Importancia pronóstica de la hipertensión pulmonar en insuficiencia cardiaca con fracción de eyección preservada / Prognostic importance of pulmonary hypertension in heart failure with preserved ejection fraction

Objetivos. La hipertensión pulmonar (HP) es una complicación frecuente en insuficiencia cardiaca (IC). Sin embargo, su impacto no está bien establecido en insuficiencia cardiaca con fracción de eyección preservada (ICFEP). El objetivo principal del estudio es conocer el valor pronóstico de la HP en pacientes hospitalizados por ICFEP. Pacientes y métodos. Estudio observacional y prospectivo de pacientes hospitalizados por ICFEP (fracción de eyección del ventrículo izquierdo [FEVI] >45%). Se definió HP por una presión arterial sistólica pulmonar (PASP) >35mmHg medido por el gradiente de regurgitación tricuspidea añadido a la presión auricular. La variable resultado fue un evento compuesto de mortalidad total y/o ingreso hospitalario por IC durante un seguimiento de 1 año. Para valorar diferencias en el seguimiento se realizó una curva de Kaplan-Meier y posteriormente se estimó riesgo ajustado mediante una regresión de Cox. Resultados. Un total de 218 pacientes completaron el periodo de seguimiento, de los que 56 (26,7%) tenían una PASP>35mmHg. La incidencia del evento combinado fue en 126 pacientes (57,8%) y la mortalidad en 70 pacientes (32,1%). El estudio de supervivencia mostró diferencias pronósticas en el grupo de HP tanto para la variable resultado combinada (Log Rank <0,001) como para la mortalidad total (log Rank 0,019). El riesgo ajustado para los pacientes con HP fue de 2,03 (IC 95%: 1,39–2,96; p<0,001) para el evento combinado y de 1,84 (IC 95%: 1,11–3,03; p=0,017) para la mortalidad total. Conclusiones. La hipertensión pulmonar (PASP >35mmHg) medida por métodos no invasivos es un marcador robusto e independiente de mal pronóstico en pacientes hospitalizados por IC con fracción eyección preservada o ligeramente deprimida(AU)

Objectives. Pulmonary hypertension (PH) is a frequent complication in heart failure (HF). However, its impact factor in heart failure with preserved ejection fraction (HFPEF) is not well-known. This study has aimed to identify the prognostic value of PH in hospitalized patients with HFPEF. Material and Methods. An observational and prospective trial of patients admitted due to HFPEF (LVEF >45%). Pulmonary hypertension was defined by Pulmonary artery systolic pressure (PASP) >35mm Hg measured by the tricuspid regurgitation velocity plus atrial pressure. The primary endpoint was all-cause mortality and/or readmissions during 1-year follow-up. Kaplan-Meier survival curves and Cox regression were performed to identify adjusted hazard ratios (HR). Results. A total of 218 patients completed the follow-up period, 56 patients (32.2%) had PASP >35mm Hg. Primary endpoint was observed in 126 patients (57.8%) and 70 patients (32.2%) died. Kaplan-Meier survival curves showed increased significantly all-cause mortality and/or readmission in patients with PH (Log Rank <0.001) and mortality (Log Rank 0.019). Patients with PH were an increased adjusted risk for primary endpoint, HR 2.03 (CI 95%: 1.39–2.96; p<0.001) and all-cause mortality, HR 1.84 (CI 95%: 1.11–3.03; p=0.017). Conclusions. Pulmonary hypertension (PASP >35mm Hg) measured by non-invasive methods is a strong and independent predictor of an unfavorable outcome in patients hospitalized due to heart failure and normal or only mildly reduced ejection fraction(AU)

[Prognostic importance of pulmonary hypertension in heart failure with preserved ejection fraction]. / Importancia pronóstica de la hipertensión pulmonar en insuficiencia cardiaca con fracción de eyección preservada.

OBJECTIVES: Pulmonary hypertension (PH) is a frequent complication in heart failure (HF). However, its impact factor in heart failure with preserved ejection fraction (HFPEF) is not well-known. This study has aimed to identify the prognostic value of PH in hospitalized patients with HFPEF. MATERIAL AND METHODS: An observational and prospective trial of patients admitted due to HFPEF (LVEF >45%). Pulmonary hypertension was defined by Pulmonary artery systolic pressure (PASP) >35mm Hg measured by the tricuspid regurgitation velocity plus atrial pressure. The primary endpoint was all-cause mortality and/or readmissions during 1-year follow-up. Kaplan-Meier survival curves and Cox regression were performed to identify adjusted hazard ratios (HR). RESULTS: A total of 218 patients completed the follow-up period, 56 patients (32.2%) had PASP >35mm Hg. Primary endpoint was observed in 126 patients (57.8%) and 70 patients (32.2%) died. Kaplan-Meier survival curves showed increased significantly all-cause mortality and/or readmission in patients with PH (Log Rank <0.001) and mortality (Log Rank 0.019). Patients with PH were an increased adjusted risk for primary endpoint, HR 2.03 (CI 95%: 1.39-2.96; p<0.001) and all-cause mortality, HR 1.84 (CI 95%: 1.11-3.03; p=0.017). CONCLUSIONS: Pulmonary hypertension (PASP >35mm Hg) measured by non-invasive methods is a strong and independent predictor of an unfavorable outcome in patients hospitalized due to heart failure and normal or only mildly reduced ejection fraction.

Quiste pericárdico post-traumático de localización atípica / Atipically postraumatic pericardial cyst

Los quistes pericárdicos son raros, y la mayoría de ellos son de origen congénito. Normalmente se localizan en los ángulos cardiofrénicos, principamente en el lado derecho. A pesar de que la forma de presentación clínica más frecuente es asintomático y el pronóstico es benigno, se han descrito importantes complicaciones. Por ello clásicamente se ha tendido a una actitud terapeútica agresiva como aspiración percutánea o resección quirúrgica mediante toracotomía o toracoscopia. El caso que describimos es interesante por tratarse de un quiste pericárdico de localización inusual, paramediastínico superior izquierda, y de origen fue postraumático, no congénito. El diagnóstico se realizó por las pruebas de imagen, y tomamos una actitud terapéutica conservadora debido a la buena evolución. Proponemos por ello la opción de tratamiento conservador como actitud válida y razonable en la ausencia de complicaciones o síntomas en su evolución

Pericardial cyst are rare, most of them congenital in origin. They usually are located in the cardiophrenic angles, mainly on the right side. Although the most frequent clinical presentation is asyntomatic, and the prognosis is benign, important complications had been described. For this reason we used to take agressive therapeutic interventions like percutaneous aspiracion or surgical reseccion by thoracotomia or thoracoscophy. The case we report is interesting because it was an atipically located left upper paramediastinal cyst, and not congenital in origin but postraumatic. The diagnosis was made by imaging techniques and we accomplished conservative alternative because of the favourable evolution. We think that it should be a good option in case of asyntomatic and no complicated cases

Derrame pericárdico crónico atribuible a minoxidil / Chronic pericardial effusion attributable to minoxidil

El minoxidil es un potente vasodilatador oral que era frecuentemente utilizado en hipertensión arterial refractaria a tratamiento con otros fármacos, cuya relación con la aparición de derrame pericárdico se conoce prácticamente desde el comienzo de su uso clínico. Describimos un caso de derrame pericárdico grave asociado a la toma de minoxidil durante más de 20 años que responde favorablemente a la retirada del fármaco a pesar de tan larga evolución. La incidencia descrita de derrame pericárdico por minoxidil se encuentra entre un 0 %-26 % y, a pesar de la posible evolución hacia taponamiento cardíaco en raros casos, el manejo conservador con la retirada del fármaco es la primera opción, que en nuestra opinión debe serlo incluso cuando el derrame sea grave y de muy larga evolución

Minoxidil is a potent oral vasodilator that was frequently used in HBP refractory to treatment with other drugs, whose relationship with the appearance of pericardial effusion has practically been known since the onset of its clinical use. We describe a case of severe pericardial effusion, associated to taking minoxidil for more than 20 years that favorably responds to withdrawal of the drug in spite of such a long course. The incidence described of pericardial effusion due to minoxidil is between 0 %-26 %. In spite of the possible evolution towards cardiac tamponade in rare cases, the conservative management with drug withdrawal is the first option, which, in our opinion, should even be so when the effusion is severe and of long durationMinoxidil is a potent oral vasodilator that was frequently used in HBP refractory to treatment with other drugs, whose relationship with the appearance of pericardial effusion has practically been known since the onset of its clinical use. We describe a case of severe pericardial effusion, associated to taking minoxidil for more than 20 years that favorably responds to withdrawal of the drug in spite of such a long course. The incidence described of pericardial effusion due to minoxidil is between 0 %-26 %. In spite of the possible evolution towards cardiac tamponade in rare cases, the conservative management with drug withdrawal is the first option, which, in our opinion, should even be so when the effusion is severe and of long duration

Derrame pericárdico crónico atribuible a minoxidil / Chronic pericardial effusion attributable to minoxidil

El minoxidil es un potente vasodilatador oral que era frecuentemente utilizado en hipertensión arterial refractaria a tratamiento con otros fármacos, cuya relación con la aparición de derrame pericárdico se conoce prácticamente desde el comienzo de su uso clínico. Describimos un caso de derrame pericárdico grave asociado a la toma de minoxidil durante más de 20 años que responde favorablemente a la retirada del fármaco a pesar de tan larga evolución. La incidencia descrita de derrame pericárdico por minoxidil se encuentra entre un 0 %-26 % y, a pesar de la posible evolución hacia taponamiento cardíaco en raros casos, el manejo conservador con la retirada del fármaco es la primera opción, que en nuestra opinión debe serlo incluso cuando el derrame sea grave y de muy larga evolución

Minoxidil is a potent oral vasodilator that was frequently used in HBP refractory to treatment with other drugs, whose relationship with the appearance of pericardial effusion has practically been known since the onset of its clinical use. We describe a case of severe pericardial effusion, associated to taking minoxidil for more than 20 years that favorably responds to withdrawal of the drug in spite of such a long course. The incidence described of pericardial effusion due to minoxidil is between 0 %-26 %. In spite of the possible evolution towards cardiac tamponade in rare cases, the conservative management with drug withdrawal is the first option, which, in our opinion, should even be so when the effusion is severe and of long duration

Varón de 40 años con accidente vascular cerebral sin secuelas / A 40-year-old male with CVA without sequelae

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[Atypically located posttraumatic pericardial cyst]. / Quiste pericárdico post-traumático de localización atípica.

Pericardial cyst are rare, most of them congenital in origin. They usually are located in the cardiophrenic angles, mainly on the right side. Although the most frequent clinical presentation is asymptomatic, and the prognosis is benign, important complications had been described. For this reason we used to take aggressive therapeutic interventions like percutaneous aspiration or surgical resection by thoracotomia or thoracoscopy. The case we report is interesting because it was an atypically located left upper paramediastinal cyst, and not congenital in origin but posttraumatic. The diagnosis was made by imaging techniques and we accomplished conservative alternative because of the favourable evolution. We think that it should be a good option in case of asymptomatic and no complicated cases.

[Heart transplantation in a patient with rheumatoid arthritis]. / Trasplante cardíaco en un paciente con artritis reumatoide.

A 56 year-old woman with rheumatoid arthritis was diagnosed with idiopathic dilated cardiomyopathy. She developed progressive heart failure that was refractory to conventional medical management. Heart transplantation was performed bearing in mind the controversy that surrounds its use in patients with a systemic disease. Transplant and rheumatoid arthritis were favorable at 33 month evolution. The immunosuppressive therapy required for the transplant helped the control of her articular disease.

Effects of bisoprolol on left ventricular hypertrophy in essential hypertension.

Previous studies have shown that beta-adrenergic blocking drugs can reverse ventricular hypertrophy in patients with systemic hypertension. Thirty patients with essential hypertension and left ventricular hypertrophy were studied at baseline after withdrawing all previous treatments and after 6 months of treatment with 5-20 mg of bisoprolol, a new beta-selective agent, to assess its possible action on left ventricular mass. Three patients did not finish the study. Blood pressure was reduced to below 160/90 mmHg in 22 of the remaining 27 patients. At the end of follow-up, the left ventricular mass (echocardiography) was reduced from 308.1 +/- 89 g to 262.3 +/- 51 g (p < 0.001) and left ventricular mass index from 165 +/- 47.4 g/m2 to 141.03 +/- 26.7 g/m2 (p < 0.001). The ratio of E wave/A wave velocity of transmitral blood flow measured by Doppler increased from 0.86 +/- 0.44 to 1.07 +/- 0.45 (p = 0.005). Peak filling rate, derived from nuclear ventriculography, changed from 2.05 +/- 0.4 EDV/sec before the treatment to 2.23 +/- 0.47 EDV/sec after it (p = 0.0046). Serum lipids as well as other biochemical tests were unchanged. Left ventricular volumes and ejection fraction did not change, and treadmill exercise time increased from 343 +/- 125 seconds to 420 +/- 135 seconds (p = 0.002). Maximal systolic blood pressure during exercise decreased from 197.2 +/- 19.7 mmHg to 182.9 +/- 25.8 mmHg (p = 0.011). There were few side effects. We conclude that bisoprolol reduces left ventricular mass, preserves systolic function, and improves diastolic function of the left ventricle in hypertensive subjects with left ventricular hypertrophy.