Rendimiento del marcapasos cardiaco Micra en nonagenarios / Performance of the Micra cardiac pacemaker in nonagenarians

INTRODUCCIÓN Y OBJETIVOS: El marcapasos transcatéter Micra presenta una alta efectividad y una tasa de complicaciones más baja que los marcapasos convencionales. Sin embargo, se desconoce su beneficio en la población más anciana (≥ 90 años). El objetivo de este estudio es evaluar la efectividad y la seguridad de Micra en pacientes de edad ≥ 90 años. MÉTODOS: Estudio observacional prospectivo con pacientes consecutivos mayores de 70 años a los que se implantó un marcapasos Micra, divididos en 2 grupos de edad: ≥ 90 y <90 años. RESULTADOS: El Micra se implantó en 129 pacientes, 41 tenían 90 o más años y 88, menos de 90. El implante fue exitoso en 40 pacientes (97,6%) de edad ≥ 90 años y en 87 (98,9%) menores de 90 (p = 0,58). Fueron necesarias 2 o menos reposiciones en el 97,5 y el 91,9% de los pacientes respectivamente (p = 0,32). Los tiempos de procedimiento (26,1±11,6 frente a 30,3±14,2min; p = 0,11) y de fluoroscopia (6,4±4,7 frente a 7,2±4,9min; p = 0,41) fueron similares en ambos grupos. Hubo 3 complicaciones mayores (2,3%), todas en el grupo menor de 90 años: 1 perforación cardiaca, 1 hematoma femoral y 1 seudoaneurisma femoral. Un total de 13 pacientes de edad ≥ 90 años (31,7%) y 16 de los menores de 90 (18,2%) murieron durante unos seguimientos medios de 230±233 y 394±285 días respectivamente. No hubo muertes relacionadas con el dispositivo. No se observaron infección, dislocación o migración de Micra. El rendimiento eléctrico fue óptimo en el seguimiento. CONCLUSIONES: El marcapasos sin cables Micra parece efectivo y seguro en pacientes mayores de 90 años. Podría considerarse una alternativa razonable a la estimulación transvenosa convencional en esta población

INTRODUCTION AND OBJECTIVES: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS: We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS: The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population

Performance of the Micra cardiac pacemaker in nonagenarians.

INTRODUCTION AND OBJECTIVES: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS: We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS: The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population.

[Combined high-sensitivity copeptin and troponin T evaluation for the diagnosis of non-ST elevation acute coronary syndrome in the emergency department]. / Evaluación de una estrategia diagnóstica combinada con copeptina y troponina T ultrasensibles en el infarto de miocardio sin elevación del segmento ST en los servicios de urgencias.

OBJECTIVES: To assess the diagnostic yield of a high-sensitivity copeptin (hs-copep) assay alone or in combination with a high-sensitivity cardiac troponin T (hs-cTnt) assay for the diagnosis of non-ST segment elevation acute coronary syndrome (NSTEMI) in patients with chest pain in the emergency department (ED). The secondary aim was to assess the 1-year prognostic utility of these biomarkers in this clinical context. MATERIAL AND METHODS: Retrospective observational study of a series of patients attended for chest pain suggesting myocardial ischemia in 5 Spanish ED. The first blood drawn in the ED was used for hs-copep and hs-cTnt assays, which were processed in a single laboratory serving all centers. Diagnostic utility was assessed by sensitivity, specificity, positive and negative predictive values and likelihood ratios, and the area under the receiver operating characteristic curve (ROC). We also performed a separate analysis with data for the subgroup of patients with early detection of symptoms (3 h of onset of symptoms). We recorded complications, mortality or reinfarction occurring within a year of the index event. RESULTS: We included 297 patients; 63 (21.2%) with NSTEMI. The median age was 69 years (interquartile range, 70-76 years), and 199 (67%) were men. The ROC was 0.89 (95% CI, 0.85-0.94) for the hs-cTnt assay, 0.58 (95% CI, 0.51-0.66) for the hscopep assay, and 0.90 (95% CI, 0.86-0.94) for the 2 assays combined. The ROC for the 2 assays combined was not significantly better than the ROC for the hs-cTnt by itself (P=.89). We saw the same pattern of results when we analyzed the subgroup of patients who presented early. Sixty percent of the complications occurred in patients with elevated findings on both assays. Elevated hs-copep findings did not provide prognostic information that was not already provided by hs-cTnt findings (P=.56). CONCLUSION: The hs-copep assay does not increase the diagnostic or prognostic yield already provided by the hs-cTnt assay in patients suspected of myocardial infarction in the ED.

OBJETIVO: Estudio fue evaluar la capacidad diagnóstica de la copeptina de elevada sensibilidad (copep-es), de forma aislada o conjuntamente con troponina cardiaca T de elevada sensibilidad (Tnc T-es), en el diagnóstico de infarto agudo de miocardio sin elevación del segmento ST (IAMSEST) en los pacientes atendidos por dolor torácico con sospecha de infarto de miocardio en los servicios de urgencias (SU), y seguidamente la capacidad pronóstica a los 12 meses. METODO: Estudio observacional retrospectivo de una serie de pacientes atendidos por dolor torácico sugestivo de isquemia miocárdica en 5 SU españoles. Se midieron centralizadamente copep-es y Tnc T-es en la primera muestra sanguínea extraída a la llegada al SU. El rendimiento diagnóstico se evaluó mediante la sensibilidad, la especificidad, los valores predictivos, las razones de verosimilitud, y el área bajo la curva (ABC) de la característica operativa del receptor (COR). Se realizó un análisis separado en el subgrupo de pacientes con presentación precoz (< 3 h desde el inicio de los síntomas). Se registraron las complicaciones, mortalidad o reinfarto, ocurridas a los 12 meses desde el evento índice. RESULTADOS: Se incluyeron 297 pacientes. Se diagnosticaron 63 (21,2%) IAMSEST. La mediana de edad fue 69 (RIC 70- 76) y 199 (67%) fueron varones. Las ABC COR fueron 0,89 (IC 95% 0,85-0,94) para Tnc T-es, 0,58 (IC 95% 0,51- 0,66) para copep-es y 0,90 (IC 95% 0,86-0,94) para la determinación conjunta. El ABC COR de la medida conjunta no mejoró a la de Tnc T-es aislada (p = 0,89). El análisis de los pacientes con presentación precoz mostró el mismo patrón de resultados. Un 60% de las complicaciones ocurrió en los pacientes con ambos biomarcadores elevados. Los incrementos aislados de copep-es no aportaron información pronóstica adicional a la proporcionada por Tnc T-es (p = 0,56). CONCLUSIONES: La medida de copep-es no mejora el valor diagnóstico o pronóstico de la Tnc T-es en los pacientes con sospecha de IAMSEST atendidos en los SU.

Evaluación de una estrategia diagnóstica combinada con copeptina y troponina T ultrasensibles en el infarto de miocardio sin elevación del segmento ST en los servicios de urgencias / Combined high-sensitivity copeptin and troponin T evaluation for the diagnosis of non-ST elevation acute coronary syndrome in the emergency department

Objetivo. Estudio fue evaluar la capacidad diagnóstica de la copeptina de elevada sensibilidad (copep-es), de forma aislada o conjuntamente con troponina cardiaca T de elevada sensibilidad (Tnc T-es), en el diagnóstico de infarto agudo de miocardio sin elevación del segmento ST (IAMSEST) en los pacientes atendidos por dolor torácico con sospecha de infarto de miocardio en los servicios de urgencias (SU), y seguidamente la capacidad pronóstica a los 12 meses. Método. Estudio observacional retrospectivo de una serie de pacientes atendidos por dolor torácico sugestivo de isquemia miocárdica en 5 SU españoles. Se midieron centralizadamente copep-es y Tnc T-es en la primera muestra sanguínea extraída a la llegada al SU. El rendimiento diagnóstico se evaluó mediante la sensibilidad, la especificidad, los valores predictivos, las razones de verosimilitud, y el área bajo la curva (ABC) de la característica operativa del receptor (COR). Se realizó un análisis separado en el subgrupo de pacientes con presentación precoz (< 3 h desde el inicio de los síntomas). Se registraron las complicaciones, mortalidad o reinfarto, ocurridas a los 12 meses desde el evento índice. Resultados. Se incluyeron 297 pacientes. Se diagnosticaron 63 (21,2%) IAMSEST. La mediana de edad fue 69 (RIC 70- 76) y 199 (67%) fueron varones. Las ABC COR fueron 0,89 (IC 95% 0,85-0,94) para Tnc T-es, 0,58 (IC 95% 0,51- 0,66) para copep-es y 0,90 (IC 95% 0,86-0,94) para la determinación conjunta. El ABC COR de la medida conjunta no mejoró a la de Tnc T-es aislada (p = 0,89). El análisis de los pacientes con presentación precoz mostró el mismo patrón de resultados. Un 60% de las complicaciones ocurrió en los pacientes con ambos biomarcadores elevados. Los incrementos aislados de copep-es no aportaron información pronóstica adicional a la proporcionada por Tnc T-es (p = 0,56). Conclusión. La medida de copep-es no mejora el valor diagnóstico o pronóstico de la Tnc T-es en los pacientes con sospecha de IAMSEST atendidos en los SU (AU)

Objectives. To assess the diagnostic yield of a high-sensitivity copeptin (hs-copep) assay alone or in combination with a high-sensitivity cardiac troponin T (hs-cTnt) assay for the diagnosis of non-ST segment elevation acute coronary syndrome (NSTEMI) in patients with chest pain in the emergency department (ED). The secondary aim was to assess the 1-year prognostic utility of these biomarkers in this clinical context. Material and methods. Retrospective observational study of a series of patients attended for chest pain suggesting myocardial ischemia in 5 Spanish ED. The first blood drawn in the ED was used for hs-copep and hs-cTnt assays, which were processed in a single laboratory serving all centers. Diagnostic utility was assessed by sensitivity, specificity, positive and negative predictive values and likelihood ratios, and the area under the receiver operating characteristic curve (ROC). We also performed a separate analysis with data for the subgroup of patients with early detection of symptoms (3 h of onset of symptoms). We recorded complications, mortality or reinfarction occurring within a year of the index event. Results. We included 297 patients; 63 (21.2%) with NSTEMI. The median age was 69 years (interquartile range, 70-76 years), and 199 (67%) were men. The ROC was 0.89 (95% CI, 0.85-0.94) for the hs-cTnt assay, 0.58 (95% CI, 0.51-0.66) for the hscopep assay, and 0.90 (95% CI, 0.86-0.94) for the 2 assays combined. The ROC for the 2 assays combined was not significantly better than the ROC for the hs-cTnt by itself (P=.89). We saw the same pattern of results when we analyzed the subgroup of patients who presented early. Sixty percent of the complications occurred in patients with elevated findings on both assays. Elevated hs-copep findings did not provide prognostic information that was not already provided by hs-cTnt findings (P=.56). Conclusion. The hs-copep assay does not increase the diagnostic or prognostic yield already provided by the hs-cTnt assay in patients suspected of myocardial infarction in the ED (AU)

Antiphospholipid syndrome and acute myocardial infarction: treatment with thrombectomy and abciximab.

Antiphospholipid syndrome (APS) is an autoimmune coagulation disorder that manifests clinically as venous and arterial thrombosis, and may affect any tissue or organ. Coronary artery involvement, however, is very rare. Case reports in the literature describing patients with coronary acute syndrome and APS treated with coronary angioplasty show conflicting results. We report an adult male patient with APS who presented with an acute myocardial infarction. Given the high risk of thrombosis in these patients, he was treated percutaneously with thrombectomy and abciximab. We review the few cases of coronary angioplasty in patients with APS reported to date. To our knowledge, this is the first case in which acute myocardial infarction due to thrombotic coronary occlusion was treated with thrombectomy and abciximab without stenting the artery.

Using high-sensitivity troponin T: the importance of the proper gold standard.

OBJECTIVE: The study objective was to determine how best to use high-sensitivity cardiac troponin T (hscTnT) to diagnose myocardial infarction. METHODS: A total of 358 patients presenting with acute coronary syndromes sampled at admission and 2, 4, and 6 to 8 hours. Both contemporary cardiac troponin T (cTnT) and hscTnT were measured. Patients were classified with conventional cTnT values by independent investigators. Myocardial infarction required a cTnT value ≥99th reference percentile and a ≥20% change. RESULTS: Seventy-nine patients had non-ST-segment elevation myocardial infarction, 105 patients had unstable angina, and 174 patients had nonacute coronary syndromes. A cTnT cutoff at the 10% coefficient of variation value missed 14.5% of infarctions. hscTnT had a sensitivity at admission of 89.9%, but specificity was only 75.1% because of elevations in 45.3% and 25.3% of those with unstable angina and nonacute coronary syndromes, respectively. The optimal value for myocardial infarction diagnosis with hscTnT was 25 ng/L at admission and 30 ng/L during serial sampling. All infarctions were diagnosed within 4 hours, with a time saving of 11 and 68 minutes compared with a cTnT value at the 99th reference percentile value and a cTnT value at a coefficient of variation of 10%. By using the 99th percentile of hsTnT plus a ≥20% change, 25 additional infarctions were identified. With these included, the optimal cutoff decreased to 12 ng/L at admission and 13 ng/L over time, but time to diagnosis increased. CONCLUSIONS: The gold standard used to diagnose myocardial infarction makes a major difference in the results. When myocardial infarction is diagnosed using hscTnT 99th percentile values with a 20% change, more are identified, diagnosis is delayed, and the optimal value for use is reduced.

Resultados del III registro IAM CAT de pacientes con infarto de miocardio con elevación del segmento ST en Cataluña. Comparación con los registros IAM CAT I y II / III Catalan registry of ST elevation acute myocardial infarction. Comparison with former Catalan registries I and II from Catalonia, Spain

Fundamento y objetivo: Analizar el tratamiento de reperfusión en el infarto de miocardio (IAM) con elevación del segmento ST (IAMEST) en Cataluña en el registro realizado en el año 2006 (IAM CAT III) y su comparación con 2 registros previos. Pacientes y método: La frecuencia del tratamiento de reperfusión y los intervalos inicio de síntomas-tratamiento fueron las variables fundamentales. El IAM CAT I (junio-diciembre de 2000) incluyó 1.450 pacientes; el IAM CAT II (octubre de 2002-abril de 2003), 1.386, y el IAM CAT III (octubre-diciembre de 2006), 367. Resultados: La proporción de pacientes tratados con reperfusión fue progresivamente mayor (el 72, el 79 y el 81%, respectivamente) con aumento también progresivo de la angioplastia primaria (el 5, el 10 y el 33%, respectivamente). En el III se utilizó más frecuentemente el SEM/061 como transporte (el 17, el 32 y el 47%, respectivamente), pero el intervalo inicio de síntomas-contacto con el sistema sanitario no mejoró (90min en el II y 105 en el III). El intervalo inicio de síntomas-tratamiento trombolítico apenas se modificó (178, 165 y 177min, respectivamente) y sí lo hizo, parcialmente, el tiempo entrada al hospital-trombólisis (“puerta-aguja”) (59, 42 y 42min, respectivamente). La mortalidad a los 30 días del IAMEST descendió en el III registro (el 12,1, el 10,6 y el 7,4%, respectivamente; p=0,012). Conclusiones: La frecuencia de tratamiento de reperfusión en el IAMEST ha mejorado y es satisfactoria. Sin embargo, los intervalos de su aplicación apenas se han reducido. Para esto es preciso una notificación más precoz al sistema sanitario y una reducción de los tiempos “puerta-aguja” y “puerta-balón” mediante una actuación conjunta más coordinada del 061, el personal sanitario y la administración hospitalaria, así como una mayor prioridad en la política sanitaria (AU)

Background and objective: To analyze the use of reperfusion therapy in patients with ST elevation myocardial infarction (STEMI) in Catalonia in a registry performed in 2006 (IAM CAT III) and its comparison with 2 previous registries. Patients and Methods: Frequency of reperfusion therapy and time intervals between symptom onset – reperfusion therapy were the principal variables investigated. The IAM CAT I (June-December 2000) included 1,450 patients, the IAM CAT II (October 2002-April 2003) 1,386, and the IAM CAT III (October-December 2006) 367. Results: The proportion of patients treated with reperfusion increased progressively (72%, 79% and 81%) as the use of primary angioplasty (5%, 10% and 33%). In the III registry the transfer system most frequently used was the SEM/061 (17%, 32% and 47%, respectively) but the time interval symptom onset-first contact with the medical system did not improve (II, 90 vs III, 105min), the interval symptom onset–thrombolytic therapy did hardly change (178, 165 and 177min) and the interval hospital arrival-trombolysis (needle-door) tended to improve (59, 42 and 42min). Thirty day mortality in STEMI patients declined progressively through the 3 registries (12.1, 10.6 and 7.4%, p=0.012). Conclusions: The proportion of STEMI patients treated with reperfusion has improved but the interval to its application has not been shortened. To improve the latter it is mandatory an earlier contact with the medical system, a shortening of the intervals door-needle and door-balloon through better coordination between the 061, the sanitary personnel and the hospital administration, and to consider the subject as a real sanitary priority (AU)

[Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin]. / Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco.

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to find out using the available diagnostic tools. Many patients present both heart and lung diseases that cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in this context has not been well settled so far. The objective was to describe the prediction usefulness of HC in patients suffering from dyspnea of heart origin, and to find out if HC changed after administering treatment. PATIENTS AND METHOD: HC was analyzed in 61 patients whose main symptom was dyspnea in the emergency department, and it was evaluated by means of clinical history, clinical course and performance of lung function tests and echocardiography. RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea of lung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea of heart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI, 8-52) than in patients with dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administering treatment. The sensitivity (52%), specificity (88%), positive predictive value (92%) and negative predictive value (58%) was established for a 30% HC cutoff. The prediction model of heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1). CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance, identifies the majority of patients suffering from current or past heart failure or severe cardiac dysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focus on selected patients.

Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco / Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin

FUNDAMENTO Y OBJETIVO: El origen respiratorio o cardíaco de la disnea no siempre es fácil de establecercon las herramientas diagnósticas disponibles. Muchos pacientes presentan a la vez procesoscardiológicos y pulmonares que la justifica. El papel que puede desempeñar el recuentode hemosiderófagos (RH) en esputo en este contexto no ha sido establecido suficientemente.El objetivo fue determinar la utilidad en la predicción y el diagnóstico del RH en pacientes condisnea de origen cardíaco, y si varía tras el tratamiento.PACIENTES Y MÉTODO: Hemos realizado el RH a 61 pacientes que consultaron por disnea en urgenciasy cuyo origen fue determinado por la historia clínica de urgencias, el curso clínico y la realizaciónde pruebas funcionales respiratorias y ecocardiograma.RESULTADOS: El RH fue superior en los pacientes con disnea de origen cardíaco (n = 35), 37%(intervalo de confianza [IC] del 95%, 26-47) o de origen cardiopulmonar (n = 9), 30% (IC del95%, 8-52) que el de origen respiratorio (n = 17), 15% (IC del 95%, 4-27). La sensibilidad(52%), especificidad (88%), valores predictivos positivo (92%) y negativo (58%) se determinaronpara un punto de corte del RH del 30%. El modelo de predicción de disnea de origen cardíaco,incluido el RH, presentó un área bajo la curva ROC de 0,978 (IC del 95%, 0,95-1).CONCLUSIONES: El RH refleja la gravedad de la alteración de la permeabilidad venocapilar pulmonar,identifica a la mayoría de los pacientes que presentan o han presentado disfunción o insuficienciacardíaca moderada o grave y predice la disnea de origen cardíaco. Su utilidad debecentrarse en casos seleccionados

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to findout using the available diagnostic tools. Many patients present both heart and lung diseasesthat cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in thiscontext has not been well settled so far. The objective was to describe the prediction usefulnessof HC in patients suffering from dyspnea of heart origin, and to find out if HC changed afteradministering treatment.PATIENTS AND METHOD: HC was analized in 61 patients whose main symptom was dyspnea in theemergency department, and it was evaluated by means of clinical history, clinical course andperformance of lung function tests and echocardiography.RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea oflung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea ofheart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI,, 8-52) than in patientswith dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administeringtreatment. The sensitivity (52%), specificity (88%), positive predictive value (92%)and negative predictive value (58%) was established for a 30% HC cutoff. The prediction modelof heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1).CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance,identifies the majority of patients suffering from current or past heart failure or severe cardiacdysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focuson selected patients

Infarto agudo de miocardio: tratamiento fibrinolítico en urgencias / Myocardial infarction: fibrinolytic treatment in the emergency room

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