were the main independent predictors of hospital mortality. In contrast, overall mortality (70.0% vs 57.1%; P=0.002) and readmission for nonfatal heart failure after a 45‐month follow‐up (10–140; 17.3% vs 7.6%; P=0.009) were higher in CAD than in non‐CAD patients. Age, peripheral vascular disease, and peak creatine kinase MB during index hospitalization, but not ejection fraction, were the main independent predictors of overall mortality, whereas coronary revascularization or valvular surgery were protective. These interventions were mostly performed during hospitalization index (294 of 307; 96%) and not intervened patients showed a higher risk profile. Conclusions Long‐term mortality in APE is high and higher in CAD than in non‐CAD patients. Considering the different in‐hospital and long‐term mortality predictors herein described, which do not necessarily involve systolic function, it is conceivable that a more aggressive interventional program might improve survival in high‐risk patients.

Selection of the Best of 2016 in Echocardiography in Heart Valve Disease

1. Amor AJ, Masana L, Soriguer F, et al. Estimación del riesgo cardiovascular en España según la guı́a Europea sobre prevención de la enfermedad cardiovascular en la práctica clı́nica. Rev Esp Cardiol. 2015;68:417–425. 2. Caballero-Güeto J, Caballero-Güeto FJ, Ulecia-Martı́nez MA, González-Cocina E, Legares-Carballo M, Ruiz-Ramos M. Tendencia de la mortalidad por enfermedades cardiovasculares en Andalucı́a y España entre 1990 y 2010. Cardiocore. 2013;48:31– 37. 3. Valdés S, Garcı́a-Torres F, Maldonado-Araque C, et al. Prevalencia de obesidad, diabetes mellitus y otros factores de riesgo cardiovascular en Andalucı́a. Comparación con datos de prevalencia nacionales. Estudio Di@bet.es. Rev Esp Cardiol. 2014;67:442–448. 4. Redondo A, Benach J, Subirana I, et al. Trends in the prevalence, awareness, treatment, and control of cardiovascular risk factors across educational level in the 1995-2005 period. Ann Epidemiol. 2011;21:555–563.

Left ventricular dynamic gradient and pericardial effusion. A life threatening combination in patients with apical ballooning syndrome

mortality in patients with acute myocardial infarction. Korean Circ J 2010;40: 616–24. [5] Durgan DJ, Pulinilkunnil T, Villegas-Montoya C, et al. Short communication: ischemia/ reperfusion tolerance is time-of-day-dependent: mediation by the cardiomyocyte circadian clock. Circ Res 2010;106:546–50. [6] Kim W, Park HH, Park CS, et al. Impaired endothelial function in medical personnel working sequential night shifts. Int J Cardiol 2011;151: 377–8. [7] Barion A. Circadian rhythm sleep disorders. Dis Mon 2011;57:423–37.