Vericiguat en insuficiencia cardíaca: de la evidencia científica a la práctica clínica / Vericiguat in heart failure: from scientific evidence to clinical practice

A pesar de los tratamientos actuales, el riesgo de muerte y hospitalizaciones en pacientes con insuficiencia cardíaca con fracción de eyección reducida (IC-FEr) sigue siendo elevado. La fisiopatología de la IC-FEr incluye activación neurohormonal caracterizada por la estimulación de las vías deletéreas (sistemas simpático y renina-angiotensina-aldosterona) y la supresión de las vías protectoras como las dependientes del óxido nítrico. La inhibición o estimulación de algunas de estas vías, pero no de todas, es insuficiente. En la IC-FEr existe una menor actividad de óxido nítrico, guanilato ciclasa soluble y GMPc que provoca efectos deletéreos a nivel miocárdico, vascular y renal. Vericiguat estimula la actividad de esta vía protectora. El estudio VICTORIA demostró, en pacientes con IC-FEr y descompensación reciente, que la adición de vericiguat al tratamiento médico óptimo reducía de forma significativa la incidencia del objetivo primario compuesto de muerte cardiovascular u hospitalización por IC, con un número de 24 pacientes que es necesario tratar, y una excelente tolerabilidad (AU)

Despite currently available treatments, risk of death and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) remains high. The pathophysiology of HFrEF includes neurohormonal activation characterized by stimulation of deleterious pathways (i.e., sympathetic nervous and renin-angiotensin-aldosterone systems) and suppression of protective pathways such as nitric oxide-dependent pathways. Inhibition or stimulation of some, but not all, of these pathways is insufficient. In HFrEF, there is reduced nitric oxide, soluble guanylate cyclase, and cGMP activity, leading to deleterious effects in the myocardial, vascular, and renal systems. Vericiguat is able to stimulate the activity of this protective pathway. The VICTORIA study demonstrated that the addition of vericiguat to optimal medical treatment in patients with HFrEF and recent decompensation significantly reduced the incidence of the primary endpoint, a composite of cardiovascular death or HF hospitalization, with a number needed to treat of 24 patients and excellent tolerability (AU)

Vericiguat in heart failure: From scientific evidence to clinical practice.

Despite currently available treatments, risk of death and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) remains high. The pathophysiology of HFrEF includes neurohormonal activation characterized by stimulation of deleterious pathways (i.e., sympathetic nervous and renin-angiotensin-aldosterone systems) and suppression of protective pathways such as nitric oxide-dependent pathways. Inhibition or stimulation of some, but not all, of these pathways is insufficient. In HFrEF, there is reduced nitric oxide, soluble guanylate cyclase, and cGMP activity, leading to deleterious effects in the myocardial, vascular, and renal systems. Vericiguat is able to stimulate the activity of this protective pathway. The VICTORIA study demonstrated that the addition of vericiguat to optimal medical treatment in patients with HFrEF and recent decompensation significantly reduced the incidence of the primary endpoint, a composite of cardiovascular death or HF hospitalization, with a number needed to treat of 24 patients and excellent tolerability.

Hospitalización por insuficiencia cardíaca durante la pandemia de COVID-19 / Heart Failure hospitalization during COVID-19 pandemic

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¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo? / Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?

Objetivo. Evaluar el efecto a largo plazo de una intervención nutricional en pacientes hospitalizados con insuficiencia cardiaca (IC) y desnutridos. Métodos. Un total de 120 pacientes hospitalizados por IC y desnutridos fueron aleatorizados a recibir o no una intervención nutricional individualizada durante 6 meses. El evento primario fue el combinado de muerte por cualquier causa o reingreso por IC. Se realizó un análisis por intención de tratar y se evaluó el efecto de la intervención a los 24 meses. Resultados. El evento combinado ocurrió en el 47,5% de los pacientes del grupo de intervención y en el 73,8% del grupo control (hazard ratio: 0,45; intervalo de confianza del 95%: 0,28-0,72; p=0,001). Fallecieron el 39% en el grupo de intervención y el 59% en el grupo control (hazard ratio: 0,53; intervalo de confianza del 95%: 0,31-0,89; p=0,017). Conclusión. Una intervención nutricional en pacientes hospitalizados por IC que están desnutridos mantiene su beneficio pronóstico en el seguimiento a largo plazo (AU)

Objective. To assess the long-term effect of nutritional intervention on malnourished, hospitalised patients with heart failure (HF). Methods. A total of 120 malnourished patients hospitalized for HF were randomised to undergo (or not) an individual nutritional intervention for 6 months. The primary event was the combination of all-cause death and readmission for HF. We performed an intent-to-treat analysis and assessed the effect of the intervention at 24 months. Results. The combined event occurred in 47.5% of the intervention group and in 73.8% of the control group (hazard ratio: 0.45; 95% confidence interval: 0.28-0.72; P=.001). Thirty-nine percent of the intervention group and 59% of the control group died (hazard ratio: 0.53; 95% confidence interval: 0.31-0.89; P=.017). Conclusion. A nutritional intervention for malnourished patients hospitalised for HF maintains its prognostic benefit in the long-term follow-up (AU)

Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure? / ¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo?

OBJECTIVE: To assess the long-term effect of nutritional intervention on malnourished, hospitalised patients with heart failure (HF). METHODS: A total of 120 malnourished patients hospitalized for HF were randomised to undergo (or not) an individual nutritional intervention for 6 months. The primary event was the combination of all-cause death and readmission for HF. We performed an intent-to-treat analysis and assessed the effect of the intervention at 24 months. RESULTS: The combined event occurred in 47.5% of the intervention group and in 73.8% of the control group (hazard ratio: 0.45; 95% confidence interval: 0.28-0.72; P=.001). Thirty-nine percent of the intervention group and 59% of the control group died (hazard ratio: 0.53; 95% confidence interval: 0.31-0.89; P=.017). CONCLUSION: A nutritional intervention for malnourished patients hospitalised for HF maintains its prognostic benefit in the long-term follow-up.

Endocarditis infecciosa protésica precoz en el anciano: cambios a lo largo de un periodo de 28 años (1987-2014) / Early prosthetic valve infective endocarditis in the elderly: changes over a 28-year period (1987-2014)

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Do physicians correctly calculate thromboembolic risk scores? A comparison of concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores.

BACKGROUND: Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF). AIM: The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score. METHODS: We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores RESULTS: The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy. CONCLUSION: We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score.

[Differential characteristics of primary acute pericarditis and severe pericardial effusion without tamponade]. / Características diferenciales de las pericarditis agudas primarias con derrame pericárdico severo sin taponamiento.

The aim or our study was to evaluate the main clinical and etiological features or primary acute pericarditis with severe pericardial effusion without cardiac tamponade. Our experience included 35 patients with this problem diagnosed in the last 5 years. Patients with a previous potential etiology for acute pericarditis were excluded. The diagnostic protocol identified a specific etiology in 20% of patients, the most frequent being idiopathic forms. Patients with severe pericardial effusion without cardiac tamponade who had a favourable clinical outcome on nonsteroidal antiinflammatory drugs therapy presented a lower proportion of specific etiology than those with a poor response to this therapy (8% versus 45%; p = 0.03). An exhaustive etiological investigation, including diagnostic pericardiocentesis should be reserved for these patients with unfavourable response to antiinflammatory drug therapy.

Características diferenciales de las pericarditis agudas primarias con derrame pericárdico severo sin taponamiento / Differential characteristics of primary acute pericarditis and severe pericardial effusion without tamponade

El objetivo de este trabajo es evaluar las principales características clínicas y etiológicas de las pericarditis agudas primarias que se inician con derrame severo sin taponamiento. Presentamos nuestra experiencia en 35 pacientes en los últimos 5 años. Todos los pacientes en los que hubiese una causa potencial de pericarditis en la primera valoración clínica fueron descartados. El protocolo diagnóstico encaminado a la búsqueda de una etiología específica ha obtenido un rendimiento global del 20%, siendo, por tanto, las formas idiopáticas las más frecuentes. Los casos con derrame severo y respuesta favorable al tratamiento presentaron menor proporción de etiologías específicas que los que no respondieron al tratamiento con antiinflamatorios no esteroideos (el 8% frente al 45%; p = 0,03). Es, por tanto,en estos últimos en los que se justificaría una investigación etiológica exhaustiva, incluyendo una pericardiocentesis diagnóstica dada la mayor probabilidad de hallar una causa específica de la enfermedad

The aim or our study was to evaluate the main clinical and etiological features or primary acute pericarditis with severe pericardial effusion without cardiac tamponade. Our experience included 35 patients with this problem diagnosed in the last 5 years. Patients with a previous potential etiology for acute pericarditis were excluded. The diagnostic protocol identified a specific etiology in 20% of patients, the most frequent being idiopathic forms. Patients with severe pericardial effusion without cardiac tamponade who had a favourable clinical outcome on nonsteroidal antiinflammatory drugs therapy presented a lower proportion of specific etiology than those with a poor response to this therapy (8% versus 45%; p = 0.03). An exhaustive etiological investigation, including diagnostic pericardiocentesis should be reserved for these patients with unfavourable response to antiinflammatory drug therapy

[Unknown etiology cardiac tamponade. Could some characteristics of the disease define higher probability of specific etiologies?]. / Taponamiento cardíaco sin causa aparente. Existen características de la enfermedad que definan una mayor probabilidad de etiología específica?

INTRODUCTION: Cardiac tamponade without definite cause (one of the forms of primary pericardial disease), always puts the clinician on the alert for the possibility of a specific etiology of disease. PATIENTS AND METHODS: The objectives of this prospective study on 50 patients with primary pericardial disease and cardiac tamponade have been to establish the real incidence of specific etiologies in our environment, as well as the principal clinical manifestations of these patients. All patients were evaluated through an exhaustive diagnostic protocol (including non-invasive diagnostic tests, analysis of the pericardial fluid and in some cases pericardial biopsy) for the search of a specific cardiac tamponade etiology. RESULTS: In our experience it has been most frequent to find a definite etiology in a slightly superior proportion (54%), without differences among the idiopathic and specific forms of cardiac tamponade with regard to the most relevant clinical manifestations, including the aspect and amount of the pericardial fluid and the recurrences of cardiac tamponade. CONCLUSIONS: The disease has no clinical manifestations that establish its etiology: this justifies in-depth etiological research in this group of patients.

Taponamiento cardíaco sin causa aparente. ¿Existen características de la enfermedad que definan una mayor probabilidad de etiología específica? / Unknown etiology cardiac tamponade. Could some characteristics of the disease define higher probability of specific etiologies?

Introducción. El taponamiento cardíaco sin causa aparente (una de las formas de enfermedad pericárdica primaria), siempre alerta al clínico ante la posibilidad de una causa específica de enfermedad. Pacientes y métodos. Los objetivos de este estudio prospectivo de 50 pacientes con enfermedad pericárdica primaria y taponamiento cardíaco han sido conocer la incidencia real de etiologías específicas en nuestro medio, así como las principales características clínicas de estos enfermos. Todos los pacientes han sido sometidos a un exhaustivo protocolo diagnóstico (incluyendo pruebas diagnósticas incruentas, análisis del líquido pericárdico y en algunos casos biopsia pericárdica) encaminado a la búsqueda de una etiología específica de taponamiento. Resultados. En nuestra experiencia ha sido más frecuente encontrar una causa definida en una proporción levemente superior (54%), no existiendo diferencias entre las formas idiopáticas y específicas de taponamiento cardíaco en cuanto a las características clínicas más relevantes, incluyendo el aspecto y cuantía del líquido pericárdico y las recidivas del taponamiento. Conclusiones. No existen características clínicas de la enfermedad que definan la etiología de la misma, justificando una profunda investigación etiológica en este grupo de pacientes

Introduction. Cardiac tamponade without definite cause (one of the forms of primary pericardial disease), always puts the clinician on the alert for the possibility of a specific etiology of disease. Patients and methods. The objectives of this prospective study on 50 patients with primary pericardial disease and cardiac tamponade have been to establish the real incidence of specific etiologies in our environment, as well as the principal clinical manifestations of these patients. All patients were evaluated through an exhaustive diagnostic protocol (including non-invasive diagnostic tests, analysis of the pericardial fluid and in some cases pericardial biopsy) for the search of a specific cardiac tamponade etiology. Results. In our experience it has been most frequent to find a definite etiology in a slightly superior proportion (54%), without differences among the idiopathic and specific forms of cardiac tamponade with regard to the most relevant clinical manifestations, including the aspect and amount of the pericardial fluid and the recurrences of cardiac tamponade. Conclusions. The disease has no clinical manifestations that establish its etiology: this justifyies in-depth etiological research in this group of patients

Farmacoeconomía y enfermedad cardiovascular / Pharmacology and cardiovascular disease

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Manejo terapéutico de la cardiopatía isquémica aguda sin elevación del ST / Therapeutic management of acute ischemic heart disease without ST increase

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