Ventricular arrhythmias are associated with increased QT interval and QRS dispersion in patients with ST-elevation myocardial infarction.

INTRODUCTION AND OBJECTIVES: The electrocardiogram continues to be essential in the diagnosis of acute myocardial infarction, and a useful tool in arrhythmic risk stratification. We aimed to determine which electrocardiographic variables can successfully predict the occurrence of ventricular arrhythmias (VA) in patients following ST-segment elevation myocardial infarction (STEMI). METHODS: We performed an observational study including 667 patients with STEMI admitted to the University Hospital in Sancti Spíritus, Cuba. Demographic variables, cardiovascular risk factors, and clinical variables were recorded. Electrocardiographic variables included QT interval duration (measured and corrected) and QT dispersion, QRS duration and dispersion, JT interval duration and ST-segment elevation magnitude. We also determined left ventricular ejection fraction and glomerular filtration rate. A binary statistical regression model and a regression tree were used to determine the variables that successfully predicted VA. RESULTS: VA occurred in 92 (13.8%) patients, within the first 48 hours in 68 (73.9%) and after this period in 24 (26.1%) patients. The variables associated with VA were QT interval duration >529 ms and QT dispersion >66 ms, QRS dispersion >50 ms, and the presence of ST-segment elevation in six or more leads. CONCLUSIONS: The main predictor of VA occurring during the initial 48 hours was QT interval duration, while, after this period, it was QRS dispersion.

Increased QRS duration and dispersion are associated with mechanical dyssynchrony in patients with permanent right ventricular apical pacing.

BACKGROUND: Permanent right ventricular apical pacing may have negative effects on ventricular function and contribute to development of heart failure. We aimed to assess intra- and interventricular mechanical dyssynchrony in patients with permanent right ventricular apical pacing, and to establish electrocardiographic markers of dyssynchrony. METHODS: 84 patients (46:38 male:female) who required permanent pacing were studied. Pacing was done from right ventricular apex in all patients. We measured QRS duration and dispersion on standard 12-lead ECG. Intra- and interventricular mechanical dyssynchrony and left ventricular ejection fraction were assessed by transthoracic echocardiography. Patients were followed-up for 24 months.  Results: Six months after implantation, QRS duration increased from 128.02 ms to 132.40 ms, p≤0.05. At 24 months, QRS dispersion increased from 43.26 ms to 46.13 ms, p≤0.05. Intra- and interventricular dyssynchrony increased and left ventricular ejection fraction decreased during follow-up. A QRS dispersion of 47 ms predicted left ventricular dysfunction and long-term electromechanical dyssynchrony with a sensitivity of 80% and a specificity of 76%.  Conclusion: In patients with permanent right ventricular apical pacing there is an increased duration and dispersion of QRS related to dyssynchrony and decreased left ventricular ejection fraction. This study shows that QRS dispersion could be a better predictive variable than QRS duration for identifying left ventricular ejection fraction worsening in patients with permanent right ventricular apical pacing. The electrocardiogram is a simple tool for predicting systolic function worsening in these patients and can be used at the bedside for early diagnosis in the absence of clinical symptoms, allowing adjustments of medical treatment to prevent progression of heart failure and improve the patient's quality of life.

Estimación de riesgo en pacientes con infarto agudo de miocardio con elevación del segmento ST: Su realidad en Cuba

RESUMEN El infarto agudo de miocardio con elevación del segmento ST es una de las enfermedades cardiovasculares con mayor mortalidad. Su pronóstico se relaciona con la probabilidad de desarrollar complicaciones a corto o largo plazo y depende más de las condiciones al ingreso que de los factores de riesgo coronario previos. Los estudios encaminados a desarrollar una fórmula que permita cuantificar riesgo de muerte o complicaciones de un paciente con infarto agudo de miocardio, mediante una puntuación o score, se remontan a la década de 1950. Las diferencias en la aplicabilidad de estas escalas de estratificación de riesgo existentes, a la población cubana, derivan del hecho de haber sido desarrolladas en países de ingresos altos, por lo cual su extrapolación es cuestionable. Existen diferencias sociodemográficas, étnicas, genéticas e idiosincráticas, que pueden ser la causa de que los resultados predichos en los estudios originales no sean reproducibles con exactitud en poblaciones diferentes.

ABSTRACT ST-segment elevation myocardial infarction is one of the cardiovascular diseases with the highest mortality. Its prognosis is related to the probability of developing short- or long-term complications and depends more on conditions at admission than on previous coronary risk factors. Studies aimed at developing a formula to quantify the risk of death or complications in patients with acute myocardial infarction using either a rating or a score date back to the 1950s. Differences in the applicability of these risk stratification scores within the Cuban population are due to the fact that they were developed in high-income countries and, therefore, their extrapolation is questionable. Sociodemographic, ethnic, genetic and idiosyncratic differences may prevent the results predicted in the original studies from being accurately reproduced in different populations.

Calidad de vida de los pacientes con síndrome coronario agudo y enfermedad arterial periférica en rehabilitación cardiovascular

RESUMEN Introducción: La coexistencia de la enfermedad arterial periférica en pacientes con síndrome coronario agudo afecta la calidad de vida relacionada con la salud; la rehabilitación cardiovascular es una herramienta eficaz para el tratamiento de ambas enfermedades. Objetivo: Evaluar la calidad de vida relacionada con la salud según el cuestionario EQ-5D, antes y después de la rehabilitación. Método: Se estudiaron 484 pacientes egresados de la sala de cuidados coronarios con diagnóstico de síndrome coronario agudo, a los que se les realizó el diagnóstico de enfermedad arterial periférica mediante índice tobillo-brazo después del ejercicio y se incorporaron a la rehabilitación cardiovascular, en el período comprendido del 1 de marzo de 2011 al 30 de febrero de 2018. Se evaluó su calidad de vida mediante el cuestionario EQ-5D, antes y después de la rehabilitación. Se utilizó el coeficiente de correlación de Pearson para variables cuantitativas, y la prueba no paramétrica de Wilcoxon para contrastar la hipótesis de igualdad entre dos medianas poblacionales en variables ordinales y de intervalo. Resultados: Las dimensiones evaluadas mediante el cuestionario de calidad de vida EQ-5D reflejan una correlación positiva entre la distancia caminada sin dolor y el tiempo de ejercicio, con los resultados de la escala EQ-5D como expresión de los beneficios de la rehabilitación. Conclusiones: La rehabilitación cardiovascular mejoró la calidad de vida de los pacientes con enfermedad arterial periférica y síndrome coronario agudo.

ABSTRACT Introduction: The coexistence of peripheral artery disease in patients with acute coronary syndrome affects health-related quality of life. Cardiac rehabilitation is an effective tool for the treatment of both diseases. Objective: To assess health-related quality of life according to the EQ-5D questionnaire before and after rehabilitation. Methods: A total of 484 patients discharged from the coronary care unit with a diagnosis of acute coronary syndrome were studied. They were diagnosed with peripheral artery disease by ankle-brachial index test and started cardiac rehabilitation from March the 1st, 2011 to February the 30th, 2018. Their quality of life was assessed using the EQ-5D questionnaire before and after rehabilitation. The Pearson correlation coefficient was employed for quantitative variables and the Wilcoxon nonparametric test was utilized to contrast the hypothesis of equality between two population medians in ordinal and interval variables. Results: The dimensions assessed by the EQ-5D quality of life questionnaire show a positive correlation between pain-free walking distance and exercise time with the results of the EQ-5D score, thus demonstrating the benefits of rehabilitation. Conclusions: Cardiac rehabilitation improved the quality of life of patients with peripheral artery disease and acute coronary syndrome.

El índice tobillo-brazo como predictor de enfermedad coronaria multivaso en pacientes con síndrome coronario agudo y enfermedad arterial periférica / The Ankle-brachial Index as a Predictor of Multivess el Coronary Disease in Patients with Acute Coronary Syndrome and Peripheral Arterial Disease

RESUMEN Fundamento: la coexistencia de la enfermedad arterial periférica y el síndrome coronario agudo se asocia con peor pronóstico. El índice tobillo-brazo ha demostrado ser un marcador de ateroesclerosis multisitios. Objetivo: determinar la relación entre el índice tobillo-brazo y la enfermedad arterial coronaria multivasos. Método: se realizó un estudio observacional analítico que incluyó a todos los pacientes egresados de la unidad de cuidados coronarios del Hospital Provincial Universitario Camilo Cienfuegos Gorriarán, de la provincia Sancti Spíritus, en el período comprendido entre el primero de marzo de 2011 al 30 de febrero de 2018, con diagnóstico de síndrome coronario agudo, con y sin elevación del segmento ST. Se recogieron datos clínicos, de índice tobillo-brazo, ecocardiográficos y de angiografía coronaria y se determinó la implicación pronóstica del índice en la enfermedad multivaso a través de un árbol de clasificación con las variables incluidas en el modelo de regresión logística binaria. Resultados: la enfermedad multivaso se presentó en 85,2 % pacientes, de ellos eran hombres el 81,9 %, el 85,9 % de ellos con enfermedad multivaso, la edad media fue de 59,1 años, el 52,3 % presentó SCACEST con enfermedad multivaso el 78,8 %. Los factores de riesgo más frecuentes fueron: el hábito de fumar (86,8 %), la dislipidemia (85,8 %) y la hipertensión arterial (84,8 %) en el grupo con enfermedad multivaso e ITB=0,9 (DE=0,3). Recibieron tratamiento con clopidogrel (86,1 %), ácido acetilsalicílico (86,3 %), IECA o ARA II (85,8 %), estatinas (73,2 %), betabloqueantes (87,5 %) y nitratos (86,3 %). En la angiografía, el 85,2 % presentó una enfermedad coronaria severa. Las dos variables predictoras fueron: el SCASEST y el ITB≤0,9 que mostraron un elevado valor predictivo positivo en el pronóstico de enfermedad arterial coronaria multivaso. Conclusiones: el índice tobillo-brazo<0,9 mostró una capacidad predictiva para la enfermedad multivaso que se incrementa si se asocia a la diabetes mellitus y el hábito de fumar.

ABSTRACT Background: the coexistence of peripheral arterial disease and acute coronary syndrome is associated with a worse prognosis. The ankle-brachial index has been shown to be a marker of multisite atherosclerosis. Objective: to determine the relationship between the ankle-brachial index and coronary artery disease. Method: an analytical observational study was carried out that included all the patients discharged from the coronary care unit of the Camilo Cienfuegos Gorriarán Provincial University Hospital, of the Sancti Spíritus province, in the period from March 1, 2011 to February 30 of 2018, with a diagnosis of acute coronary syndrome, with and without ST segment elevation. Clinical data, ankle-brachial index, echocardiography and coronary angiography were collected and the prognostic implication of the index in disease was determined through a classification tree with the variables included in the binary logistic regression model. Results: multivessel disease occurred in 85.2 % patients, 81.9 % of them were men, 85.9 % of them with multivessel disease, the mean age was 59.1 years, 52.3 % presented STEACS with multivessel disease 78.8 %. The most frequent risk factors were: smoking (86.8 %), dyslipidemia (85.8 %) and arterial hypertension (84.8 %) in the group with multivessel disease and ABI = 0.9 (SD = 0.3). They received treatment with clopidogrel (86.1 %), acetylsalicylic acid (86.3 %), ACEI or ARB (85.8 %), statins (73.2 %), beta-blockers (87.5 %) and nitrates (86, 3 %). On angiography, 85.2 % had severe coronary disease. The two-predictor variables were: NSTEACS and ABI≤0.9, which showed a high positive predictive value in the prognosis of multivessel coronary artery disease. Conclusions: ankle-brachial index <0.9 showed a predictive capacity for multivessel disease that increases if it is associated with diabetes mellitus and smoking.

Prognostic Scale to Stratify Risk of Intrahospital Death in Patients with Acute Myocardial Infarction with ST-Segment Elevation.

INTRODUCTION The scales available to predict death and complica-tions after acute coronary syndrome include angiographic studies and serum biomarkers that are not within reach of services with limited resources. Such services need specifi c and sensitive instruments to evaluate risk using accessible resources and information. OBJECTIVE Develop a scale to estimate and stratify the risk of intra-hospital death in patients with acute ST-segment elevation myocardial infarction. METHODS An analytical observational study was conducted in a universe of 769 patients with acute ST-segment elevation myocardial infarction who were admitted consecutively to the Camilo Cienfuegos Provincial Hospital in Sancti Spíritus Province, Cuba, from January 2013 to March 2018. The fi nal study cohort included 667 patients, ex-cluding 102 due to branch blocks, atrial fi brillation, drugs that prolong the QT interval, low life expectancy or history of myocardial infarction. The demographic variables of age, sex, skin color, classic cardiovas-cular risk factors, blood pressure, heart rate, blood glucose level, in addition to duration and dispersion of the QT interval with and without correction, left ventricular ejection fraction, and glomerular fi ltration rate were included in the analysis. Patients were categorized according to the Killip-Kimball Classifi cation for degree of heart failure. A risk scale was constructed, the predictive ability of which was evaluated using the detectability index associated with an receiver-operator curve.RESULTS Seventy-seven patients died (11.5%). Mean blood glucose levels were higher among the deceased, while their systolic and dia-stolic blood pressure, left ventricular ejection fraction, and glomerular fi ltration rate were lower than those participants discharged alive. Rel-evant variables included in the scale were systolic blood pressure, Killip-Kimball class, cardiorespiratory arrest, glomerular fi ltration rate, corrected QT interval dispersion, left ventricular ejection fraction, and blood glucose levels. The variable with the best predictive ability was cardiorespiratory arrest, followed by a blood glucose level higher than 11.1 mmol/L. The scale demonstrated a great predictive ability with a detectability index of 0.92. CONCLUSIONS The numeric scale we designed estimates and strati-fi es risk of death during hospitalization for patients with ST-segment elevation myocardial infarction and has good metric properties for predictive ability and calibration. KEYWORDS ST-segment elevation myocardial infarction, mortality, risk assessment, Cuba.

Fístula coronaria a ventrículo derecho en paciente con ateroesclerosis sistémica / Coronary artery fistula to the right ventricle in a patient with systemic atherosclerosis

RESUMEN La ateroesclerosis es una enfermedad sistémica que afecta múltiples lechos vasculares. Después de períodos prolongados de progresión comienzan las manifestaciones clínicas, de forma aguda o crónica (infarto agudo de miocardio, angina estable, claudicación intermitente, enfermedad cerebrovascular, entre otras); por lo que puede cursar de manera subclínica en pacientes con enfermedad arterial coronaria. Lo interesante de esta forma de presentación es que dentro de una serie de casos con enfermedad multivaso, asociado a un índice tobillo-brazo (ITB) < 0,9, después de un síndrome coronario agudo, hemos encontrado, como hallazgo angiográfico, la presencia de una fístula coronaria a ventrículo derecho en un paciente con ITB muy bajo y clínica de claudicación intermitente. Esta fístula es la causa de los síntomas que interrumpieron la rehabilitación cardiovascular; es una enfermedad poco frecuente y causa de dolor torácico, que se informa solo de 0,3 a 0,8%, como hallazgo incidental en angiografías coronarias.

ABSTRACT Atherosclerosis is a systemic disease that affects a number of vascular beds. Clinical manifestations whether acute or chronic (acute myocardial infarction, stable angina, intermittent claudication, cerebrovascular disease, among others) start after long periods of progression; so it may present subclinically in patients with coronary artery disease. What is particularly interesting about this form of presentation is that within a series of cases with multivessel disease, associated with an ankle-brachial index (ABI)<0.9, after an acute coronary syndrome, we have identified, as an angiographic finding, the presence of a coronary artery fistula to the right ventricle in a patient with very low ABI and clinical intermittent claudication. This fistula led to the symptoms that hampered cardiovascular rehabilitation. It is an infrequent disease characterized by chest pain; with low reporting (0.3 to 0.8%), as an incidental finding in coronary angiographies.

Corrected QT-Interval Dispersion: An Electrocardiographic Tool to Predict Recurrence of Myocardial Infarction.

INTRODUCTION Many clinical settings lack the necessary resources to complete angiographic studies, which are commonly used to predict complications and death following acute coronary syndrome. Corrected QT-interval dispersion can be useful for assessing risk of myocardial infarction recurrence. OBJECTIVE Evaluate the relationship between corrected QT-interval dispersion and recurrence of myocardial infarction in patients with ST-segment elevation. METHODS We conducted a prospective observational study of 522 patients with ST-segment elevation myocardial infarction admitted consecutively to the Camilo Cienfuegos General Provincial Hospital in Sancti Spiritus, Cuba, from January 2014 through June 2017. Of these, 476 were studied and 46 were excluded because they had other disorders. Demographic variables and classic cardiovascular risk factors were included. Blood pressure, heart rate, blood glucose, and corrected and uncorrected QT-interval duration and dispersion were measured. Patients were categorized according to the Killip-Kimball classification. Association between dispersion of the corrected QT-interval and recurrence of infarction was analyzed using a binary logistic regression model, a regression tree and receiver operator characteristic curves. RESULTS Patients with recurrent infarction (56; 11.8%) had higher average initial blood glucose values than those who did not have recurrence; the opposite occurred for systolic and diastolic blood pressure and for left ventricular ejection fraction. Dispersion of the corrected QT-interval was a good predictor of infarction recurrence according to a multivariate analysis (OR = 3.09; 95% CI = 1.105-8.641; p = 0.032). Cardiac arrest is the variable that best predicts recurrence. No recurrence of infarction occurred in 97% of patients without cardiac arrest, left ventricular ejection fraction >45% and corrected QT-interval dispersion <80 ms. CONCLUSIONS Risk of infarction recurrence is low in patients without cardiac arrest, with left ventricular ejection fraction >45% and with dispersion of corrected QT-interval <80 ms. Patients with corrected QT-interval dispersion ≥80 ms have greater risk of recurrence of infarction, which suggests that this variable could be used for stratification of risk following ST-segment elevation myocardial infarction. KEYWORDS ST-elevation myocardial infarction, myocardial infarction, electrocardiography, chronic disease, risk assessment, Cuba.

Índice leuco-glucémico como factor pronóstico tras un infarto agudo del miocardio con elevación del segmento ST / Leuko-glycemic Index as a Prognostic Factor after Acute Myocardial Infarction with ST-segment Elevation

RESUMEN Fundamento: la glucosa sanguínea y el recuento leucocitario al ingreso han demostrado tener significación pronóstica en pacientes con infarto del miocardio. El índice leuco-glucémico es un marcador recientemente propuesto como predictor de mortalidad. Objetivo: evaluar la utilidad del índice leuco-glucémico en la estratificación del riesgo de muerte intrahospitalaria tras un IAMCEST. Método: se realizó un estudio observacional prospectivo que incluyó a todos los pacientes que ingresaron de forma consecutiva con diagnóstico de infarto agudo de miocardio con elevación del segmento ST y clase Killip > I, de enero de 2012 a junio de 2015 en el Hospital Provincial Universitario Camilo Cienfuegos Gorriarán. Se recogieron datos clínicos, de laboratorio y ecocardiográficos y se determinó la implicación pronóstica del índice leuco-glucémico en la mortalidad intrahospitalaria a través de la regresión logística binaria. Las variables estudiadas fueron: edad, sexo y color de la piel, historial médico y factores de riesgo cardiovasculares, datos clínicos como la tensión arterial sistólica y diastólica además de la frecuencia cardiaca al ingreso. Resultados: el índice leuco-glucémico resultó un predictor de mortalidad tanto en los pacientes diabéticos como en los no diabéticos (c= 0,673 y c=0,707) respectivamente. Existió una correlación positiva entre el la clase Killip y el índice leuco-glucémico (r: 0,471 p<0,001). El percentil 75 mostró una aceptable sensibilidad y buena especificidad como predictor de complicaciones y mortalidad tras un IAMCEST. Conclusiones: el índice leuco-glucémico en el curso de un infarto agudo del miocardio puede asociarse a una mayor mortalidad intrahospitalaria. Su detección sería de utilidad en la estratificación pronóstica del síndrome coronario agudo.

ABSTRACT Foundation: blood glucose and leukocyte count at admission have shown prognostic significance in patients with myocardial infarction. Leuko-glycemic index is a recently proposed marker as a predictor of mortality. Objective: to evaluate the usefulness of the leuko-glycemic index in the stratification of the risk of in-hospital death after STEMI. Method: a prospective observational study was conducted which included all patients admitted consecutively with a diagnosis of acute myocardial infarction with ST segment elevation and Killip> I class, from January 2012 to June 2015 at the Provincial University Hospital Camilo Cienfuegos Gorriarán. Clinical, laboratory and echocardiographic data were collected and the prognostic implication of the leuko-glycemic index in in-hospital mortality was determined through binary logistic regression. The studied variables were: age, sex and color of the skin, medical history and cardiovascular risk factors, clinical data such as systolic and diastolic blood pressure as well as heart rate at admission. Results: LGI was a predictor of mortality in both diabetic and non-diabetic patients (c = 0.673 and c = 0.707) respectively. There was a positive correlation between the Killip class and the leuco-glycemic index (r: 0.471 p <0.001). The 75th percentile showed an acceptable sensitivity and good specificity as a predictor of complications and mortality after STEMI. Conclusions: the leuko-glycemic index in the course of an acute myocardial infarction can be associated with a higher in-hospital mortality. Its detection would be useful in the prognostic stratification of acute coronary syndrome.

Dispersión del intervalo QT corregido como predictor de arritmias ventriculares en el infarto agudo del miocardio / Dispersion of the corrected QT interval as a predictor of ventricular arrhythmias in acute myocardial infarction

RESUMEN Fundamento: La dispersión del intervalo QT es un marcador electrocardiográfico que puede resultar útil en la estratificación de riesgo arrítmicos en pacientes con infarto agudo del miocardio. Objetivo: Describir la influencia de la dispersión del intervalo QT corregido en asociación a otros factores de riesgo como predictores de arritmias ventriculares en el infarto agudo del miocardio con elevación del segmento ST. Metodología: Se estudiaron de menera prospectiva 209 pacientes que ingresaron de forma consecutiva con diagnóstico de infarto agudo de miocardio con elevación del segmento ST de enero de 2013 a junio de 2014 en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus. Se recogieron datos clínicos, de laboratorio electrocardiográficos y ecocardiográficos; se determinó la implicación pronóstica de la dispersión del intervalo QT corregido en la aparición de arritmias ventriculares a través de la regresión logística binaria y las curvas de operador-receptor. Resultados: Las arritmias ventriculares se presentaron en 39 (18.7 %) pacientes. La dispersión del QT corregido mostró una adecuada capacidad de discriminación en la predicción de cualquier episodio arrítmico ventricular grave (c=0.768, p=0.0001). En el análisis multivariado la dispersión del QT resultó un predictor independiente de arritmias ventriculares (OR= 7.075; IC 95%= 1.6- 32.9; p=0.009). Conclusiones: La probabilidad de presentar arritmias ventriculares durante el infarto agudo del miocardio es mayor cuando se incrementan la dispersión del intervalo QT, por lo que se sugiere debe ser una variable a evaluar en la estratificación pronostica del infarto agudo del miocardio.

ABSTRACT Background: Dispersion of the QT interval is an electrocardiographic marker that can be useful in the stratification of arrhythmic risk in patients with acute myocardial infarction. Objective: To describe the influence of corrected QT interval dispersion in association with other risk factors as predictors of ventricular arrhythmias in acute myocardial infarction with ST-segment elevation. Methodology: 209 patients who entered consecutively with diagnosis of acute myocardial infarction with elevation of the ST segment from January 2013 to June 2014 at Camilo Cienfuegos General Provincial Hospital of Sancti Spíritus were studied prospectively. Clinical, electrocardiographic and echocardiographic laboratory data were collected; the prognostic implication of the corrected QT interval dispersion in the appearance of ventricular arrhythmias through binary logistic regression and operator-receiver curves was determined. Results: Ventricular arrhythmias occurred in 39 (18.7%) patients. The dispersion of the corrected QT showed an adequate discrimination capacity in the prediction of any serious ventricular arrhythmic episode (c = 0.768, p = 0.0001). In the multivariate analysis, QT dispersion was an independent predictor of ventricular arrhythmias (OR = 7.075, 95% CI = 1.6-32.9, p = 0.009). Conclusions: The probability of presenting ventricular arrhythmias during acute myocardial infarction is greater when the dispersion of the QT interval is increased, so it is suggested that it should be a variable to be evaluated in the prognostic stratification of acute myocardial infarction.

Dispersión del intervalo QT corregido como predictor de arritmias ventriculares en el infarto agudo del miocardio / Dispersion of the corrected QT interval as a predictor of ventricular arrhythmias in acute myocardial infarction

RESUMEN Fundamento: La dispersión del intervalo QT es un marcador electrocardiográfico que puede resultar útil en la estratificación de riesgo arrítmicos en pacientes con infarto agudo del miocardio. Objetivo: Describir la influencia de la dispersión del intervalo QT corregido en asociación a otros factores de riesgo como predictores de arritmias ventriculares en el infarto agudo del miocardio con elevación del segmento ST. Metodología: Se estudiaron de menera prospectiva 209 pacientes que ingresaron de forma consecutiva con diagnóstico de infarto agudo de miocardio con elevación del segmento ST de enero de 2013 a junio de 2014 en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus. Se recogieron datos clínicos, de laboratorio electrocardiográficos y ecocardiográficos; se determinó la implicación pronóstica de la dispersión del intervalo QT corregido en la aparición de arritmias ventriculares a través de la regresión logística binaria y las curvas de operador-receptor. Resultados: Las arritmias ventriculares se presentaron en 39 (18.7 %) pacientes. La dispersión del QT corregido mostró una adecuada capacidad de discriminación en la predicción de cualquier episodio arrítmico ventricular grave (c=0.768, p=0.0001). En el análisis multivariado la dispersión del QT resultó un predictor independiente de arritmias ventriculares (OR= 7.075; IC 95%= 1.6- 32.9; p=0.009). Conclusiones: La probabilidad de presentar arritmias ventriculares durante el infarto agudo del miocardio es mayor cuando se incrementan la dispersión del intervalo QT, por lo que se sugiere debe ser una variable a evaluar en la estratificación pronostica del infarto agudo del miocardio.(AU)

ABSTRACT Background: Dispersion of the QT interval is an electrocardiographic marker that can be useful in the stratification of arrhythmic risk in patients with acute myocardial infarction. Objective: To describe the influence of corrected QT interval dispersion in association with other risk factors as predictors of ventricular arrhythmias in acute myocardial infarction with ST-segment elevation. Methodology: 209 patients who entered consecutively with diagnosis of acute myocardial infarction with elevation of the ST segment from January 2013 to June 2014 at Camilo Cienfuegos General Provincial Hospital of Sancti Spíritus were studied prospectively. Clinical, electrocardiographic and echocardiographic laboratory data were collected; the prognostic implication of the corrected QT interval dispersion in the appearance of ventricular arrhythmias through binary logistic regression and operator-receiver curves was determined. Results: Ventricular arrhythmias occurred in 39 (18.7%) patients. The dispersion of the corrected QT showed an adequate discrimination capacity in the prediction of any serious ventricular arrhythmic episode (c = 0.768, p = 0.0001). In the multivariate analysis, QT dispersion was an independent predictor of ventricular arrhythmias (OR = 7.075, 95% CI = 1.6-32.9, p = 0.009). Conclusions: The probability of presenting ventricular arrhythmias during acute myocardial infarction is greater when the dispersion of the QT interval is increased, so it is suggested that it should be a variable to be evaluated in the prognostic stratification of acute myocardial infarction.(AU)

Síndrome cardiorrenal como predictor de mortalidad intrahospitalaria en el síndrome coronario agudo con elevación del segmento ST / Cardiorenal syndrome as predictor of in-hospital mortality in ST-segment elevation myocardial infarction

Introducción: El síndrome cardiorrenal incluye numerosas enfermedades que afectan el corazón y el riñón y empeora el pronóstico de los pacientes con síndrome coronario agudo. Método: Se estudiaron prospectivamente 157 pacientes que ingresaron de forma consecutiva con diagnóstico de infarto agudo de miocardio con elevación del segmento ST y clase Killip>I, de enero de 2013 a diciembre de 2016, en el Hospital General Docente Camilo Cienfuegos. Se recogieron datos clínicos, de laboratorio y ecocardiográficos en relación con la presencia de síndrome cardiorrenal y se determinó la implicación pronóstica del mismo en la mortalidad intrahospitalaria a través de la regresión logística binaria. Resultados: El síndrome cardiorrenal se presentó en 52 pacientes (33,1%). La hemoglobina mostró medias inferiores en el grupo de pacientes con síndrome cardiorrenal (117,2 ± 15,3 vs. 123,3 ± 15,1; p = 0,019), al igual que la fracción de eyección del ventrículo izquierdo (34,8 ± 8 vs. 43,2 ± 10,8). Existió una correlación positiva entre la clase Killip y el aumento de la creatinina a las 48h y de esta con la fracción de eyección del ventrículo izquierdo (r = 0,166; p = 0,038). El síndrome cardiorrenal fue más frecuente en el infarto anterior extenso y resultó un predictor independiente de mortalidad (OR 4,1; IC 95% 1,2-13,9; p = 0,022). Conclusiones: El síndrome cardiorrenal en el curso de un infarto agudo del miocardio puede asociarse a una mayor mortalidad intrahospitalaria. Su detección sería de utilidad en la estratificación pronóstica del síndrome coronario agudo

Introduction: Cardiorenal syndrome includes numerous conditions affecting the heart and kidney, and is a strong predictor of cardiovascular mortality. Method: An analysis was performed on 157 consecutive patients admitted to the Coronary Care Unit of the Camilo Cienfuegos Hospital due to an ST-segment elevation myocardial infarction and heart failure, from January 2013 to December 2016. An analysis was made of the presence of cardiorenal syndrome and its relationship with epidemiological, clinical, and analytical variables, as well as complementary explorations. The relationship between cardiorenal syndrome and in-hospital mortality was assessed using binary logistical regression. Results: A total of 52 (33.1%) patients had a cardiorenal syndrome. The haemoglobin level was lower in the group of patients with cardiorenal syndrome (117.2 ± 15.3 vs. 123.3 ± 15.1, P = .019), and in left ventricular ejection fraction (34.8 ± 8 vs. 43.2 ± 10.8). A positive correlation was found between the Killip class and the increase in serum creatinine after 48 h. The serum creatinine was associated with left ventricular ejection fraction (r = 0.166; P = .038). The multivariate analysis showed that cardiorenal syndrome was an independent predictor of in-hospital mortality when adjusted for a history of ischaemic heart disease, diabetes mellitus status, atrial fibrillation, ventricular arrhythmias, left ventricular ejection fraction, age and systolic blood pressure. Conclusions: The presence of cardiorenal syndrome has an influence on the prognosis of patients who suffer a cardiorenal syndrome. Its detection could be useful in the risk stratification

Cardiorenal syndrome as predictor of in-hospital mortality in ST-segment elevation myocardial infarction. / Síndrome cardiorrenal como predictor de mortalidad intrahospitalaria en el síndrome coronario agudo con elevación del segmento ST.

INTRODUCTION: Cardiorenal syndrome includes numerous conditions affecting the heart and kidney, and is a strong predictor of cardiovascular mortality. METHOD: An analysis was performed on 157 consecutive patients admitted to the Coronary Care Unit of the Camilo Cienfuegos Hospital due to an ST-segment elevation myocardial infarction and heart failure, from January 2013 to December 2016. An analysis was made of the presence of cardiorenal syndrome and its relationship with epidemiological, clinical, and analytical variables, as well as complementary explorations. The relationship between cardiorenal syndrome and in-hospital mortality was assessed using binary logistical regression. RESULTS: A total of 52 (33.1%) patients had a cardiorenal syndrome. The haemoglobin level was lower in the group of patients with cardiorenal syndrome (117.2 ± 15.3 vs. 123.3 ± 15.1, P = .019), and in left ventricular ejection fraction (34.8 ± 8 vs. 43.2 ± 10.8). A positive correlation was found between the Killip class and the increase in serum creatinine after 48 h. The serum creatinine was associated with left ventricular ejection fraction (r = 0.166; P = .038). The multivariate analysis showed that cardiorenal syndrome was an independent predictor of in-hospital mortality when adjusted for a history of ischaemic heart disease, diabetes mellitus status, atrial fibrillation, ventricular arrhythmias, left ventricular ejection fraction, age and systolic blood pressure. CONCLUSIONS: The presence of cardiorenal syndrome has an influence on the prognosis of patients who suffer a cardiorenal syndrome. Its detection could be useful in the risk stratification.

Duración del QRS como predictor de baja fracción de eyección en el infarto miocárdico con elevación del ST / QRS duration as a predictor of low ejection fraction in the ST-segment elevation myocardial infarction

Se realizó un estudio analítico transversal con 347 pacientes con infarto agudo de miocárdico con elevación del segmento ST, ingresados en el Hospital Universitario Camilo Cienfuegos del 1 de enero de 2013 al 31 de diciembre de 2015. Las variables estudiadas fueron: edad, sexo, factores de riesgo cardiovascular clásicos, tensión arterial, estrategia de reperfusión, clase de Killip-Kimbal, filtrado glomerular, duración del QRS y la fracción de eyección del ventrículo izquierdo. Las variables cualitativas se analizaron con el método estadístico Chi cuadrado, las cuantitativas con la t de Student y la regresión lineal. Se construyó la curva ROC para la capacidad de discriminación y se realizó un análisis multivariado para determinar la independencia de variables(AU)

A cross-sectional study was conducted with 347 patients with ST-segment elevation myocardial infarction, admitted at the Hospital Universitario CamiloCienfuegos from January 1st, 2013 to December 31st, 2015. The variables studied were: age, sex, classical cardiovascular risk factors, blood pressure, reperfusion strategy, Killip-Kimball class, glomerular filtration rate, QRS duration and left ven-tricular ejection fraction. The qualitative variables were analyzed with the Chi-square statistical method and the quantitative with the t of Student and linear re-gression. The ROC curve was constructed for the discrimination capacity and a multivariate analysis was performed to determine the independence of variables(AU)

Síndrome cardiorrenal como predictor de mortalidad intrahospitalaria en el síndrome coronario agudo con elevación del segmento ST / Introduction Cardiorenal syndrome includes numerous conditions affecting the heart and kidney, and is a strong predictor of cardiovascular mortality

Método Se estudiaron prospectivamente 157 pacientes que ingresaron de forma consecutiva con diagnóstico de infarto agudo de miocardio con elevación del segmento ST y clase Killip > I, de enero de 2013 a diciembre de 2016, en el Hospital General Docente Camilo Cienfuegos. Se recogieron datos clínicos, de laboratorio y ecocardiográficos en relación con la presencia de síndrome cardiorrenal y se determinó la implicación pronóstica del mismo en la mortalidad intrahospitalaria a través de la regresión logística binaria(AU)

Method An analysis was performed on 157 consecutive patients admitted to the Coronary Care Unit of the Camilo Cienfuegos Hospital due to an ST-segment elevation myocardial infarction and heart failure, from January 2013 to December 2016. An analysis was made of the presence of cardiorenal syndrome and its relationship with epidemiological, clinical, and analytical variables, as well as complementary explorations. The relationship between cardiorenal syndrome and in-hospital mortality was assessed using binary logistical regression(AU)

Fibrilación auricular de novo ¿incrementa la mortalidad intrahospitalaria en el infarto miocárdico con elevación del ST? / De Novo Atrial Fibrillation Increases Intra-hospital Mortality in Myocardial Infarction with ST Elevation?

Fundamento: la fibrilación auricular es la arritmia más frecuente en la población general y complica del 2 al 22 % de los infartos miocárdicos. Objetivo: determinar la implicación pronóstica de la fibrilación auricular de novo en mortalidad hospitalaria de los pacientes con infarto miocárdico con elevación del segmento ST. Método: se realizó un estudio observacional, retrospectivo de 326 pacientes con infarto miocárdico con elevación del ST ingresados en el Hospital Provincial Universitario Camilo Cienfuegos del 1 de enero de 2013 al 30 de junio de 2015. Las variables estudiadas fueron: edad, sexo, factores de riesgo coronario, antecedentes de cardiopatía isquémica, presencia de fibrilación auricular, disfunción miocárdica, choque cardiogénico, número de pacientes trombolizados, éxito de la trombolisis, valores de glucemia, ácido úrico, creatinina, colesterol, triacilglicéridos leucocitos y hemoglobina. Para la significación estadística de las variables en estudio se empleó la prueba ji cuadrado si fueron cualitativas y la t de student para las cuantitativas. Se realizó además un análisis multivariado para determinar la independencia de la fibrilación auricular como factor pronóstico. Resultados: las variables asociadas a la mortalidad intrahospitalaria fueron: la diabetes mellitus, el antecedente de cardiopatía isquémica, la edad mayor de 75 años, la fracción de eyección menor del 30 %, el filtrado glomerular menor de 60 ml/min, la clase Killip Kimbal III-IV y la fibrilación auricular de novo. La fibrilación auricular resultó tener asociación estadística significativa con la mortalidad intrahospitalaria. Conclusiones: la fibrilación auricular de novo resultó ser un predictor independiente de mortalidad intrahopitalaria en pacientes con infarto miocárdico con elevación del segmento ST.

Foundation: atrial fibrillation is the most common arrhythmia in the general population and complicates 2 to 22 % of myocardial infarctions. Objective: to determine the prognostic implications of de novo atrial fibrillation in hospital mortality in patients with myocardial infarction with ST-segment elevation. Method: an observational, retrospective study was performed of 326 patients with myocardial infarction and ST-elevation admitted to the Camilo Cienfuegos Provincial University Hospital from January 1, 2013 to June 30, 2015. The studied variables were: age, sex, factors of coronary risk, history of ischemic heart disease, presence of atrial fibrillation, myocardial dysfunction, cardiogenic shock, number of thrombolyzed patients, success of thrombolysis, glycemia values, uric acid, creatinine, cholesterol, triacylglycerides, leukocytes and hemoglobin. For the statistical significance of the variables under study, the chi-squared test was used if they were qualitative and the student's t test for quantitative ones. A multivariate analysis was also performed to determine the independence of atrial fibrillation as a prognostic factor. Results: the variables associated with in-hospital mortality were: diabetes mellitus, history of ischemic heart disease, age over 75 years, ejection fraction less than 30 %, glomerular filtration rate less than 60 ml/min, Killip class Kimbal III-IV and de novo atrial fibrillation. Atrial fibrillation was found to have a statistically significant association with in-hospital mortality. Conclusions: de novo atrial fibrillation was an independent predictor of intra-hospital mortality in patients with myocardial infarction with ST-segment elevation.

Valor pronóstico del filtrado glomerular renal en pacientes diabéticos con infarto agudo de miocardio / Prognostic Value of Glomerular Filtration Rate in Diabetic Patients with Acute Myocardial Infarction

Fundamento: La presencia de un filtrado glomerular renal bajo, es un conocido factor de mal pronóstico en el síndrome coronario agudo, sobre todo cuando se asocia a la diabetes mellitus.Objetivo: determinar el valor pronóstico del filtrado glomerular renal en la evolución intrahospitalaria de pacientes diabéticos con infarto agudo del miocardio con elevación del segmento ST.Métodos: estudio de serie de casos, que incluyó a los 68 pacientes diabéticos con infarto agudo del miocardio con elevación del segmento ST, ingresados en el Hospital Camilo Cienfuegos, de Sancti Spíritus, desde enero de 2012 hasta diciembre de 2013. Se estimó el filtrado glomerular renal en el momento del ingreso, mediante la fórmula de Cockcroft- Gault y se analizaron factores de riesgo cardiovascular, variables clínicas y de laboratorio, la fracción de eyección y mortalidad hospitalaria.Resultados: el filtrado glomerular bajo estuvo asociado a la presencia de una fracción de eyección del ventrículo izquierdo <45 % al egreso (p =0,0060), a la presencia de complicaciones cardiacas como arritmias, trastornos de la conducción aurículo-ventricular de alto grado, reinfarto, angina postinfarto y clase Killip ≥ III (p= 0,0000). Se asoció además a una mayor mortalidad y una menor tasa de reperfusión.Conclusión: en pacientes diabéticos con síndrome coronario agudo, el cálculo del filtrado glomerular renal al ingreso, aporta información relevante para el pronóstico en la fase aguda, aún en aquellos con valores normales de creatinina. Un filtrado glomerular renal inferior a 53 mL/min, incrementa ocho veces el riesgo de padecer un evento adverso durante el ingreso.

Background: low glomerular filtration rate is a known poor prognostic factor in acute coronary syndrome, particularly when associated with diabetes mellitus.Objective: to determine the prognostic value of glomerular filtration rate in hospitalized diabetic patients with acute ST-segment elevation myocardial infarction.Methods: a case-series study was conducted in 68 diabetic patients with acute ST-segment elevation myocardial infarction admitted to the Camilo Cienfuegos Hospital in Sancti Spiritus from January 2012 to December 2013. The glomerular filtration rate on admission was estimated using the Cockcroft-Gault equation. Cardiovascular risk factors, clinical and laboratory variables, the ejection fraction and hospital mortality were analyzed.Results: low glomerular filtration rate was associated with a left ventricular ejection fraction <45% at discharge (p = 0.0060) and cardiac complications including arrhythmias, atrioventricular conduction disturbances, reinfarction, postinfarction angina and Killip class ≥ III (p = 0.0000). It was also associated with increased mortality and lower reperfusion rates.Conclusions: estimating the glomerular filtration rate in diabetic patients with acute coronary syndrome at the time of admission provides significant information for prognosis in the acute phase, even in those with normal creatinine values. A glomerular filtration rate less than 53 mL/min increases the risk of suffering an adverse event during hospitalization eight times.

Síndrome de Guillain Barré: un reto en su tratamiento y rehabilitación / Guillain Barré syndrome: a challenge in treatment and rehabilitation

Se realizó un estudio observacional descriptivo longitudinal y retrospectivo con el objetivo de describir el comportamiento y la evolución en relación a algunas variables del síndrome de Guillain Barré en el Hospital Universitario Camilo Cienfuegos de Sancti Spíritus entre el 1ro de enero de 1996 al 31 de diciembre de 2006. El universo y la muestra estuvieron constituidos por el total de pacientes ingresados con síndrome de Guillain Barré. La información fue recogida del departamento de archivo y estadística. Para el análisis de la información se utilizaron estadísticas descriptivas y análisis de tendencia gráficos y matemáticos. La tendencia del síndrome de Guillain Barré en el período estudiado fue al ascenso, el antecedente más frecuentemente presentado fue el proceso agudo febril y las manifestaciones clínicas más frecuentes al ingreso fueron disminución de la fuerza muscular seguida de disminución o abolición de los reflejos osteotendinosos. Los pacientes donde la punción lumbar resultó negativa tuvieron una mayor letalidad y que el tratamiento empleado no influyó en la misma. Los pacientes que requirieron ventilación mecánica presentaron una mayor letalidad, la complicación más frecuentemente presentada fue la bronconeumonía bacteriana y la estadía hospitalaria promedio fue superior a un mes(AU)

A longitudinal and retrospective observational descriptive study was made with the objective of describing the behavior and evolution in relation to some variables of Guillain Barré syndrome in Camilo Cienfuegos University Hospital of Sancti Spíritus between January 1st, 1996 and December 31st, 2006. The universe and the sample were constituted by the total number of patients admitted with Guillain Barré syndrome. The information was collected from the department of Photography and statistics. For data analysis descriptive statistics, graphical and mathematical trend analysis were used. The trend of Guillain Barré syndrome in the study period resulted in an ascent, the antecedent most often presented was acute febrile process and the most frequent clinical manifestations at admission were decreased muscle strength followed by decreased or absent tendon reflexes. Patients where lumbar puncture was negative had a higher mortality rate and the treatment used did not influence it. Patients requiring mechanical ventilation had a higher mortality rate, the most frequent presented complication was bacterial bronchopneumonia and the average hospital stay was more than one month(AU)

Proyecto Policlínico Universitario: una alternativa para incrementar la motivación hacia la Medicina Familiar / University Polyclinic Project: an alternative to increase motivation for Family Medicine

Se realizó estudio observacional analítico con diseño transversal en estudiantes de la Facultad de Ciencias Médicas Dr Faustino Pérez Hernández de Sancti Spíritus, en febrero del 2007. Objetivo: determinar la eficacia del Proyecto Policlínico Universitario para incrementar la motivación hacia la especialidad de Medicina General Integral con el Modelo Tradicional. El universo fueron los estudiantes de 1ro, 2do y 3er año de medicina y la muestra, 51 estudiantes matriculados en el Proyecto Policlínico Universitario del municipio Sancti Spíritus. Se obtuvo un grupo control para realizar comparaciones encuestándose un total de 51 estudiantes. La información fue recolectada mediante encuesta. Las variables: modelo de estudio, motivación hacia la carrera de medicina, criterio acerca del proyecto, actitud hacia la medicina general integral, percepción de la especialidad, participación en investigaciones en atención primaria de salud, opinión acerca de la especialidad y motivación hacia la especialidad de medicina general integral. La motivación hacia la carrera de medicina es predominantemente media en ambos modelos y el criterio sobre el proyecto es alto en los alumnos del mismo, no así del modelo tradicional. La motivación hacia la especialidad Medicina General Integral fue superior en los estudiantes del Proyecto Policlínico con diferencias estadísticas significativas respecto al modelo tradicional(AU)

An observational study was made with cross design in students of Dr Faustino Pérez Hernández Medical Sciences Faculty of Sancti Spíritus, on February 2007. Objective: to determine the effectiveness of the University Polyclinic Project to increase motivation to the specialty of General Medicine with the traditional model. The universe was 1st, 2nd and 3rd year medical students and the sample, 51 students enrolled in Sancti Spíritus University Polyclinic Project. A control for comparison was obtained interviewing a total group of 51 students. The information was collected through a survey. Variables: study model, motivation to study medicine, criterion on the project, attitude to general medicine, specialty perception, participation in research on primary health care, opinion on the specialty and motivation towards general medicine specialty. The motivation towards the medical career is predominantly average in both models and the criterion on the project is high among its students, not behaving in this way the traditional model. The motivation toward General Medicine Specialty was higher in Polyclinic Project students with statistically significant differences from the traditional model(AU)