Heart transplantation in patients with anthracycline-induced cardiomyopathy.

OBJECTIVE: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy. METHODS: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. RESULTS: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). CONCLUSION: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.

OBJETIVO: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. MÉTODOS: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. RESULTADOS: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). CONCLUSIÓN: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.

Predictors of inappropriate antimicrobial prescription: Eight-year point prevalence surveys experience in a third level hospital in Spain.

Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. We aimed to describe the Point Prevalence Surveys (PPS) methodology implemented in our hospital as an efficient tool to guide ASP strategies. Annually repeated PPS were conducted from 2012 to 2019 at a 750-bed university hospital in South Spain. Key quality indicators and inappropriateness of antimicrobial treatment, defined strictly according to local guidelines, were described. Variables associated with inappropriate treatment were identified by bi/multivariable analysis. A total of 1,600 patients were included. We found that 49% of the prescriptions were inappropriate due to unnecessary treatment (14%), not first line drug recommended (14%), inadequate drug according to microbiological results (9%), unsuitable doses (8%), route (3%) or duration (7%). Samples collection presented a significant protective effect together with sepsis presentation at onset and intensive care unit admission. However, age, receiving an empirical treatment and an unknown or urinary source of the infections treated were independent risk factors for inappropriateness. Site and severity of infection were documented in medical charts by prescribers (75 and 61% respectively). PPS may allow identifying the main risk factors for inappropriateness. This simple methodology may be useful for ASP to select modifiable factors to be prioritized for targeted interventions.

Registro Nacional Argentino de Resonancia Cardíaca (RENAREC) / Argentine National Cardiac Magnetic Resonance Imaging Registry (RENAREC)

RESUMEN Introducción: La utilidad de la resonancia magnética cardíaca (RMC) ha crecido ampliamente en los últimos años, en los cuales se han publicado distintos registros internacionales sobre su uso e impacto clínico. Sin embargo, no contamos con este tipo de información en Argentina. Objetivo: Evaluar indicaciones, protocolos utilizados, seguridad y consecuencias terapéuticas de la RMC en la República Argentina. Material y métodos: Se diseñó un registro prospectivo a nivel nacional con recolección de datos demográficos, indicaciones de RMC, complicaciones asociadas, diagnósticos y consecuencias terapéuticas. Resultados: Participaron 34 centros de 10 provincias de Argentina (85% centros privados, 59% centros con internación). Se incluyeron 1131 pacientes (edad 54 ± 18 años, 61% varones). Las principales indicaciones para el estudio de RMC fueron la miocardiopatía hipertrófica (13,9%) y la arritmia ventricular (12,3%). El 99,7% de los estudios fueron reportados sin complicaciones. Los resultados más frecuentes de la RMC fueron: normal (31,2%), miocardiopatía no isquémica (14,7%), miocardiopatía isquémico-necrótica (11,6%) y miocardiopatía hipertrófica (8,9%). La sospecha clínica fue confirmada en el 23,6% de los casos y la RMC generó un diagnóstico nuevo no sospechado en el 48,7% de los casos. Las consecuencias terapéuticas más frecuentes fueron el alta hospitalaria (31,6%) seguida por el cambio en la medicación (28,1%). Conclusiones: La RMC es un estudio ampliamente utilizado en Argentina, principalmente en centros privados, con un número muy bajo de complicaciones. Las principales indicaciones son las miocardiopatías (hipertrófica y dilatada) y la arritmia ventricular, y provee un diagnóstico nuevo no sospechado en casi la mitad de los casos. Se requieren de otros estudios en el futuro para evaluar las implicancias clínicas y terapéuticas.

ABSTRACT Background: The usefulness of cardiac magnetic resonance imaging (MRI) has greatly increased in the last years. Different international registries have been published on its use; however, there is no data available from Argentina. Objective: The aim of this study was to evaluate different indications, protocols, safety and therapeutic consequences of cardiac MRI in Argentina. Methods: A prospective national registry was designed with collection of demographic data, indications for cardiac MRI, associated complications, diagnoses and therapeutic consequences. Results: A total of 34 centers from 10 provinces of Argentina (85% private and 59% with inpatient capacity) participated in the study, including 1131 patients (mean age 54±18 years and 61% males). The main indications for cardiac MRI were hypertrophic cardiomyopathy (13.9%), and ventricular arrhythmia (12.3%). In 99.7% of cases, no study complications were reported. The most frequent results of cardiac MRI were: normal (31.2%), non-ischemic cardiomyopathy (14.7%), ischemic-necrotic cardiomyopathy (11.6%) and hypertrophic cardiomyopathy (8.9%). Clinical suspicion was confirmed in 23.6% of cases and cardiac MRI generated an unsuspected new diagnosis in 48.7% of cases. The main therapeutic consequences were hospital discharge (31.6%) followed by change in medication (28.1%). Conclusions: Cardiac MRI is widely used in Argentina, mainly in private centers with a very low incidence of complications. Cardiomyopathies (hypertrophic and dilated) and ventricular arrhythmia are its main indication, and it provides a new unsuspected diagnosis in almost half of the cases. Further studies are required to assess its clinical and therapeutic impact.

Compatibility of prolonged infusion antibiotics during Y-site administration.

BACKGROUND: Antimicrobial resistance is a threat to global public health. The use of prolonged infusions in the hospital setting for certain antimicrobials is widely increasing in order to improve their efficacy and safety, including resistance development. Due to limited vascular access, it is important to clarify whether they can be infused through the same line with other drugs during Y-site administration. AIM: The aim of this review is to update and summarize the evidence on Y-site compatibility of antibacterial agents administered as prolonged infusions in intensive care units (ICUs). STUDY DESIGN: A literature review of PubMed, EMBASE and Trissel's Handbook on Injectable Drugs databases was conducted on the compatibility of selected antimicrobials administered simultaneously at a Y-site connection with parenteral nutrition and other widely used drugs in ICUs. All articles published up to October 30, 2021, in English or Spanish were included, regardless of the type of publication (original articles, case reports, letters, etc.). Eligible antimicrobials were those that can be administered as prolonged infusions: ceftazidime, cefepime, piperacillin/tazobactam, meropenem, ceftolozane/tazobactam, ceftaroline, cloxacillin, ceftobiprole, vancomycin and fosfomycin. RESULTS: A total of 1302 drug-to-drug potential combinations were explored, 196 (15.05%) were found to be incompatible, and in 541 (41.55%), data were not available. The results were presented in a simple 2-dimensional consultation chart as a quick reference for health care professionals. CONCLUSIONS: This review provides useful and reliable information on the compatibility of antimicrobials administered as Y-site infusion with other drugs commonly used in the critical setting. This review contributes to patient safety in nursing practice. RELEVANCE TO CLINICAL PRACTICE: To our knowledge, this is the first review on Y-site compatibility of antimicrobials used as prolonged infusions with other commonly used drugs, including anti-emetics, analgesics and anti-epileptic and parenteral nutrition. The results of the current review need to be addressed to promote the knowledge sharing between health professionals and improve the quality and safety of patients. We believe that this review may serve as a simple and effective 2-dimensional updated drug-to-drug compatibility reference chart for critical care nurses.

Interacciones potenciales en una cohorte de pacientes VIH positivos de edad avanzada / Potential interactions in a cohort of elderly HIV-positive patients

Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e identificar potenciales interacciones entre antirretrovirales y medicación domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder prevenirlas. Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se relacionaron con inhibidores de proteasa potenciados. La principal consecuencia fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un papel crucial en su detección, manejo y comunicación precoz

Objective: An increased life expectancy leads to a new model of HIV patient with chronic diseases and occasionally polymedicated. With this study, we intend to understand treatment complexity and to identify any potential interactions between antiretroviral drugs and home medication in our patients, in order to identify and prevent them. Method: A retrospective, descriptive study carried out in a cohort of > 50-year-old patients on antiretroviral treatment in a tertiary hospital. Results: We included 242 patients; 148 (61%) of them were receiving some concomitant treatment. We detected 243 potential interactions: 197 considered moderate and 46 severe, in 110 patients. Of the severe interactions, 35 (76%) were related to boosted protease inhibitors. The main consequence of these interactions was an increase in the plasma concentrations of the home medication (48%). Statins (24%) were the group most involved in severe interactions, followed by inhaled corticosteroids (15%). Conclusions: Practically half of patients were polymedicated, and a high number of potential moderate or severe interactions were observed. The Hospital Pharmacist must play an essential role in their detection, management and early communication

Potential interactions in a cohort of elderly hiv-positive patients.

OBJECTIVE: The increase of HIV-patients life expectancy leads to a new model of patient with chronic diseases and polymedicated. For this reason we ought to  know in clinical practice the prevalence of polypharmacy and drug-drug  interactions between the antiretroviral drugs and comedication in our patients in  order to identify and prevent them. METHOD: A retrospective, descriptive study carried out in > 50 years old patients on antiretroviral treatment. Results: We included 242 patients of whom 148 (61%) were receiving concomitant treatment. 243 potential interactions were detected,  where 197 are considered moderate and 46 severe, affecting 110 patients. 35  (76%) interactions were related to boosted protease inhibitors. The main  consequence of these interactions was the increase in plasma concentrations of  comedication (48%). Statins were the comedication most involved in severe  drug-druginteractions (24%), followed by inhaled corticosteroids (15%). CONCLUSIONS: Polypharmacy was found in about half of our study population and the prevalence of drug-drug interactions was high. Hospital pharmacists may  play a crucial role in their detection, management and early communication.

Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de  paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e  identificar potenciales interacciones entre antirretrovirales y medicación  domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder  prevenirlas.Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con  tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún  otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas  moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se  relacionaron con inhibidores de proteasa potenciados. La principal consecuencia  fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario  (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las  interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un  papel crucial en su detección, manejo y comunicación precoz.

Comportamiento plasmático y clínico del ácido láctico en el trasplante cardíaco / Plasmatic pattern and clinical outcomes of lactic acid in heart transplantation

Resumen Introducción Hay controversia en relación con el ácido láctico luego del trasplante cardíaco. Objetivo Evaluar el patrón plasmático del ácido láctico y su valor pronóstico luego del trasplante cardíaco. Métodos Entre el 2011 y el 2014 se incluyeron 127 pacientes luego de cirugía cardíaca, 71 pertenecieron al grupo trasplante y 56 al grupo "control", conformado por pacientes sometidos a cirugía de revascularización miocárdica. Se compararon los niveles de ácido láctico antes de la cirugía, al ingreso en la Unidad Coronaria, y a las 6, 12 y 24 h en los 2 grupos. Dentro del grupo trasplante se realizó un análisis uni y bivariado entre niveles de ácido láctico y mortalidad hospitalaria. Resultados La media de edad fue de 57 años. Los niveles de ácido láctico fueron significativamente mayores durante y luego de la cirugía cardíaca en los pacientes del grupo trasplante respecto a los pacientes del grupo control (p<0.001), pero no existieron diferencias significativas en los valores antes de la cirugía (p=0.143; comparaciones no ajustadas). En los trasplantados, los niveles de ácido láctico se asociaron de forma significativa a una mayor mortalidad durante la cirugía, al ingreso, y a las 6, 12 y 24 h. El ácido láctico al ingreso fue un predictor de muerte ajustado por volumen minuto postoperatorio (p=0.011), uso de ≥ 2 inotrópicos (p=0.033), glucemia al ingreso (p=0.004), edad ≥ 60 años (p=0.015), tiempo de bomba (p=0.027) y pH (p=0.017). Conclusiones Los niveles de ácido láctico fueron mayores en los trasplantados y se asociaron a una mayor mortalidad hospitalaria.

Abstract Introduction It is not well established the prognostic value of elevated lactic acid after heart transplantation. Objective To evaluate the plasmatic pattern and the prognostic value of elevated lactate after heart transplantation. Methods One-hundred and twenty seven patients were included between 2011 and 2014, 71 comprising the transplantation group and 56 the control group, represented by on pump coronary artery by-pass surgery patients. Lactic acid levels were compared between groups before, within and after surgery upon Coronary Care Unit admission, at 6, 12 and 24 h. In addition, in the transplantation group univariate and bivariate analysis were performed between lactic acid levels and in-hospital mortality. Results The mean age of the entire cohort was 57 years. Among transplanted patients, lactic acid levels were significantly higher over control group: within the surgery; and after surgery (P<.001), but not before surgery (P=.143; unadjusted comparisons). In transplanted patients, lactic acid levels were significantly associated with in-hospital mortality during surgery, at admission, and thereafter but not before surgery. Lactic acid at admission was associated with in-hospital mortality after adjustment of postoperative cardiac output (P=.011), ≥ 2 inotropic drug support within 24 h (P=.033), glycemic level at admission (P=.004), age ≥ 60 years (P=.015), on pump time (P=.027), and pH (P=.017). Conclusions Acid lactic levels were higher in transplanted patients than in the control group and was associated to higher in-hospital mortality.

[Plasmatic pattern and clinical outcomes of lactic acid in heart transplantation]. / Comportamiento plasmático y clínico del ácido láctico en el trasplante cardíaco.

INTRODUCTION: It is not well established the prognostic value of elevated lactic acid after heart transplantation. OBJECTIVE: To evaluate the plasmatic pattern and the prognostic value of elevated lactate after heart transplantation. METHODS: One-hundred and twenty seven patients were included between 2011 and 2014, 71 comprising the transplantation group and 56 the control group, represented by on pump coronary artery by-pass surgery patients. Lactic acid levels were compared between groups before, within and after surgery upon Coronary Care Unit admission, at 6, 12 and 24h. In addition, in the transplantation group univariate and bivariate analysis were performed between lactic acid levels and in-hospital mortality. RESULTS: The mean age of the entire cohort was 57 years. Among transplanted patients, lactic acid levels were significantly higher over control group: within the surgery; and after surgery (P<.001), but not before surgery (P=.143; unadjusted comparisons). In transplanted patients, lactic acid levels were significantly associated with in-hospital mortality during surgery, at admission, and thereafter but not before surgery. Lactic acid at admission was associated with in-hospital mortality after adjustment of postoperative cardiac output (P=.011),≥2 inotropic drug support within 24h (P=.033), glycemic level at admission (P=.004), age≥60 years (P=.015), on pump time (P=.027), and pH (P=.017). CONCLUSIONS: Acid lactic levels were higher in transplanted patients than in the control group and was associated to higher in-hospital mortality.

Diagnóstico etiológico de la miocardiopatía en pacientes receptores de trasplante cardíaco: Concordancia entre el diagnóstico clínico pretrasplante y la anatomía patológica / Etiologic Diagnosis of Cardiomyopathy in Heart Transplant Recipients: Agreement Between Pre-transplant Clinical Diagnosis and Pathology

Introducción: El diagnóstico etiológico en pacientes con miocardiopatías en estadio avanzado puede ser un desafío. Un gran número de pacientes permanecen sin diagnóstico a pesar de una evaluación exhaustiva, por lo que quedan rotuladas como miocardiopatías dilatadas idiopáticas. Objetivos: Describir la etiología de la miocardiopatía en pacientes receptores de trasplante cardíaco según el diagnóstico clínico pretrasplante y su grado de concordancia con el diagnóstico anatomopatológico del corazón explantado. Material y métodos: Se realizó un análisis retrospectivo de pacientes consecutivos trasplantados en un hospital de alta complejidad de la Ciudad Autónoma de Buenos Aires desde 2003 hasta fines de 2013. Se efectuó un análisis de concordancia entre el diagnóstico clínico pretrasplante y el diagnóstico anatomopatológico del corazón explantado utilizando el coeficiente kappa. Resultados: Se analizaron 100 pacientes con una edad media en el momento del trasplante de 49,7 ± 12,5 años y una mediana de fracción de eyección del 26,6%. El diagnóstico clínico pretrasplante más frecuente fue el de miocardiopatía dilatada idiopática (37%), seguida por la miocardiopatía isquémico-necrótica (32%) y la miocardiopatía chagásica (10%). Entre los diagnósticos histopatológicos más frecuentes se encontraron el de miocardiopatía isquémico-necrótica (35%), de miocardiopatía hipertrófica (10%), de miocardiopatía chagásica (10%) y de miocarditis (8%); no se arribó a un diagnóstico causal en el 25% (miocardiopatía dilatada idiopática). El resultado del coeficiente kappa fue de 0,64 (IC 0,52-0,76). Conclusiones: Aproximadamente un tercio de los pacientes llegan al trasplante sin un diagnóstico etiológico. El análisis anatomopatológico permite identificar la causa en más de la mitad de estos pacientes. A pesar de que la concordancia entre el diagnóstico pretrasplante y la anatomía patológica fue estadísticamente buena, un porcentaje importante de pacientes podría beneficiarse con un diagnóstico etiológico más preciso, que podría tener implicaciones pronósticas, terapéuticas y/o en la evaluación de familiares.

Introduction: Etiologic diagnosis in patients with end-stage cardiomyopathy can be challenging. A large number of patients remain undiagnosed despite a thorough evaluation, so they are classified as idiopathic dilated cardiomyopathies. Objectives: To describe the etiology of cardiomyopathy in heart transplant recipients according to pretransplant clinical diagnosis and its degree of agreement with the anatomopathological diagnosis of the explanted heart. Methods: We performed a retrospective analysis of consecutively transplanted patients in a high complexity hospital of the Autonomous City of Buenos Aires from 2003 to the end of 2013. An agreement analysis between pretransplantation clinical diagnosis and anatomopathological diagnosis of the explanted heart was done using the kappa coefficient. Results: One-hundred patients with mean age of 49.7 ± 12.5 years at the time of transplantation and median ejection fraction of 26.6% were analyzed. The most common pretransplant clinical diagnosis was idiopathic dilated cardiomyopathy (37%), followed by ischemic-necrotic cardiomyopathy (32%) and Chagas cardiomyopathy (10%). The most common histopathological diagnoses were ischemic-necrotic cardiomyopathy (35%), hypertrophic cardiomyopathy (10%), Chagas cardiomyopathy (10%) and myocarditis (8%); a causal diagnosis was not reached in 25% of cases (idiopathic dilated cardiomyopathy). The kappa coefficient was 0.64 (CI 0.52-0.76). Conclusions: Approximately one third of patients reach transplantation without an etiologic diagnosis. Anatomopathological analysis allows identifying the cause in more than half of these patients. Although the correlation between pretransplant diagnosis and pathological anatomy was statistically adequate, a significant percentage of patients could benefit from a more specific etiologic diagnosis, which may have prognostic, therapeutic and/or family assessment implications.

Diagnóstico etiológico de la miocardiopatía en pacientes receptores de trasplante cardíaco: Concordancia entre el diagnóstico clínico pretrasplante y la anatomía patológica / Etiologic Diagnosis of Cardiomyopathy in Heart Transplant Recipients: Agreement Between Pre-transplant Clinical Diagnosis and Pathology

Introducción: El diagnóstico etiológico en pacientes con miocardiopatías en estadio avanzado puede ser un desafío. Un gran número de pacientes permanecen sin diagnóstico a pesar de una evaluación exhaustiva, por lo que quedan rotuladas como miocardiopatías dilatadas idiopáticas. Objetivos: Describir la etiología de la miocardiopatía en pacientes receptores de trasplante cardíaco según el diagnóstico clínico pretrasplante y su grado de concordancia con el diagnóstico anatomopatológico del corazón explantado. Material y métodos: Se realizó un análisis retrospectivo de pacientes consecutivos trasplantados en un hospital de alta complejidad de la Ciudad Autónoma de Buenos Aires desde 2003 hasta fines de 2013. Se efectuó un análisis de concordancia entre el diagnóstico clínico pretrasplante y el diagnóstico anatomopatológico del corazón explantado utilizando el coeficiente kappa. Resultados: Se analizaron 100 pacientes con una edad media en el momento del trasplante de 49,7 ± 12,5 años y una mediana de fracción de eyección del 26,6%. El diagnóstico clínico pretrasplante más frecuente fue el de miocardiopatía dilatada idiopática (37%), seguida por la miocardiopatía isquémico-necrótica (32%) y la miocardiopatía chagásica (10%). Entre los diagnósticos histopatológicos más frecuentes se encontraron el de miocardiopatía isquémico-necrótica (35%), de miocardiopatía hipertrófica (10%), de miocardiopatía chagásica (10%) y de miocarditis (8%); no se arribó a un diagnóstico causal en el 25% (miocardiopatía dilatada idiopática). El resultado del coeficiente kappa fue de 0,64 (IC 0,52-0,76). Conclusiones: Aproximadamente un tercio de los pacientes llegan al trasplante sin un diagnóstico etiológico. El análisis anatomopatológico permite identificar la causa en más de la mitad de estos pacientes. A pesar de que la concordancia entre el diagnóstico pretrasplante y la anatomía patológica fue estadísticamente buena, un porcentaje importante de pacientes podría beneficiarse con un diagnóstico etiológico más preciso, que podría tener implicaciones pronósticas, terapéuticas y/o en la evaluación de familiares.(AU)

Introduction: Etiologic diagnosis in patients with end-stage cardiomyopathy can be challenging. A large number of patients remain undiagnosed despite a thorough evaluation, so they are classified as idiopathic dilated cardiomyopathies. Objectives: To describe the etiology of cardiomyopathy in heart transplant recipients according to pretransplant clinical diagnosis and its degree of agreement with the anatomopathological diagnosis of the explanted heart. Methods: We performed a retrospective analysis of consecutively transplanted patients in a high complexity hospital of the Autonomous City of Buenos Aires from 2003 to the end of 2013. An agreement analysis between pretransplantation clinical diagnosis and anatomopathological diagnosis of the explanted heart was done using the kappa coefficient. Results: One-hundred patients with mean age of 49.7 ± 12.5 years at the time of transplantation and median ejection fraction of 26.6% were analyzed. The most common pretransplant clinical diagnosis was idiopathic dilated cardiomyopathy (37%), followed by ischemic-necrotic cardiomyopathy (32%) and Chagas cardiomyopathy (10%). The most common histopathological diagnoses were ischemic-necrotic cardiomyopathy (35%), hypertrophic cardiomyopathy (10%), Chagas cardiomyopathy (10%) and myocarditis (8%); a causal diagnosis was not reached in 25% of cases (idiopathic dilated cardiomyopathy). The kappa coefficient was 0.64 (CI 0.52-0.76). Conclusions: Approximately one third of patients reach transplantation without an etiologic diagnosis. Anatomopathological analysis allows identifying the cause in more than half of these patients. Although the correlation between pretransplant diagnosis and pathological anatomy was statistically adequate, a significant percentage of patients could benefit from a more specific etiologic diagnosis, which may have prognostic, therapeutic and/or family assessment implications.(AU)

[Estimation of the "vascular age" based on body mass index in a population in primary prevention. Association with subclinical carotid atherosclerosis]. / Estimación de la «edad vascular¼ basada en el índice de masa corporal en una población en prevención primaria. Asociación con la aterosclerosis carotídea subclínica.

BACKGROUND AND OBJECTIVES: To know the relationship between "vascular age" (VA) and the diagnosis of subclinical atherosclerosis could improve cardiovascular risk stratification. OBJECTIVES: 1) to know the VA in a primary prevention population, and 2) to determine the relationship between VA and the presence of carotid atherosclerotic plaque (CAP). PATIENTS AND METHODS: We calculated VA based on body mass index (BMI). We obtained the difference between VA and chronological age (Delta). The screening of CAP was done by ultrasound. We analyzed the association between quintiles of VA and Delta with the presence of CAP. ROC analysis was performed. RESULTS: In total, 411 patients were included (age 47 [10] years, 54% men). The VA and Delta were 55 (15) and 7 (9) years respectively. In 75% of the patients VA was higher than the chronological age (50%≥ 6 years). Subjects with CAP had significantly higher VA (66 [11] versus 50 [14] years, P<.0001) and Delta (13 [9] versus 5 [7] years, P<.0001) than subjects without CAP. We observed a positive association of quintiles of VA and Delta with the prevalence of CAP. The area under de curve and the optimal cutoff point of VA for the detection of CAP were 0.813 and 60 years, respectively, and for Delta, 0,771 and 11 years, respectively. CONCLUSIONS: The VA based on BMI could be a simple tool to estimate the presence of CAP and improve cardiovascular risk stratification in patients in primary prevention.