Juan Krauss

Prospective Validation of the Prognostic Usefulness of Brain Natriuretic Peptide in Asymptomatic Patients With Chronic Severe Mitral Regurgitation

OBJECTIVESnThe purpose of the study was to determine the independent and additive prognostic value of brain natriuretic peptide (BNP) in patients with severe asymptomatic mitral regurgitation and normal left ventricular function.nnnBACKGROUNDnEarly surgery could be advisable in selected patients with chronic severe mitral regurgitation, but there are no criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied in asymptomatic patients with severe mitral regurgitation; hence, its prognostic value remains unclear.nnnMETHODSnWe prospectively evaluated 269 consecutive patients with severe asymptomatic organic mitral regurgitation and left ventricular ejection fraction above 60%. The first 167 consecutive patients served as the derivation cohort, and the following 102 patients served as a validation cohort. The combined end point was the occurrence of either symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up.nnnRESULTSnThe end point was reached in 35 (21%) patients of the derivation set and in 21 (20.6%) patients of the validation cohort. The receiver-operating characteristics curve yielded an optimal cutoff point of 105 pg/ml of BNP that was able to discriminate patients at higher risk in both cohorts (76% vs. 5.4% and 66% vs. 4.0%, respectively). In both sets, BNP was the strongest independent predictor by multivariate analysis.nnnCONCLUSIONSnAmong patients with severe asymptomatic organic mitral regurgitation, BNP > or =105 pg/ml discriminates a subgroup of patients at higher risk. Because of its incremental prognostic value, BNP assessment should be considered in clinical routine workup for risk stratification.

Aplicabilidad clínica de la función de Framingham a 30 años. Utilidad en la estratificación del riesgo cardiovascular y en el diagnóstico de placa aterosclerótica carotídea

INTRODUCTION AND OBJECTIVESnThe traditional Framingham score underestimates cardiovascular risk in certain populations. Extending its time-scale to 30 years and assessing its relationship with the presence of carotid atherosclerotic plaque may improve risk stratification. The objectives were: a) to determine the percentage of patients previously classified with the traditional score who were reclassified when using Framingham 30-year risk score; b) to analyze the prevalence of carotid atherosclerotic plaque; and c) to determine the diagnostic potential of the 30-year score to detect carotid plaque.nnnMETHODSnA carotid Doppler ultrasound study was performed and the Framingham 10-year risk score and 30-year score (based on lipids and body mass index) for hard cardiovascular events were calculated in a population of primary prevention patients. Prevalence of carotid plaque was determined. Receiver operating characteristic analysis was conducted.nnnRESULTSnIn total, 305 subjects were included (age 48 [11] years, 52% men). The 30-year scores based on lipids and on body mass index reclassified 70% and 63% of the population, respectively. Prevalence of carotid plaque was 28.5% and associated gradually with risk category. The area under the curve and optimal cutoff points of the 30-year score to detect carotid plaque were 0.862 and 26% (based on lipids) and 0.845 and 22% (based on body mass index), respectively.nnnCONCLUSIONSnThe 30-year score reclassified a large number of patients and discriminated between those with or without evidence of carotid plaque.

Cardiac Fibroelastoma: Cardiovascular Magnetic Resonance Characteristics

Diego Perez de Arenaza,1 Marcelo Pietrani,2 James C. Moon, 3 Hernan Garcia Rivello,4 Nicolas Coccaro,2 Juan Krauss,1 Arturo Cagide,1 Ricardo Garcia Monaco2 Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina1 Radiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina2 The Heart Hospital, London, UK 3 Pathology Departments, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina4