Noninvasive Prediction of Pulmonary Capillary Wedge Pressure in Patients With Normal Left Ventricular Ejection Fraction: Comparison of Cardiac Magnetic Resonance With Comprehensive Echocardiography.

BACKGROUND: Cardiac magnetic resonance (CMR) was recently reported to predict mean pulmonary capillary wedge pressure (PCWP). However, there is a paucity of data on its accuracy for estimation of PCWP in patients with normal left ventricular (LV) ejection fraction (EF). We sought to examine its accuracy against the invasive gold standard and to compare it with the accuracy of comprehensive echocardiography. METHODS: Stable patients with EF of ≥50% who underwent right heart catheterization, CMR, and echocardiographic imaging within 1 week were included. Pulmonary capillary wedge pressure was estimated by CMR using a previously validated equation where PCWP is estimated based on the left atrial maximum volume and LV mass. Echocardiographic estimation of PCWP was based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines, taking into account the presence of myocardial disease. RESULTS: The mean age of the 79 patients was 55 ± 15 years, and 58.2% were female. There were 33 patients with PCWP >15 mm Hg by right heart catheterization. Cardiac magnetic resonance prediction of PCWP had an area under the curve (AUC) = 0.72. In comparison, echocardiographic prediction of PCWP showed a higher accuracy (AUC = 0.87 vs AUC = 0.72; P = .008). CONCLUSIONS: In patients with normal LV EF, CMR estimation of mean PCWP based on LV mass and left atrial volume has modest accuracy for detecting patients with mean PCWP >15 mm Hg. Comprehensive echocardiography predicts elevated PCWP with higher accuracy in comparison with CMR.

The Beneficial Effects of Inoculation with Selected Nodule-Associated PGPR on White Lupin Are Comparable to Those of Inoculation with Symbiotic Rhizobia.

Nodule endophytes and associated bacteria are non-symbiotic bacteria that colonize legume nodules. They accompany nodulating rhizobia and can form beneficial associations, as some of them are plant growth-promoting rhizobacteria (PGPR) that are able to promote germination and plant growth and increase tolerance to biotic and abiotic stress. White lupin (Lupinus albus) is a legume crop that is gaining relevance as a suitable alternative to soybean as a plant protein source. Eleven nodule-associated bacteria were isolated from white lupin nodules grown in a Tunisian soil. They belonged to the genera Rhizobium, Ensifer, Pseudomonas and Bacillus. Their plant growth-promoting (PGP) and enzymatic activities were tested in vitro. Strains Pseudomonas sp., L1 and L12, displayed most PGP activities tested, and were selected for in planta assays. Inoculation with strains L1 or L12 increased seed germination and had the same positive effects on all plant growth parameters as did inoculation with symbiotic Bradyrhizobium canariense, with no significant differences among treatments. Inoculation with efficient nitrogen-fixing rhizobia must compete with rhizobia present in the soil that sometimes nodulate efficiently but fix nitrogen poorly, leading to a low response to inoculation. In such cases, inoculation with highly effective PGPR might represent a feasible alternative to boost crop productivity.

Factores asociados a resultados funcionales en pacientes con ictus isquémico tratados con trombolisis endovenosa en un hospital del Perú / Factors associated with the functional outcome of patients with ischemic stroke treated with intravenous thrombolysis in a Peruvian hospital

Resumen Objetivo: Describir el tratamiento del ictus isquémico agudo con reperfusión endovenosa y determinar los factores asociados al rendimiento funcional de pacientes sometidos a trombolisis en un hospital peruano. Material y Métodos: Estudio prospectivo y longitudinal de una cohorte de pacientes con ictus isquémico que recibieron rtPA en un periodo de 3 años. Se evaluó la relación entre datos demográficos y clínicos y el estado funcional a los 3 meses de la intervención. La asociación del pronóstico funcional se valoró mediante el modelo de regresión simple y multivariado de Poisson, y el Riesgo Relativo (RR) con un intervalo de confianza (IC) al 95%, como medida de asociación. Resultados: Durante el periodo del estudio, 74 pacientes (1.19% del total) recibieron el tratamiento. El 68,18% logró independencia funcional (mRS 0-2) a los 90 días. La mortalidad fue de 6 % y un 3% mostró hemorragia intracerebral (HIC). Glicemia >140 mg/dl (OR 5,12; 1,31-20,02; p=0,019) e infarto de tipo posterior (OR 7,47; 1,01-55,15; p =0,04) se asociaron a un mayor riesgo de dependencia funcional. Conclusiones: En la cohorte estudiada, la mayoría de los pacientes alcanzaron independencia funcional a los 3 meses de tratamiento trombolítico. La hiperglicemia (>140gr/dl) y el infarto vertebro-basilar se asociaron con un mayor riesgo de dependencia funcional.

SUMMARY Objective: To describe the treatment of acute ischemic strokes with intravenous rtPA and determine the factors associated with the functional outcomes of patients treated with thrombolysis in a Peruvian hospital. Material and Methods: A prospective, longitudinal cohort study of patients with ischemic stroke who received rtPA over a period of 3 years was performed. The association of demographic and clinical data with functional status was assessed 3 months after the intervention. Simple and multivariate Poisson regression models were performed to evaluate associations with functional prognosis, and Relative Risk (RR) with a 95% confidence interval (CI) was used as a measure of association. Results: During the study period, 74 patients (1.19% of the total) received IV thrombolysis, and 68.18% of them achieved functional independence (mRS 0-2) at 90 days. We found a mortality of 6%, an intracerebral hemorrhage (ICH) rate of 3%. Glycemia >140 mg/dl (OR 5.12; 1.31-20.02; p = 0.019), and posterior circulation infarcts (OR 7.47; 1.01-55.15; p = 0,04) were associated with an increased risk of functional dependency. Conclusions: In the studied cohort, most of the patients who underwent thrombolytic therapy achieved a functional independence at 3 months. Hyperglycemia (>140gr/dl) and vertebro-basilar infarcts were associated with an increased risk of functional dependence.

Uso de fribrinoliticos en la enfermedad cerebrovascular isquemica, resultados de una serie de 23 pacientes. Hospital Nacional Guillermo Almenara Irigoyen / Fribrinoliticos use in cerebrovascular disease ischemic, results of a series of 23 patients. Guillermo Almenara Irigoyen National Hospital

Con el objetivo de describir los resultados del uso de fibrinolíticos (alteplase endovenoso o rtPA) en pacientes con ECV isquemico, se realizó un estudio descriptivo, observacional y prospectivo en 23 pacientes que fueron diagnosticados con ECV isquemico, además se describieron los principales factores de riesgo y los porcentajes de recuperación usando las escalas de Rankin y Barthel modificados. Se encontró que el factor de riesgo más frecuente fue la hipertensión arterial. El tiempo total desde que se presentaron los síntomas hasta la administración del tratamiento tuvo una media de 168,78 minutos, la escala de NISSH aplicada a los pacientes tuvo un promedio de 2,1 puntos a las 24 horas, 1,26 puntos a los 7 días y 0,5 puntos a los 3 meses, 20 de los pacientes trombolisados obtuvieron un puntaje de 0-2 en la escala de Rankin de y de >95 en la escala de Barthel. Finalmente concluimos que el uso de fibrinoliticos en pacientes con ECV isquemico produce mejoría clínica y menor discapacidad evaluados por las escalas de Rankin y Barthel modificados. (AU)

In order to describe the results of the use of fibrinolytic (alteplase intravenous or rtPA) in patients with ischemic CVD, a descriptive, observational and prospective study was performed in 23 patients who were diagnosed with ischemic CVD, also were described the main risk factors and recovery rates using the modified Rankin scale Barthel. It was found that the most common risk factor was hypertension. The total time since the symptoms appeared to treatment administration had an average of 168.78 minutes, NISSH scale applied to the patients had an average of 2.1 points at 24 hours, to 1.26 points 7 days and 0.5 points at 3 months, 20 patients trombolisados average score was 0-2 at the Rankin scale and> 95 on the Barthel scale. Finally we conclude that the use of fibrinolytic in patients with ischemic CVD produces clinical improvement and less disability assessed by the modified Rankin scale Barthel. (AU)

Fisiopatología de la insuficiencia cardíaca diastólica / Pathophysiology of diastolic heart failure

Se discuten las principales características clínicas y fisiopatológicas de la insuficiencia cardiaca diastólica así como los factores intrínsecos y extrínsecos que pueden precipitarla o empeorarla.