[Diagnostic usefulness of N-terminal brain natriuretic peptide in patients admitted to a cardiology service]. / Utilidad diagnóstica del fragmento N-terminal del propéptido natriurético cerebral en los pacientes ingresados en un servicio de cardiología.

BACKGROUND AND OBJECTIVE: The N-terminal brain natriuretic peptide (NT-proBNP) is a new tool for the diagnosis of patients with evidence of heart failure (HF). The diagnosis of HF is improbable in patients with a level of NT-proBNP<300 pg/ml. Our objective is to determine the validity of the cut-off points proposed by literature (inclusion/exclusion) regarding the age for NT-proBNP in patients admitted to our service. PATIENTS AND METHOD: We gathered consecutively the data of 76 patients admitted to our service with the diagnosis of HF (n=37) and with other diseases (n=39), taking a sample of plasma to determine NT-proBNP. We studied the sensitivity, specificity and predictive values of this test, as well as the relation between the levels of that marker and the clinical and echocardiographic variables. RESULTS: The ventricular diameter was larger and the ejection fraction was lower in patients with HF. Sensitivity for the diagnosis of exclusion reached a value of 97% and the negative predictive value was 94%. CONCLUSIONS: The cut-off point proposed for exclusion (300 pg/ml) shows high sensitivity and negative predictive value in the diagnosis of HF in patients admitted to our service.

Infective endocarditis in patients with oncological diseases. / Endocarditis infecciosa en pacientes con enfermedades oncológicas.

INTRODUCTION: Cancer patients may constitute a special risk group for the development of infective endocarditis (IE) because they are often subjected to invasive procedures. The aim of this study is to determine the differential clinical profile and prognosis of patients with IE and cancer. METHODS: A retrospective observational study was conducted on all patients consecutively diagnosed with IE in a single centre between 2005 and 2015. A comparative analysis was performed between patients with cancer and those free of disease, as well as a long-term follow-up. RESULTS: There were 208 IE cases, of which 32 had a cancer diagnosis. There were no significant differences in age (67.5 [59.2-74] vs. 64 [51-74] years). The Charlson comorbidity index was same whether cancer was diagnosed or not (4 [2.2-5] vs. 3.9 [2-5]). IE in cancer patients was mainly associated with health care (59.5% vs 24.4%, P<.001). Staphylococcus aureus was the main causative agent (35%), and the tricuspid location was three times more common (18.8% vs. 6.2%). Surgery was not performed in 18.7% of patients, despite having an indication, compared with 7.4% of patients without cancer. In-hospital mortality for cancer patients was 45.5%, and the probability of survival at one year was 40%. CONCLUSIONS: IE in patients with cancer is predominantly caused by staphylococci, and has high early mortality. Although it is often related to health care, patients are limited from the therapeutic point of view.

Aortic valve tethering: embryonic remnant of a common origin?

A 14-year-old asymptomatic girl without relevant medical history was referred to our department for heart murmur evaluation. The echocardiogram showed cardiac chambers with normal size and function. Noteworthy was the presence of an apparently fibrous tissue joining the ventricular surfaces of the aortic non-coronary and right coronary leaflets with the anterior mitral leaflet. Both valves were slightly thickened and there was a mild anterior mitral valve 'billowing' causing an eccentric mild-to-moderate regurgitant jet. During systole, tethering of this tissue caused the incomplete opening of both mentioned aortic leaflets, causing a turbulent flow with no significant gradient across the valve. During diastole, moderate eccentric aortic regurgitation jet was noted, probably related to incomplete coaptation at the insertion point of this anomalous tissue. We speculate that this finding may represent the remnant of some tissue during heart development that abnormally persisted in this young lady.