[Cognitive impairment in the elderly patient with symptomatic severe aortic stenosis. Therapeutic decisions and impact on one-year mortality]. / Deterioro cognitivo en el paciente mayor con estenosis aórtica grave sintomática. Toma de decisiones terapéuticas e impacto sobre la mortalidad al año.

INTRODUCTION: Interventional treatment of severe aortic stenosis includes valve replacement by surgery or transcatheter - transcatheter aortic valve implantation (TAVI). In order to make an adequate selection and to rule out patients with little/no therapeutic benefit, it is recommended to assess comorbidities, frailty and cognitive impairment. AIMS: a) To determine the prevalence of cognitive impairment in older patients with severe aortic stenosis; b) to analyse its influence on decision-making (surgery, TAVI or conservative treatment); and c) to analyse its impact on mortality at one year. MATERIAL AND METHODS: Prospective, longitudinal epidemiological study of patients aged 75 years and older with severe aortic stenosis treated by the Heart-Team. VARIABLES: sociodemographic, clinical, cardiological, functional and mental variables; cognitive impairment assessed by applying the Mini-Mental State Examination (MMSE). RESULTS: We included 300 patients in the study (83.99 ± 4.02 years old; 61.2%, women). Prevalence of cognitive impairment of 15.3%, which was associated with albumin level - odds ratio (OR): 0.082; p = 0.011 - and Barthel (OR: 0.962; p = 0.02) and Lawton (OR: 0.787; p = 0.025) index scores. Surgery was chosen in 24.7% of cases; TAVI in 63.3%; and conservative treatment in 12%. This decision was associated with the score on the Barthel (OR: 0.93; p = 0.012) and Lawton indices (OR: 0.678; p = 0.014), the Short Physical Performance Battery (OR: 0.75; p = 0.037) and the MMSE (OR: 0.691; p < 0.001). Mortality at one year was 14%, and higher in patients with MMSE scores <24 (23.5% vs. 12.8%; p = 0.094). CONCLUSIONS: Cognitive impairment is a very common geriatric syndrome in older patients with severe aortic stenosis that is associated with functional disability in activities of daily living. Cognitive impairment has a high impact on decision-making and appears to be a variable associated with increased mortality.

TITLE: Deterioro cognitivo en el paciente mayor con estenosis aórtica grave sintomática. Toma de decisiones terapéuticas e impacto sobre la mortalidad al año.Introducción. El tratamiento intervencionista de la estenosis aórtica grave incluye el recambio valvular mediante cirugía o vía transcatéter ­implante transcatéter de la válvula aórtica (TAVI)­. Para realizar una adecuada selección y descartar pacientes con escaso/nulo beneficio terapéutico, se recomienda evaluar las comorbilidades, la fragilidad y el deterioro cognitivo. Objetivos. a) Determinar la prevalencia de deterioro cognitivo en pacientes mayores con estenosis aórtica grave; b) analizar su influencia en la toma de decisiones (cirugía, TAVI o tratamiento conservador), y c) analizar su impacto sobre la mortalidad al año. Material y métodos. Estudio epidemiológico longitudinal y prospectivo sobre pacientes de 75 años o más con estenosis aórtica grave atendidos por el Heart-Team. Variables: sociodemográficas, clínicas, cardiológicas, funcionales y mentales; deterioro cognitivo evaluado aplicando el Minimental State Examination (MMSE). Resultados. Incluimos a 300 pacientes en el estudio (83,99 ± 4,02 años; 61,2%, mujeres). Prevalencia de deterioro cognitivo del 15,3%, que se asoció con el nivel de albúmina ­odds ratio (OR): 0,082; p = 0,011­ y las puntuaciones en los índices de Barthel (OR: 0,962; p = 0,02) y Lawton (OR: 0,787; p = 0,025). En el 24,7% de los casos se decidió cirugía; en el 63,3%, TAVI; y en el 12%, tratamiento conservador. Esta decisión se asoció con la puntuación en los índices de Barthel (OR: 0,93; p = 0,012) y Lawton (OR: 0,678; p = 0,014), la Short Physical Performance Battery (OR: 0,75; p = 0,037) y el MMSE (OR: 0,691; p menor de 0,001). La mortalidad al año fue del 14%, superior en los pacientes con puntuaciones en el MMSE menor de 24 (23,5% frente a 12,8%; p = 0,094). Conclusiones. El deterioro cognitivo es un síndrome geriátrico muy frecuente en pacientes mayores con estenosis aórtica grave que se asocia con incapacidad funcional en las actividades de la vida diaria. El deterioro cognitivo tiene un elevado impacto en la toma de decisiones y parece presentarse como una variable asociada a mayor mortalidad.

[Guidelines of the Spanish Society of Cardiology on requirements and equipment in hemodynamic and interventional cardiology]. / Guías de práctica clínica de la Sociedad Española de Cardiología sobre requerimientos y equipamiento en hemodinámica y cardiología intervencionista.

In the last 20 years the work performed in catheterization laboratories has changed greatly, and while also taking the diagnostic aspects also into account, interventional cardiology has acquired an important role. Work in the catheterisation laboratory has evolved from only diagnostic studies of cardiac anatomy and function, and evaluation of potential surgical candidates, to interventional procedures mainly based on catheters techniques. As new diagnostic and interventional procedures are now available, human and technical requirements of the catheterization laboratory have changed. The aim of this report is to make an update of the requirements needed to perform diagnostic and interventional procedures in the cardiac catheterization laboratory.

Etiología y factores de riesgo en una muestra de 200 pacientes consecutivos con insuficiencia cardiaca / Etiology and risk factors in a serie of 200 consecutive patients with heart failure

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[The etiology and associated risk factors in a sample of 300 patients with atrial fibrillation]. / Estudio de la etiología y factores de riesgo asociados en una muestra de 300 pacientes con fibrilación auricular.

PURPOSE: To analyze the etiology and the prevalence of risk factors in patients with atrial fibrillation. PATIENTS AND METHODS: Applying an unpaired case controlled study, we examined 300 consecutive patients (143 men) with atrial fibrillation and a mean age of 66 +/- 8 years. This group is compared with a control group of 700 patients (mean age 64 +/- 12 years). RESULTS: In the group with atrial fibrillation the etiology in 32% was arterial hypertension, in 20% coronary heart disease, in 13% valvular heart disease, in 11% heart failure, in 4% hyperthyroidism and in 20% idiopathic. 50% presented hypertension, 29% tobaccoism, 26% left ventricular hypertrophy, 20% consumption of alcohol, 19% hypercholesterolemia and 16% diabetes. Compared with the control group, patients with atrial fibrillation had coronary heart disease (p < 0.05), VHD (p < 0.01), myocardiopathy (p < 0.05), HT (p < 0.001), left ventricular hypertrophy (p < 0.001), diabetes (p < 0.01) and alcohol consumption (p < 0.01) more frequently. In the multivariant analysis heart failure (odds ratio 2.1 [1.2-3.3]), the valvular heart disease (odds ratio 2.2 [1.4-3.5]), the coronary heart disease (odds ratio 1.8 [1.2-2.6]), the arterial hypertension (odds ratio 1.7 [1.2-2.3]), the left ventricular hypertrophy (odds ratio 2.6 [1.7-3.8]), the diabetes (odds ratio 1.9 [1.2-2.9]) and alcoholic habits (odds ratio 2 [1.3-3.9]) were independent risk factors for atrial fibrillation in our population. CONCLUSIONS: Atrial fibrillation in our study, is more frequent in patients with arterial hypertension, coronary heart disease or valvular heart disease. There are other risk factors such as arterial hypertension, diabetes and consumption of alcohol too, the modification of which could diminish the risk of the appearance of atrial fibrillation.

Estudio de los factores de riesgo asociados y la prevalenciade cardiopatía en varones consumidores habituales de alcohol / Study of associated risk factors and prevalence of heart disease in men with alcoholic habit

Fundamento: Se estudia la prevalencia de cardiopatía y la asociación con otros factores de riesgo cardiovascular. Método: En una muestra prospectiva de 166 varones consumidores excesivos de alcohol (>60 grs/etanol/día) con edad media de 60ñ10 años (Grupo A). Este grupo se compara con 367 varones no bebedores y con edad media de 61ñ9 años (Grupo C). Resultados: En nuestro medio el 89 % de los varones con hábito etílico eran fumadores, el 36 porciento tenían hipertensión arterial, el 25 porciento niveles altos de colesterol total y el 17 porciento de triglicéridos, el 19 porciento hiperuricemia, el 13 porciento diabetes y el 15 porciento hipertrofia ventricular izquierda. La cifra media de HDL-Col fue de 67ñ12 mgrs/dl en el grupo A y de 58ñ10 en el grupo C con p<0,001. El 48 porciento del grupo A presentaba algún tipo de cardiopatía, isquémica en el 15 porciento, insuficiencia cardíaca en el 18 porciento y fibrilación auricular en el 15 porciento. Comparados con el grupo control se encontraron diferencias significativas para el tabaquismo (89 % A y 50 porciento C, p<0,001), la diabetes (13 % A y 7 porciento C, p<0,05), la hiperuricemia (19 % A y 8 % C, p<0,001), la hipertrigliceridemia (17 % A y 8 porciento C, p<0,01) y número total de factores de riesgo (2,9ñ1,2 A y 1,5ñ1,2 C, p<0,001). El porcentaje de individuos con cardiopatía es mayor en los varones bebedores (69 porciento C y 52 % A, p<0,05), siendo mayor también la prevalencia de insuficiencia cardíaca (18 % A y 10 porciento B, p<0,05) y fibrilación auricular (15 % A y 9 porciento C, p<0,05). Conclusiones: Los varones consumidores excesivos de alcohol en nuestro medio presentan habitualmente otros factores de riesgo coronario, fundamentalmente tabaco, diabetes, hiperuricemia e hipertrigliceridemia. En este grupo es más frecuente la presencia de cardiopatía, siendo el alcohol un factor de riesgo importante para el desarrollo de fibrilación auricular e insuficiencia cardíaca (AU)

Spontaneous coronary artery dissection.

Spontaneous coronary artery dissection is a rare coronary pathology whose precise incidence, etiology, pathogenesis, treatment and evolution have not been clearly established. Sudden death accounts for the majority of presentations. It occurs most commonly in young women in the left anterior descending coronary artery. We report the case of a 48-year-old male with asymptomatic spontaneous dissection in the anterior descending coronary artery.

PTCA procedure for Shepherd's Crook right coronary artery lesion with a new long soft-tip 6F guiding catheter.

A new Cordis Long Brite Tip 6F guiding catheter (I.D. .064") is described. Because of its technical characteristics, this product provides greater balloon catheter support by means of deeper intubation of the right coronary artery (RCA). We present our experience with a Shepherd's Crook RCA lesion PTCA procedure.

[Reversible dilated cardiomyopathy and hyperthyroidism]. / Miocardiopatía dilatada reversible e hipertiroidismo.

Thyrotoxicosis may precipitate atrial fibrillation, myocardial ischemia or heart failure if underlying heart disease is present. However, reversible dilated cardiomyopathy is rare. We report a case of a 51-year-old man with thyrotoxicosis and dilated cardiomyopathy that was reversed with antithyroid treatment.

[Left coronary artery with anomalous origin and course]. / Arteria coronaria izquierda con origen y trayecto anómalos.

We report a 45 year-old patient with angina and positive exercise test. In the coronary arteriography that left coronary artery rose from a vascular structure that connected the aorta to the middle of the left anterior descending coronary artery. In the right coronary artery there was a 90% stenosis. An ACTP was made in this stenosis. The patient displayed no symptoms eight months after the procedure. We have not found in the literature and anomaly of the left coronary artery similar to what was found in this patient.

[Coronary angioplasty through 6 French guiding catheters]. / Angioplastia coronaria a través de catéteres guía 6 French.

BACKGROUND: The development of new small guiding catheters with large internal lumen has allowed their use in routine coronary angioplasty. OBJECTIVES: The aim of this study is to present the technical characteristics, results and complication rates obtained with the use of 6 French guiding catheters compared with those obtained with the use of 8 French. METHODS: During a 23 month period, a total of 355 consecutive patients was enrolled in this study. Coronary angioplasty was performed in 177 of them using a 6F guiding catheter and 178 using an 8F. RESULTS: We found no differences in technical characteristics between both groups: Radiation time (15.7 +/- 14 min vs 16.2 +/- 14 min), guiding catheter to patient ratio (1.1 +/- 0.3 vs 1.06 +/- 0.2), number of balloon catheters per patient (1.2 +/- 0.7 vs 1.36 +/- 0.7). There were no differences in the results obtained (Success 93% in 6F group vs 91% in 8F), major complication rates (Death 0.5% vs 1.6%, CABG 1.1% vs 2.2% or AMI 0% vs 2.2%), or peripheral complications. CONCLUSIONS: In coronary angioplasty, with the use of 6F guiding catheters the same results can be achieved as with the use of larger catheters without an increase in technical difficulties or in complication rates.

[A retroaortic anomalous left coronary artery]. / Coronaria izquierda anómala retroaórtica.

We report a 67-years-old patient with angina pectoris and positive treadmill test. In the coronary arteriography the left coronary artery arose from the right coronary sinus of Valsalva through an independent ostium and followed a retroaortic course. Coronary artery disease was no demonstrated, so we thought that the myocardial ischaemia shown in the treadmill test, was due to the anomalous origin of the left coronary artery. Surgical treatment was recommended.

[Study of associated risk factors and prevalence of heart diseases in patients with arterial hypertension]. / Estudio de los factores de riesgo asociados y la prevalencia de cardiopatía en pacientes con hipertensión arterial.

We studied the frequency of heart disease and association with other coronary risk factors in 243 consecutive patients (124 male and 119 female) suffering from arterial hypertension (Group HT). The mean age was 67.5 +/- 9.6 years. This group was compared to a group of 357 subjects (217 male and 140 female) without arterial hypertension (Group noHT) and mean age of 63.5 +/- 13 years. In our group the patients with arterial hypertension presented smoking habits in 35%, hypercholesterolemia in 22%, left ventricular hypertrophy (LVH) in 18%, alcoholic habits in 15%, hypertriglyceridemia in 12%, diabetes in 9% and hyperuricemia in 7%. 15% of the patients suffering from arterial hypertension turned out with coronary heart disease (62% angina and 38% myocardial infarction), 19% with atrial fibrillation and 13% with heart failure. Compared to the patients without hypertension we found significant statistical correlation with the age (67.5 +/- 9.6 HT and 63.5 +/- 13 no HT, p < 0.001), the LVH (18% HT and 4% no HT, p < 0.001) and number of coronary risk factors (2 +/- 1 HT and 1.1 +/- 0.9, p < 0.001). The percentage of people without cardiac disease is lower among the group with arterial hypertension (53% HT and 71% noHT, p < 0.001), showing as well a higher incidence of atrial fibrillation (19% HT and 11% noHT, p < 0.05) and heart failure (13% HT and 7% noHT, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)