The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients.

BACKGROUND: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. METHODS: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0-1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. RESULTS: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. CONCLUSIONS: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.

Congenital complete absence of pericardium in a young woman with non-specific symptoms.

Congenital absence of the pericardium is a very rare entity that is usually asymptomatic and hence difficult to diagnose. However, cases of sudden death have been reported in patients with partial pericardial defects (even asymptomatic ones), and such patients require surgical treatment. We report the case of a 17-year-old patient with complete pericardial agenesis (diagnosed by chance during a cardiological consultation) and briefly review the radiological findings of this entity.

Influencia de la desnutrición en la mortalidad a largo plazo de pacientes hospitalizados por insuficiencia cardiaca / Impact of malnutrition on long-term mortality in hospitalized patients with heart failure

Introducción y objetivos. Actualmente se desconoce la prevalencia de desnutrición entre los pacientes con insuficiencia cardiaca y el papel que este estado pudiera tener en su pronóstico. El objetivo de este estudio es analizar la prevalencia y riesgo de desnutrición y su posible influencia en la mortalidad a largo plazo de los pacientes con insuficiencia cardiaca. Métodos. Se analizó prospectivamente a 208 pacientes dados de alta consecutivamente desde nuestro centro entre enero de 2007 y marzo de 2008 tras un ingreso por insuficiencia cardiaca. Antes del alta, se realizó una completa valoración nutricional y se realizó el diagnóstico de desnutrición y riesgo de desnutrición mediante la encuesta Mini Nutritional Assessment. Su posible asociación independiente con la mortalidad se valoró mediante un análisis multivariable de Cox. Resultados. La media de edad fue 73±10 años, el 46% eran mujeres y la etiología más frecuente de la insuficiencia cardiaca fue la isquémica (41%). El 13% de los pacientes fueron clasificados como desnutridos; el 59,5%, en riesgo de desnutrición y el 27,5%, bien nutridos. A los 25 meses (mediana de seguimiento), la mortalidad en los tres grupos fue del 76, el 35,9 y el 18,9% respectivamente (log-rank test, p<0,001). En el análisis multivariable de Cox, el estado de desnutrición resultó ser un predictor independiente de mortalidad (hazard ratio=3,75; intervalo de confianza del 95%, 1,75-8,02; p=0,001). Conclusiones. La desnutrición y el de riesgo de desnutrición alcanzan una prevalencia elevada en pacientes hospitalizados por insuficiencia cardiaca. Además, hemos encontrado que el estado de desnutrición definido mediante el Mini Nutritional Assessment es un predictor independiente de mortalidad en estos pacientes (AU)

Introduction and objectives. The prevalence of malnutrition among patients with heart failure and the role it might play in prognosis is not currently known. The aim of this study was to analyse the prevalence and risk of malnutrition as well as its possible influence on long-term mortality in patients with heart failure. Methods. A prospective analysis was conducted on 208 patients discharged consecutively from our centre between January 2007 and March 2008 after being hospitalised with heart failure. Before discharge, a complete nutritional assessment was performed and diagnosis of malnutrition and risk of malnutrition was done with the Mini Nutritional Assessment. Its possible independent association with mortality was assessed by a Cox multivariate analysis. Results. The mean age of the patients was 73±10 years, with 46% women; the most common aetiology of heart failure was ischaemia (41%). In addition, 13% were classified as malnourished, 59.5% at risk of malnutrition and 27.5% were well-nourished. At a median follow-up of 25 months, mortality in the three groups was 76%, 35.9% and 18.9%, respectively (log-rank, P<.001). In the Cox multivariate analysis, the malnutrition state was an independent predictor of mortality (hazard ratio 3.75, 95% confidence interval, 1.75-8.02, P=.001). Conclusions. Malnutrition and the risk of malnutrition are highly prevalent in patients hospitalised for heart failure. Furthermore, we found that the state of malnutrition as defined by the Mini Nutritional Assessment survey is an independent predictor of mortality in these patients (AU)

[Impact of malnutrition on long-term mortality in hospitalized patients with heart failure]. / Influencia de la desnutrición en la mortalidad a largo plazo de pacientes hospitalizados por insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: The prevalence of malnutrition among patients with heart failure and the role it might play in prognosis is not currently known. The aim of this study was to analyse the prevalence and risk of malnutrition as well as its possible influence on long-term mortality in patients with heart failure. METHODS: A prospective analysis was conducted on 208 patients discharged consecutively from our centre between January 2007 and March 2008 after being hospitalised with heart failure. Before discharge, a complete nutritional assessment was performed and diagnosis of malnutrition and risk of malnutrition was done with the Mini Nutritional Assessment. Its possible independent association with mortality was assessed by a Cox multivariate analysis. RESULTS: The mean age of the patients was 73 ± 10 years, with 46% women; the most common aetiology of heart failure was ischaemia (41%). In addition, 13% were classified as malnourished, 59.5% at risk of malnutrition and 27.5% were well-nourished. At a median follow-up of 25 months, mortality in the three groups was 76%, 35.9% and 18.9%, respectively (log-rank, P<.001). In the Cox multivariate analysis, the malnutrition state was an independent predictor of mortality (hazard ratio 3.75, 95% confidence interval, 1.75-8.02, P=.001). CONCLUSIONS: Malnutrition and the risk of malnutrition are highly prevalent in patients hospitalised for heart failure. Furthermore, we found that the state of malnutrition as defined by the Mini Nutritional Assessment survey is an independent predictor of mortality in these patients.

Measurement of aortic valve annulus using different cardiac imaging techniques in transcatheter aortic valve implantation: agreement with finally implanted prosthesis size.

AIMS: To compare the measurements of the aortic annulus obtained with various imaging techniques in patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation, and to determine the grade of agreement between the predicted size of the prosthesis for each technique, and the size of the finally implanted valve. METHODS AND RESULTS: The aortic annulus was measured in 40 patients treated by transcatheter aortic valve implantation (CoreValve aortic valve) with transthoracic (TTE) and transesophageal echocardiography (TEE), 64-slice tomography, and angiography. A large valve was implanted when annulus was >23 mm and a small one if it was ≤23 mm. If the size of the prosthesis predicted by several techniques was not the same in one case, we selected the size in which more techniques presented agreement. Forty aortic valves, 26 small and 14 large, were implanted percutaneously. The best correlation was obtained with TTE and TEE (r = 0.93, P < 0.001). The correlation of TTE and TEE with angiography also was good (r = 0.58, P < 0.001 and r = 0.53, P < 0.001, respectively). Correlations between these techniques and computed tomography were poor (P = NS for all comparisons). The best agreement between estimated aortic annulus and implanted valve size was obtained with transtoracic and TEE (κ= 0.88 and 0.76). CONCLUSIONS: The aortic annulus measurements obtained by TTE, TEE, and angiography correlated well, while tomography correlated poorly with other techniques. The imaging techniques that showed the best agreement between estimated aortic annulus size and implanted aortic valve size were TTE and TEE.

Anomalías cardiacas en el síndrome de LEOPARD / Cardiac abnormalities in LEOPARD syndrome

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