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Background/Objectives: Heart failure (HF) is a highly prevalent clinical syndrome with serious morbidity and mortality. Furthermore, acute heart failure (AHF) is the main cause of hospital admission in people aged 65 years or more. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) have been shown to improve the survival and quality of life in patients with HF regardless of left ventricular ejection fraction (LVEF). Our aims were to describe the characteristics of adults with multiple pathologies admitted with acute heart failure as the main diagnosis and of the population treated with SGLT2is, as well as to evaluate if their use was associated with lower readmission and mortality rates. Methods: A prospective study of patients from the PROFUND-IC registry who were admitted with AHF as the main diagnosis was conducted. Clinical and analytical characteristics were analyzed, as well as readmissions and mortality. Descriptive and bivariate analyses of the sample between those taking SGLT2is and those who were not were performed, using the chi-square test for qualitative variables and Welch's test for quantitative measures, as well as the Fisher and Wilcoxon tests as indicated for nonparametric tests. Kaplan-Meier curves were constructed to analyze the readmission and mortality of patients at 12 months based on SGLT2i treatment. Finally, a propensity score matching was performed, guaranteeing that the observed effect of the drug was not influenced by the differences in the characteristics between the groups. Results: There were 750 patients included: 58% were women, and the mean age was 84 years. Functional class II according to the NYHA scale predominated (54%), and the mean LVEF was 51%. SGLT2 inhibitors were prescribed to only 28% of patients. Most of the patients were men (48.6% vs. 39.8%, p = 0.029), they were younger (82 vs. 84 years, p = 0.002), and their LVEF was lower (48% vs. 52%, p < 0.001). Lower mortality was observed in the group treated with SGLT2is, both during baseline admission (2.4% vs. 6.9%, p = 0.017) and at the 12-month follow-up (6.2% vs. 13%, p = 0.023); as well as a lower readmission rate (23.8% vs. 38.9%, p < 0.001). After the propensity score matching, a decrease in the 12-month readmission rate continued to be observed in the group treated with SGLT2is (p = 0.03). Conclusions: SGLT2is use was associated with lower readmission rates at the 12-month follow-up in older adults with multiple pathologies admitted with acute heart failure.
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Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. Methods: An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip <27 kg in men and <16 kg in women), using the Welch test for quantitative measures and Chi-square for qualitative variables. In addition, Kaplan-Meier curves of readmission and mortality and a logistic regression analysis were also performed. Results: 377 patients were included (56% female, mean age 83 years). 310 (82.23%) had low muscle strength. Those with low muscle strength were older (84 vs. 78 years, p < 0.001), with more cognitive impairment (11.9% vs. 0%, p = 0.021), worse functional class (p = 0.016), lower scores in the Barthel index and Rockwood scale (p < 0.001), and higher in the PROFUND index (p < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09-1.31), p < 0.001). Conclusions: Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year.
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TAFRO syndrome is characterized by the presence of thrombocytopenia, anasarca, fever, reticular myelofibrosis, organomegaly, and is frequently associated with kidney damage in the form of membranoproliferative glomerulonephritis (MPGN) or thrombotic microangiopathy (TMA). Treatment is based on corticosteroids. A 59-year-old man who suffered from heart disease, pancytopenia and hepatosplenomegaly of unknown etiology developed nephrotic syndrome and progressive renal insufficiency, with a kidney biopsy suggestive of MPGN with a "full-house" immunofluorescence pattern. Positron emission tomography (PET) revealed multiple lymphadenopathies which histologically were compatible with multicentric Castleman's disease. The patient was diagnosed with TAFRO syndrome and treatment with siltuximab was started, with evident improvement at 3 months. TAFRO syndrome is a rare entity which may present with severe kidney involvement and histological findings of MPGN or TMA, with or without immune complex deposits. Our case suggests that a corticosteroid-free regimen with siltuximab could be an attractive therapeutic option.
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Hiperplasia do Linfonodo Gigante , Glomerulonefrite Membranoproliferativa , Microangiopatias Trombóticas , Masculino , Humanos , Pessoa de Meia-Idade , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/tratamento farmacológicoRESUMO
BACKGROUND: Most patients diagnosed with heart failure (HF) are older adults with multiple comorbidities. Multipathological patients constitute a population with common characteristics: greater clinical complexity and vulnerability, frailty, mortality, functional deterioration, polypharmacy, and poorer health-related quality of life with more dependency. OBJECTIVES: To evaluate the clinical characteristics of hospitalized patients with acute heart failure and to determine the prognosis of patients with acute heart failure according to the Short Physical Performance Battery (SPPB) scale. METHODS: Observational, prospective, and multicenter cohort study conducted from September 2020 to May 2022 in patients with acute heart failure as the main diagnosis and NT-ProBNP > 300 pg. The cohort included patients admitted to internal medicine departments in 18 hospitals in Spain. Epidemiological variables, comorbidities, cardiovascular risk factors, cardiovascular history, analytical parameters, and treatment during admission and discharge of the patients were collected. Level of frailty was assessed by the SPPB scale, and dependence, through the Barthel index. A descriptive analysis of all the variables was carried out, expressed as frequencies and percentages. A bivariate analysis of the SPPB was performed based on the score obtained (SPPB ≤ 5 and SPPB > 5). For the overall analysis of mortality, HF mortality, and readmission of patients at 30 days, 6 months, and 1 year, Kaplan-Meier survival curves were used, in which the survival experience among patients with an SPPB > 5 and SPPB ≤ 5 was compared. RESULTS: A total of 482 patients were divided into two groups according to the SPPB with a cut-off point of an SPPB < 5. In the sample, 349 patients (77.7%) had an SPPB ≤ 5 and 100 patients (22.30%) had an SPPB > 5. Females (61%) predominated in the group with an SPPB ≤ 5 and males (61%) in those with an SPPB > 5. The mean age was higher in patients with an SPPB ≤ 5 (85.63 years). Anemia was more frequent in patients with an SPPB ≤ 5 (39.5%) than in patients with an SPPB ≥ 5 (29%). This was also seen with osteoarthritis (32.7%, p = 0.000), diabetes (49.6%, p = 0.001), and dyslipidemia (69.6%, p = 0.011). Patients with an SPPB score > 5 had a Barthel index < 60 in only 4% (n = 4) of cases; the remainder of the patients (96%, n = 96) had a Barthel index > 60. Patients with an SPPB > 5 showed a higher probability of survival at 30 days (p = 0.029), 6 months (p = 0.031), and 1 year (p = 0.007) with (OR = 7.07; 95%CI (1.60-29.80); OR: 3.9; 95%CI (1.30-11.60); OR: 6.01; 95%CI (1.90-18.30)), respectively. No statistically significant differences were obtained in the probability of readmission at 30 days, 6 months, and 1 year (p > 0.05). CONCLUSIONS: Patients admitted with acute heart failure showed a high frequency of frailty as assessed by the SPPB. Patients with an SPPB ≤ 5 had greater comorbidities and greater functional limitations than patients with an SPPB > 5. Patients with heart failure and a Barthel index > 60 frequently presented an SPPB < 5. In daily clinical practice, priority should be given to performing the SPPB in patients with a Barthel index > 60 to assess frailty. Patients with an SPPB ≤ 5 had a higher risk of mortality at 30 days, 6 months, and 1 year than patients with an SPPB ≤ 5. The SPPB is a valid tool for identifying frailty in acute heart failure patients and predicting 30-day, 6-month, and 1-year mortality.
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INTRODUCTION AND OBJECTIVES: Hypertension is highly common in heart failure (HF). However, there is limited information on its prevalence, circadian variation, and relationship with the various HF phenotypes. The objective of this study was to describe the prevalence of hypertension and its patterns in HF. METHODS: This was a cross-sectional observational study of patients with optimized stable chronic HF. The patients underwent blood pressure (BP) measurement in the office and 24-hour ambulatory monitoring. We estimated the prevalence of hypertension, and its diurnal (controlled, uncontrolled, white coat, and masked) and nocturnal (dipper, nondipper, and reverse dipper) patterns. We also analyzed the factors associated with the different patterns and HF phenotypes. RESULTS: From 2017 to 2021, 266 patients were included in the study (mean age, 72±12 years, 67% male, 46% with reduced ejection fraction). Hypertension was present in 83%: controlled in 68%, uncontrolled in 10%, white coat in 10%, and masked in 11%. Among patients with high office BP, 51% had white coat hypertension. Among those with normal office BP, 14% had masked hypertension. The prevalence of dipper, nondipper, and reverse dipper patterns was 31%, 43%, and 26%, respectively. Systolic BP was lower in HF with reduced ejection fraction than in HF with preserved ejection fraction (P <.001). CONCLUSIONS: Ambulatory BP monitoring in HF identified white coat hypertension in more than half of patients with high office BP and masked hypertension in a relevant percentage of patients. The distribution of daytime patterns was similar to that of the population without HF in the literature, but most of the study patients had a pathological nocturnal pattern.
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Insuficiência Cardíaca , Hipertensão , Hipertensão Mascarada , Hipertensão do Jaleco Branco , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/epidemiologia , Hipertensão do Jaleco Branco/complicações , Monitorização Ambulatorial da Pressão Arterial , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/epidemiologia , Hipertensão Mascarada/complicações , Prevalência , Estudos Transversais , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/complicações , Pressão Sanguínea/fisiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/complicações , Ritmo Circadiano/fisiologiaRESUMO
Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139−0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
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Introducción: La hipotermia perioperatoria está asociada con mayor morbimortalidad, por lo que la temperatura del paciente quirúrgico debería ser una preocupación fundamental; sin embargo, es el parámetro fisiológico menos valorado. Objetivos: Evaluar el manejo de la temperatura en el perioperatorio, determinar la frecuencia de hipotermia inadvertida y los factores relacionados. Material y métodos: Estudio prospectivo observacional en pacientes adultos programados para procedimiento quirúrgico con tiempo > 30 min de anestesia. La hipotermia se definió como una temperatura de la piel de la frente <35,9°C. Se planteó la hipótesis nula de no diferencia entre los pacientes con normotermia e hipotermia. La comparación de las variables cuantitativas fue analizada con la prueba t de Student y las cualitativas con la prueba del Chi cuadrado, y después se realizó un análisis de regresión logística. Resultados: Se incluyeron 167 pacientes consecutivos; la monitorización intraoperatoria de la temperatura se usó en el 10% de los pacientes, el uso de líquidos intravenosos tibios y calentamiento con aire forzado en el 78 y el 63%, respectivamente. La frecuencia de hipotermia inadvertida fue del 56,29%, asociada a edad > 65 años, sexo femenino e índice de masa corporal >30kg/m². Esta última variable podría estar influenciada por el método de medición de la temperatura. Conclusiones: Las medidas de calentamiento sin monitorización de la temperatura no tienen el efecto esperado. La frecuencia elevada de hipotermia inadvertida hace necesaria una guía de actuación de prevención y manejo en especial en pacientes de riesgo, que en este estudio fueron edad > 65 años y sexo femenino.
Introduction: Perioperative hypothermia is associated with increased morbidity and mortality. Consequently, surgical patient temperature should be the fundamental concern but, nonetheless, it is still the least valued physiological parameter. Objectives: To assess temperature management during the perioperative period and determine the frequency of inadvertent hypothermia and related factors. Material and methods: Prospective observational study in adult patients scheduled for surgical procedure with anesthesia time ≥30 minutes. Hypothermia is defined as a forehead skin temperature ≤35.9 ◦C. The null hypothesis of no difference between patients with normothermia and hypothermiawas proposed. Comparison of quantitative variableswas analyzed with the Student t test, and the Chi square was used for the qualitative variables. The analysis was followed by a logistic regression analysis. Results:We included 167 consecutive patients; intraoperative monitoring of temperaturewas used in 10% of patients, and the use ofwarm intravenous fluids and forced air heating in 78% and 63%, respectively. The frequency of inadvertent hypothermia was 56.29%, associated with age ≥65 years, female gender and BMI≥30 kg/m². This last variable might have been influenced by the method of temperature measurement. Conclusion:Warming measures without temperature monitoring do not result in the desired effect. The high frequency of inadvertent hypothermia requires action guidelines for prevention and management, especially in high-risk patients who, in this study, were patients≥65 years of age and females.
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HumanosRESUMO
La enfermedad de von Hippel-Lindau es un transtorno genético autosómico dominante con penetrancia variable, caracterizado por hemangioblastomas multiorgánicos principalmente en la retina y cerebelo y con predisposición a desarrollar carcinoma. Se comunica el caso de una gestante a término de 28 años de edad, portadora de la enfermedad de von Hippel Lindau, sin clínica neurológica en el momento de la cesárea, con historia de afectación ocular y cerebelosa, a quien se le habían extirpado hemangioblastomas cerebelosos en varias ocasiones. Se eligió anestesia epidural por no presentar afectación del sistema nervioso, en el momento de la cirugía.
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Humanos , Adulto , Feminino , Anestesia Epidural , Anestesia Obstétrica , Cesárea , Doença de von Hippel-LindauRESUMO
El objetivo de este estudio fue evaluar si el sevofluranoa flujos bajos produce daño en la función renal ya que al ponerse e contacto con la cal sodada produce la formación de Compuesto A que es la sustancia responsable de daño renal en ratas de laboratorio. Se incluyeron 60 pacientes divididos en 2 grupos; grupo I recibió una mezcla de 500cc de oxigeno + oxido nitroso y el grupo II 1000 cc de oxígeno sometidos a cirugias electivas y de emergencia ASA i y II se realiza la monitorización, inducción e intubación del paciente reduciendo el flujo de gas a 1 litro/minuto hasta el final del procedimiento. De los resultados se puede concluir que el uso de anestesia general con sevoflurano a flujo bajo no produce alteración de la función renal, siendo esta una técnica poco aprovechada debido a que los aparatos de anestesia debe cumplir requerimiento técnicos determinados, también por criterio impuesto de que la utilización de altos flujos empleados habitualmente en anestesia alcanza una mayor seguridad para el paciente y finalmente por la falta de los conocimientos necesarios del anestesiólogo para el uso de esta técnica, esperando que con este trabajo contribuya a que nuestros colegas puedan hacer uso de este sistema de anestesia en forma mas rutinaria para beneficio de nuestros pacientes.