Clinical Characteristics and Outcomes of Patients with Heart Failure of Hypertensive Etiology: Analysis of Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Arterial hypertension represents one of the main comorbidities observed in patients with heart failure (HF) and one of the main risk factors for its development. Despite this, studies assessing this hypertensive etiology are scarce in Latin America. Our objective was to analyze the prevalence of HF of hypertensive etiology and evaluate its prognosis in patients enrolled in the Colombian Heart Failure Registry (RECOLFACA by its Spanish acronym). METHODS: RECOLFACA recruited adult patients diagnosed with HF in 60 centers in Colombia between 2017 and 2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess factors associated with primary outcomes in patients with hypertensive HF. A p value <0.05 was considered significant. All statistical tests were two-tailed. RESULTS: Out of the total number of patients evaluated in RECOLFACA (n = 2,514), 804 had a diagnosis of HF with hypertensive etiology (31.9%). These patients were less frequently males and had a significantly older age and lower prevalence of comorbidities than those with HF of other etiologies. Additionally, patients with hypertensive HF had a higher prevalence of HF with preserved ejection fraction (HFpEF) (34.1% vs. 28.3%; p = 0.004). Finally, type 2 diabetes mellitus, chronic obstructive pulmonary disease diagnosis, and NYHA class IV were classified as independent mortality risk factors. CONCLUSIONS: Hypertensive HF represents about one-third of the total number of patients with HF in RECOLFACA. Compared with HF of other etiologies, it presents a differential clinical profile - older age and a higher prevalence of HFpEF. RECOLFACA has become a useful tool to characterize patients with HF in Colombia, with which it has been possible to carry out a more specific search and reach the diagnosis of this pathology in our population, and it has served as an example to stimulate registries of patients with HF in other countries in the region.

Characterization of Patients With Heart Failure of Chagas Etiology in Colombia: An Analysis Based on the Colombian Registry of Heart Failure (RECOLFACA).

Chronic Chagas cardiomyopathy (CCM) represents a relevant origin of Heart Failure (HF) in countries where the disease is endemic. CCM exhibits distinct myocardial involvement and is associated with a poorer prognosis compared to different HF etiologies. The aim is to explain the features and prognosis of individuals with HF resultant to CCM registered in the Colombian Registry of Heart Failure (RECOLFACA). RECOLFACA registry enrolled 2528 adult patients with HF. A comparison was made between patients diagnosed with CCM and those diagnosed with other etiologies of HF. Eighty-eight patients (3.5%) present CCM diagnosis. The individuals diagnosed with both HF and CCM were notably younger in age, had less comorbidities, poorer functional class, and significantly inferior ejection fraction. Finally, the presence of CCM diagnosis was linked to a substantially elevated mortality risk throughout the follow-up period (HR 2.01; 95% CI, 1.01-4.00) according to a multivariate model adjusted. CCM represents an important etiology of HF in Colombia, drawing attention to a distinct clinical profile and a higher risk of mortality compared to other HF etiologies.

Analysis of 101 Mechanical Failures in Distal Femur Fractures Treated with 3 Generations of Precontoured Locking Plates.

OBJECTIVES: To evaluate mechanical treatment failure in a large patient cohort sustaining a distal femur fracture treated with a distal femoral locking plate (DFLP). DESIGN: This retrospective case-control series evaluated mechanical treatment failures of DFLPs. SETTING: The study was conducted at 8 Level I trauma centers from 2010 to 2017. PATIENTS AND PARTICIPANTS: One hundred one patients sustaining OTA/AO 33-A and C distal femur fractures were treated with DFLPs that experienced mechanical failure. INTERVENTION: The intervention included the treatment of a distal femur fracture with a DFLP, affected by mechanical failure (implant failure by loosening or breakage). MAIN OUTCOME MEASURE: The main outcome measures included injury and DFLP details; modes and timing of failure were studied. RESULTS: One hundred forty-six nonunions were found overall (13.4%) including 101 mechanical failures (9.3%). Failures occurred in different manners, locations, and times depending on the DFLPs. For example, 33 of 101 stainless steel (SS) plates (33%) failed by bending or breaking in the working length, whereas no Ti plates failed here ( P < 0.05). Eleven of 12 failures with titanium-Less Invasive Stabilization System (92%) occurred by lost shaft fixation, mostly by the loosening of unicortical screws (91%). Sixteen of 44 variable -angled-LCP failures (36%) occurred at the distal plate-screw junction, whereas only 5 of 61 other DFLPs (8%) failed this way ( P < 0.05). Distal failures occurred on average at 23.7 weeks compared with others that occurred at 38.4 weeks ( P < 0.05). Variable -angled-LCP distal screw-plate junction failures occurred earlier (mean 21.4 weeks). CONCLUSION: Nonunion and mechanical failure occurred in 14% and 9% of patients, respectively, in this large series of distal femur fracture treated with a DFLP. The mode, location, presence of a prosthesis, and timing of failure varied depending on the characteristics of DFLP. This information should be used to optimize implant usage and design to prolong the period of stable fixation before potential implant failures occur in patients with a prolonged time to union. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Characteristics and Outcomes of Heart Failure Patients from a Middle-Income Country: The RECOLFACA Registry.

Background: There is a lack of epidemiological data around heart failure (HF) in Latin America; the potential impact description of this disease in middle-income countries is relevant. Objective: This study aimed to describe the characteristics and healthcare resource utilization patterns of HF patients at baseline and six-month follow-up. Methods: This retrospective observational study used data from the RECOLFACA (Registro Colombiano de Falla Cardíaca) registry, which includes data obtained from the examination of clinical records from 2,528 patients in 60 Colombian healthcare institutions. Baseline and six-month follow-up data were evaluated from patients with previous hospital admissions due to HF during the 12 months prior to enrollment. Results: This study analyzed 2,045 patients (42.8% female) with a mean age of 67.71 ± 13.64 years. The most common etiologies were ischemic (44.4%) and hypertensive heart disease (38.5%). At baseline, 53.4% of patients were classified with NYHA class II, and 73.6% had a reduced left ventricle ejection fraction (LVEF). A year prior to entering the registry, patients were hospitalized an average of 1.4 ± 1.1 times due to HF. Prescription of evidence-based treatment at baseline included sacubitril/valsartan (10%), ACEI (33%), ARB (41%), beta-blocker (79%), diuretics (68%), and MRA (56%). The average quality of life score measured using the EQ-5D-3L questionnaire was 78.7 ± 20.8 at baseline and 82.3 ± 20.1 at the six-month follow-up. The mortality rate was 6.7%. Conclusions: The use of information from the RECOLFACA registry allowed characterization as well as analyses of healthcare resource utilization of patients with heart failure in Colombia. The results of this study show that multiple evidence-based treatments for HF are being widely used in Colombia, but there seems to be room for improvement regarding some interventions for the treatment of patients with HF.

Predictores de mortalidad en pacientes hospitalizados con fibrilación auricular en un hospital universitario / Mortality predictors in patients with atrial fibrillation admitted into a University Hospital

Resumen Introducción: La fibrilación auricular es la arritmia cardíaca sostenida más común. Se espera que su incidencia aumente mundialmente dado el envejecimiento de la población. Esta se asocia con el incremento de la morbimortalidad y las hospitalizaciones. En Colombia no se han estudiado predictores de mortalidad intrahospitalaria en pacientes con fibrilación auricular, de modo que se llevó a cabo un estudio analítico que muestra las variables demográficas, clínicas y ecocardiográficas predictoras de mortalidad en esta población. Métodos: Se hizo un estudio analítico de tipo observacional. Los datos se recolectaron a través de la base de datos Registro Colombiano de Enfermedad Cardiovascular. Se tuvieron en cuenta 830 historias clínicas de pacientes hospitalizados con diagnóstico de fibrilación auricular. Para evaluar las variables relacionadas con la mortalidad intrahospitalaria se construyeron tres modelos de regresión logística multivariable. Resultados: Se obtuvieron tres modelos de regresión logística multivariable para predecir mortalidad global, por causas cardiovasculares y no cardiovasculares. El ingreso por fibrilación auricular fue un factor protector para mortalidad global (OR = 0,2 95% IC = 0,07-0,57, p .003) y no cardiovascular (OR = 0,29 95% IC = 0,09-0,99, p .048). El grosor del septum interventricular tuvo una correlación positiva con mortalidad global (OR = 5,89 95% IC = 1,46-23,66, p .013). El infarto agudo de miocardio asociado tuvo una relación positiva con mortalidad cardiovascular (OR = 5,29 95% IC = 2,05-13,70, p .001). La infección asociada fue predictora para los tres desenlaces. Conclusiones: Los resultados permiten conocer predictores de mortalidad en los pacientes hospitalizados con fibrilación auricular en nuestro medio. Los pacientes que no fueron hospitalizados por esta arritmia como causa principal tuvieron un aumento del riesgo de mortalidad global en 5 veces y de mortalidad no cardiovascular en 3,4 veces.

Abstract Introduction: Atrial fibrillation is the most common sustained cardiac arrhythmia. Its incidence is expected to increase worldwide due to the aging of the population. This is associated with an increase in morbidity and mortality and hospital admissions. In-hospital mortality predictors have not been studied in patients with atrial fibrillation. For this reason, an analytical study is carried out that shows the demographic, clinical and echocardiographic variables, predictors of mortality in this population. Methods: An observational, analytical study was conducted on data collected from the Colombian Cardiovascular Disease Registry data base. It took into account 830 medical records of patients admitted to hospital with a diagnosis of atrial fibrillation. Three logistic multivariate regression models were constructed in order to evaluate the variables associated with hospital mortality. Results: Three logistic multivariate regression models were obtained to predict the overall mortality due to cardiovascular and non-cardiovascular causes. Hospital admission due atrial fibrillation was a protective factor for overall mortality (OR = 0.2; 95% CI = 0.07-0.57, P = .003) and non-cardiovascular mortality (OR = 0.29; 95% CI = 0.09-0.99, P = .048). The thickness of the inter-ventricular septum had a positive correlation with overall mortality (OR = 5.89, 95% CI = 1.46-23.66, P = .013). The associated myocardial infarction had a positive relationship with cardiovascular mortality (OR = 5.29; 95% CI = 2.05-13.70, P = .001). The associated infection was a predictor for the three outcomes. Conclusions: The results show the predictors of mortality in patients admitted to hospital with atrial fibrillation in this region. Patients that were not admitted to hospital for this arrhythmia as a primary cause had a 5 times risk of overall mortality, and a 3.4 times risk of non-cardiovascular mortality.

Características clínicas de pacientes con falla cardiaca aguda según la función ventricular izquierda / Clinical characteristics of acute heart failure patients according to left ventricular function

Resumen Introducción: la insuficiencia cardiaca aguda es la causa más frecuente de hospitalización en pacientes mayores de 65 años. A la fecha se han publicado pocos estudios descriptivos en la población colombiana, por lo que se realizó un estudio observacional que expone las características clínicas de los pacientes con diagnóstico de falla cardiaca aguda en Colombia. Métodos: se hizo un estudio observacional tipo corte-transversal con información obtenida de historias clínicas de pacientes con diagnóstico de falla cardiaca aguda entre los años 2011 a 2015 en la Fundación Santa Fe de Bogotá. Estos datos se recolectaron a través del Registro Colombiano de Enfermedad Cardiovascular (RECODEC). Resultados: se analizaron los datos de 550 pacientes, con un promedio de edad de 77 años. El análisis univariado evidenció mayor prevalencia de la enfermedad en hombres (55%) y una importante relación con hipertensión arterial (78,2%), enfermedad coronaria (31,8%) y fibrilación auricular (29,6). En cuanto a la estancia hospitalaria, se observó un promedio de 8 días en hospitalización general y de 1 día en la unidad de cuidado intensivo. En el análisis bivariado se dividieron los pacientes en tres grupos según la fracción de eyección del ventrículo izquierdo: disminuida (<40%), limítrofe (41-49%) y preservada (>50). Como desenlaces finales se evaluaron mortalidad (8,4%) y aparición de arritmias (22,5%). Conclusiones: el análisis de la base de datos de RECODEC se ha utilizado para evaluar los aspectos epidemiológicos y clínicos de la enfermedad cardiovascular. Existe la necesidad de crear registros nacionales que en general permitan analizar el comportamiento de la población colombiana.

Abstract Introduction: Acute heart failure is the most frequent cause of hospital admissions in patients over 65 years-old. Only few descriptive studies have been published on the Colombian population. The aim is to carry out an observational study that determines the clinical characteristics of patients with acute heart failure in a hospital in Colombia. Methods: An observational, cross-sectional study was conducted using information from clinical records of patients diagnosed with acute heart failure between 2011 and 2015 in our Foundation. These data were collected using the Colombian Registry of Cardiovascular Disease (RECODEC). Results: The analysis was performed on the data from 550 patients, with a median age of 77 years. The univariate analysis showed a higher prevalence of the disease in men (55%), and a significant association with hypertension (78.2%), coronary disease (31.8%), and atrial fibrillation (29.6%). In the bivariate analysis, the patients were divided into three groups according to their left ventricular ejection fraction: decreased (<40%), restricted (41%-49%), and preserved (> 50%), with the preserved ejection fraction being the most prevalent. The main outcomes were mortality (8.4%) and the occurrence of arrhythmias (22.5%). Conclusions: It is important to take into account that the analysis of the RECODEC database has been used to evaluate the epidemiological and clinical aspects of cardiovascular disease. However, there is a need to create registries at a national level in order to analyse the general characteristics of the Colombian population.

Frecuencia de los tipos de infarto agudo de miocardio según la tercera definición / Frequency of myocardial infarction according to the third universal definition

Resumen Introducción y objetivos: El infarto agudo de miocardio (IAM) es una patología muy prevalente con una morbimortalidad significativa en Colombia y en el mundo. Es por esto, que desde el 2011 en la Fundación Santa Fe de Bogotá se inició la recolección de datos demográficos y clínicos de pacientes con patologías cardiovasculares en una base de datos denominada, Registro Colombiano de Enfermedades Cardiovasculares. Actualmente se tienen 736 registrados según el tipo de IAM que presentan de acuerdo a la tercera clasificación de infarto. Por lo anterior, se quiso conocer la frecuencia de cada tipo de infarto en nuestra población y su asociación con diferentes variables. Métodos: Se realizó un estudio descriptivo observacional de corte transversal en el cual se revisaron los datos de los pacientes pertenecientes a RECODEC, evaluando el tipo de IAM que presentaba. Resultados: Se encontró una alta frecuencia para el infarto tipo 1, intermedia para el tipo 2 y baja para los otros tipos de infarto; además una asociación positiva entre ser hombre y presentar infarto tipo 1 (n=427, 85.7% con un OR 1.91 IC95% 1.29-2.82) y una asociación entre infarto tipo 2 y ser mujer (n=51, 21.4% con un OR 0.51 IC95% 0.33-0.76). Conclusiones: Una adecuada clasificación del tipo de infarto permite definir una mejor ruta terapéutica para el paciente y predecir posibles complicaciones. Con este estudio se logró realizar la caracterización de la población en cada grupo establecido por la tercera definición.

Abstract Introduction and objectives: Acute myocardial infarction is a disease associated with a high prevalence and morbidity in Colombia and worldwide. Since 2011, at the Fundación Santa Fe de Bogotá, a registry known as RECODEC began to be used to collect data in order to characterise the population with cardiovascular diseases. A total of 736 patients have currently been registered according to the type of myocardial infarction, taking into account its third universal definition. The application of this definition has been related with an increase in the number of cases diagnosed, with prediction of 10 year mortality, and with improvement of care. The prevalence is presented of each type of infarction and its association with different kind of variables. Methods: A descriptive, observational, cross sectional study was conducted using the patient data from RECODEC registry, in order to evaluate the type of infarction each patient presented. Results: A high prevalence was found for type 1 infarction, with intermediate for type 2, and low for the other types of myocardial infarction. A positive association was also found between being male and having a type 1 infarction (n=427, 85.7% and OR: 1.91, 95% CI: 1.29-2.82, P<.001) and an association between being female and type 2 infarction (n=51, 21.4% and OR: 0.51, 95% CI: 0.33-0.76, P<.001). Conclusions: It is important to classify the type of infarction presented by the patients, so that the type of population that suffers from each type could be characterised, so that it may be possible to offer a more specific treatment for each disease.

Cardiomiopatía periparto / Peripartum cardiomyopathy

Resumen La cardiomiopatía periparto es una causa poco común de la insuficiencia cardiaca aguda por la disfunción sistólica ventricular izquierda en las mujeres que se encuentran en el tercer trimestre del embarazo o durante los meses siguientes al puerperio. Se expone el caso de una paciente de 37 años de edad primigestante con fertilización in vitro que ingresa con cuadro clínico de preeclampsia severa y estado fetal insatisfactorio, llevada a cesárea de emergencia, presentando posteriormente clínica de insuficiencia cardiaca aguda calientehúmeda. Se presenta una revisión de la literatura de esta patología con el diagnóstico, las manifestaciones clínicas, el tratamiento y el pronóstico.

Abstract Peripartum cardiomyopathy is a rare cause for acute heart failure caused by left ventricular systolic dysfunction in women in their third trimester of pregnancy or during the months of the postpartum period. The case of a 37 year-old primiparous patient with in vitro fertilisation is presented; she was admitted with symptoms of severe preeclampsia and fetal distress, hence she was taken for emergency c-section, later showing symptoms of hot-humid acute heart failure. A literature review of this condition with the diagnosis, clinical manifestations, treatment and prognosis is presented.

Implicaciones del endotelio en la insuficiencia cardiaca / Implications of endothelium dysfunction in heart failure

El papel del endotelio en la insuficiencia cardíaca (IC) ha sido el centro de intensa investigación, puesto que tiene importantes implicaciones sistémicas expresadas en su efecto vasomotor, hemostático e inflamatorio. Existen diferencias individuales en el patrón de la disfunción endotelial de acuerdo a la etiología y severidad de la IC. La disfunción endotelial tiene un importante valor pronóstico en la IC y, aunque aún necesitamos conocer más aspectos de relevancia clínica, es evidente que esta condición se relaciona con desenlaces negativos en estos pacientes. Estamos a la espera de nuevos agentes farmacéuticos dirigidos específicamente al endotelio vascular. En esta revisión, nuestro objetivo es ofrecer un análisis crítico y contemporáneo de la evidencia disponible sobre las consecuencias patológicas y pronóstico de las anomalías endoteliales que definen el inicio, la historia natural y, en última instancia, los desenlaces en la IC...

The role of the endothelium in heart failure has been the focus of intense research, since it has important biologic implications. There are individual differences in the pattern of endothelial dysfunction according to the etiology and severity of heart failure. Endothelial dysfunction is also associated with negative outcomes. We are eagerly waiting for new pharmacological agents targeted specifically to the vascular endothelium. In this review, we aim to provide a critical analysis of the available evidence on the pathological consequences and prognosis of endothelial abnormalities as related to the onset and natural history of heart failure...

Cardiomiopatía restrictiva como presentación de amiloidosis / Restrictive cardiomyopathy as a presentation of amyloidosis

La cardiopatía amiloidea es una rara entidad que se puede presentar dentro del contexto de la amiloidosis sistémica. Su presentación clínica tiende a ser tardía, cuando la función cardiaca se encuentra altamente comprometida. Actualmente han surgido herramientas no invasivas que facilitan su diagnóstico. El tratamiento depende del subtipo y en su mayoría comprende medidas de soporte a la falla cardiaca para proteger otros órganos, junto con quimioterapia oral y trasplante autólogo de medula ósea. Adicionalmente, nuevos factores pronósticos se han postulado para su manejo. Se presenta un paciente que ingresó por disnea de rápida progresión, y cuyo cuadro clínico es consistente con falla cardiaca congestiva. Los estudios paraclínicos reportaron hipertrofia concéntrica del ventrículo izquierdo y un patrón de infiltrados ecogénicos en el miocardio con extensa fibrosis. Se diagnóstica cardiomiopatía restrictiva secundaria a amiloidosis AL. A partir del caso, se describen las características de la enfermedad y los nuevos adelantos en su manejo (Acta Med Colomb 2010; 35: 126-131).

Cardiac amyloidosis is a rare disease that may occur as a component of systemic amyloidosis. Its symptomatic phase usually presents when cardiac function is highly compromised. Recently, some non-invasive diagnostic tools have emerged improving diagnosis. Treatment for this disease depends on its subtype. In most cases, it consists on supportive measures to improve heart failure and organ function, in addition with oral chemotherapy and autologous stem-cell transplantation. Alongside, new prognostic factors have been introduced. As an example, a clinical case about a patient who develops rapid-progression dyspnea and congestive heart failure is described. The ecocardiographic report stated a left ventricular concentric hypertrophy and ecogenic infiltrate patterns associated with extensive fibrosis. This leaded to the diagnosis of cardiac amyloidosis secondary to systemic amyloidosis. Based on this case, characteristics and new advances in its management are presented (Acta Med Colomb 2010; 35: 126-131).