[Evolution of antimicrobial resistance and mortality in Staphylococcus aureus endocarditis during 15 years in a university hospital]. / Evolución de la resistencia antimicrobiana y mortalidad en la endocarditis por Staphylococcus aureus durante 15 años en un hospital universitario.

OBJECTIVE: One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. METHODS: Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. RESULTS: Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04). CONCLUSIONS: We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.

Síndrome de Twiddler / Twiddler's syndrome

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Comentarios al artículo «Accesibilidad al sistema sanitario de los pacientes diabéticos con síndrome coronario agudo con elevación del segmento ST» / Comments to article ‘Accessibility to health care of diabetic patients with ST-segment elevation acute coronary syndrome’

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Anatomía angiográfica femoral y complicaciones derivadas del cateterismo cardiaco / Femoral angiographic anatomy and complications arising from cardiac catheterisation

INTRODUCCIÓN: Las complicaciones vasculares derivadas del cateterismo cardiaco por vía femoral prolongan la estancia hospitalaria y ponen en peligro la integridad de los pacientes. Conocer la anatomía angiográfica podría ayudar a predecir la aparición de complicaciones. OBJETIVOS: Averiguar los factores relacionados con una anatomía angiográfica femoral desfavorable para el acceso vascular y si ésta se asocia a una mayor frecuencia de complicaciones derivadas del cateterismo cardiaco. MÉTODOS: Estudio observacional prospectivo de todos los pacientes a los que se les realizó cateterismo por vía femoral entre mayo de 2011 y abril de 2012 en un hospital universitario. Se analizaron las variables relacionadas con una anatomía vascular desfavorable y con la aparición de complicaciones derivadas del procedimiento. RESULTADOS: Entre 917 procedimientos se produjeron 35 complicaciones (3,8%). Los pacientes con una angiografía femoral de riesgo presentaban mayor edad (67 [60-76] vs 65 [55-73] años, p < 0,001), menor aclaramiento de creatinina (73,6 [54-95,2] vs 84,4 [64-106,8] ml/min, p < 0,001) y mayor frecuencia de diabetes (47,7 vs 35,1%, p < 0,001). Aunque una anatomía vascular desfavorable no se asoció significativamente con la aparición de complicaciones (5,4 vs 3,1%, p = 0,103), los operadores la tomaron en cuenta para decidir el tipo de hemostasia posterior. En el análisis multivariable solo fue significativo el cruce de heparinas (OR = 3,19; IC 95%, 1,44-7,06; p = 0,004). CONCLUSIONES: La edad, la diabetes y la función renal se asocian a un acceso femoral desfavorable. Las complicaciones del cateterismo no se relacionan con la anatomía angiográfica, aunque esta es útil para el manejo del punto de acceso

INTRODUCTION: Vascular complications during cardiac catheterization using the femoral artery extend hospital stay and jeopardize the integrity of patients. Knowing the angiographic anatomy could help to predict the development of complications. OBJECTIVES: To investigate the factors associated with unfavorable femoral anatomy and vascular access, and whether it is associated with more complications during cardiac catheterization. METHODS: Prospective observational study of all patients who underwent catheterization between May 2011 and April 2012 at a university hospital. We analyzed the variables related with an unfavorable vascular anatomy and with the development of complications arising from the procedure. RESULTS: Of the 917 procedures, there were 35 complications (3.8%). Patients with femoral angiography were older (67 [60-76] vs 65 [55-73] years, P<0.001), with lower creatinine clearance (73.6 [54-95.2] vs 84.4 [64 to 106.8] mL/min, P<0.001), and higher frequency of diabetes (47.7 vs. 35.1%, P<0.001). Although unfavorable vascular anatomy was not significantly associated with the occurrence of complications (5.4 vs 3.1%, P=0.103), operators took it into account when choosing the type of subsequent hemostasis. In the multivariate analysis only crossing heparins was significantly related with the development of complications (OR = 3.19, 95% CI, 1.44 to 7.06, P=0.004). CONCLUSIONS: Age, diabetes and kidney function are associated with an unfavorable femoral access. Catheterization complications are not directly related to the angiographic anatomy, although it is useful for management of the access point

Diagnóstico de una taquicardia supraventricular en el seno de la corrección quirúrgica de un pectus carinatum / Diagnosis of supraventricular tachycardia during surgical correction of pectus carinatum

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Impact of mild pulmonary hypertension on mortality and pulmonary artery pressure profile after heart transplantation.

BACKGROUND: Pulmonary hypertension is a risk factor for early mortality after transplantation, but the risk threshold is debated. Also, little is known about the evolution of pulmonary circulation after transplantation. The aim of this study was to determine the influence of current risk pulmonary pressure parameters on early post-operative mortality and to assess the time-related changes in pulmonary pressure after surgery. METHODS: One hundred twelve consecutive transplanted patients were studied retrospectively to determine the influence of trans-pulmonary gradient of >12 mm Hg and pulmonary vascular resistance of >2.5 Wood units, at baseline or after vasodilator test, on early mortality. A multivariate analysis was used to study the hemodynamic parameters associated with early mortality. The pulmonary pressures of all surviving patients were studied for up to 3 years after surgery. RESULTS: Early mortality in the groups with and without pulmonary hypertension were 24.4% and 5.6%, respectively (p =.009). The only variable that was independently associated with early mortality was the pulmonary vascular resistance index (odds ratio = 1.459). Mild pulmonary hypertension disappeared 1 year after heart transplantation. CONCLUSIONS: Mild pulmonary hypertension is a risk factor for early postoperative mortality. The hemodynamic parameter most closely associated with early mortality is pulmonary vascular resistance index. The hemodynamic profile of pulmonary circulation after heart transplantation is partially dependent on the level of pulmonary hypertension before transplantation, at least during the first year after surgery.

[Pulmonary arterial hypertension and heart transplantation: hemodynamic evolution and survival]. / Hipertensión arterial pulmonary y trasplante cardíaco: evolución hemodinámica y supervivencia.

BACKGROUND: Patients with chronic heart failure and pulmonary arterial hypertension are at risk of developing fatal right graft failure after transplantation, and there is no agreement about the limit of pulmonary vascular resistance for such risk. PURPOSE: To study what the impact is on the survival of a degree of pulmonary hypertension not considered to be an exclusion for orthotopic heart transplantation and to analyze the hemodynamic profile in the minor circuit after surgery. PATIENTS AND METHODS: We studied a group of 69 patients consecutively transplanted and with followup of at least one year. Patients were classified in two groups depending on the hemodynamic factors previous to transplant: group A (without pulmonary hypertension, 22 patients) and group B (with pulmonary hypertension, 47 patients). After heart transplantation we analyzed the causes of mortality and the evolution hemodynamic profile in both groups. RESULTS: In the group of patients with pulmonary hypertension there was an increase in perioperative mortality due to graft failure (p < 0.05), although at the end of the first year, the survival rate was similar in both groups. After heart transplantation, the level of pulmonary pressures dropped in the same group, but at the end of the first year, a 17% of the patients maintains some criteria of pulmonary hypertension. CONCLUSIONS: Our results confirm that degrees of pulmonary hypertension classically not considered as an exclusion for orthotopic heart transplantation were associated with an increase mortality by graft failure. The majority of survivors after heart transplantation normalize pulmonary pressures at one year of transplantation.

[Immediate hemodynamic response to atrioventricular+ stimulation in severe hypertrophic obstructive myocardiopathy]. / Respuesta hemodinámica inmediata a la estimulación bicameral en la miocardiopatía hipertrófica obstructiva severa.

INTRODUCTION AND OBJECTIVES: Atrial synchronized ventricular pacing has shown to be an alternative to surgery in the therapeutic management of obstructive hypertrophic cardiomyopathy. Our purpose is the analysis of the hemodynamic mechanisms associated with the reduction of left ventricular outflow tract gradient and the changes in left ventricular diastolic function induced by dual-chamber pacing. PATIENTS AND METHODS: We studied twenty patients (age range 40-78 years; mean 63 +/- 10), who were evaluated while receiving their current medication with cardiac catheterization and angiography, at baseline and under dual-chamber pacing. RESULTS: The atrioventricular delay was 127 +/- 26 ms. The subaortic gradient was reduced from 96 +/- 38 to 36 +/- 28 mmHg (p < 0.001), the ejection period index was shortened from 523 +/- 26 to 491 +/- 30 ms (p < 0.001) and the left ventricular end-diastolic pressure fell from 22 +/- 6 to 13 +/- 5 mmHg (p < 0.001). There was no remarkable change in cardiac output. The median wedge pressure decreased from 17 +/- 5 to 12 +/- 2.5 mmHg (p < 0.01), the pulmonary systolic pressure from 39 +/- 15 to 30 +/- 10 mmHg (p < 0.01), the pulmonary diastolic pressure from 19 +/- 5 to 13 +/- 4 mmHg (p < 0.01) and the right ventricular end-diastolic pressure from 7 +/- 3 to 5 +/- 3 mmHg (p < 0.05). The left ventricular ejection fraction was reduced from 79 +/- 6 to 72 +/- 6 per cent (p < 0.001). The initial ejection fraction diminished from 49 +/- 13 to 34 +/- 13 per cent (p < 0.01), the early diastolic filling increased from 39 +/- 11 to 52 +/- 10 per cent (p < 0.001) and the atrial contribution was reduced from 36 +/- 10 to 24 +/- 10 per cent (p < 0,001). The degree of mitral regurgitation changed from 1.4 +/- 1.2 to 0.7 +/- 0.9 (p < 0.01). CONCLUSIONS: There is an obstruction in the left ventricular outflow tract in patients with obstructive hypertrophic cardiomyopathy that is relieved with dual-chamber pacing. The reduction in the intraventricular pressure seems to improve the ventricular relaxation and the diastolic function. The decrease in the degree of mitral regurgitation and the improvement in diastolic function diminish pulmonary capillary and right circuit pressures.

[Pharmacologic maintenance of sinusal rhythm and/or control of the ventricular response in patients with atrial fibrillation or flutter]. / Mantenimiento farmacológico del ritmo sinusal y/o control de la respuesta ventricular en pacientes con fibrilación o flutter auricular.

Atrial fibrillation is the most common cardiac arrhythmia and is usually responsible for symptoms requiring some treatment. Antiarrhythmic drugs are the first choice therapy, but their potential risks are significant. This together with their limited efficacy restricts their use. Antiarrhythmic drug use should be tailored; mainly according to the underlying heart disease. When reversion to sinus rhythm is not eligible, the adequate control of ventricular rate and the reduction of embolic risk are the therapeutic goals. Atrial flutter shows different behaviour regarding the very limited efficacy of antiarrhythmic drugs for reversion to and maintenance in sinus rhythm.