The Diurnal Profile of Central Hemodynamics in a General Uruguayan Population.

BACKGROUND: No previous population study assessed the diurnal profile of central arterial properties. METHODS: In 167 participants (mean age, 56.1 years; 63.5% women), randomly recruited in Montevideo, Uruguay, we used the oscillometric Mobil-O-Graph 24-h PWA monitor to measure peripheral and central systolic (SBP), diastolic (DBP), and pulse (PP) pressures and central hemodynamics standardized to a heart rate of 75 bpm, including aortic pulse wave velocity, systolic augmentation (first/second peak × 100), and pressure amplification (peripheral PP/central PP). RESULTS: Over 24 hours, day and night, peripheral minus central differences in SBP/DBP and in PP averaged 12.2/-1.1, 14.0/-0.7, and 9.7/0.2mm Hg and 12.6, 14.7, and 9.5mm Hg, respectively (P < 0.001 except for nighttime DBP (P = 0.38)). The central-to-peripheral ratios of SBP, DBP, and PP were 0.89, 1.00, and 0.70 unadjusted, but after accounting for anthropometric characteristics decreased to 0.74, 0.97, and 0.63, respectively, with strong influence of height for SBP and DBP and of sex for PP. From day (10-20h) to nighttime (0-6h), peripheral (-10.4/-10.5 mm Hg) and central (-6.0/-11.3mm Hg) SBP/DBP, pulse wave velocity (-0.7 m/s) and pressure amplification (-0.05) decreased (P < 0.001), whereas central PP (+5.3mm Hg) and systolic augmentation (+2.3%) increased (P < 0.001). CONCLUSIONS: The diurnal rhythm of central pressure runs in parallel with that of peripheral pressure, but the nocturnal fall in SBP is smaller centrally than peripherally. pulse wave velocity, systolic augmentation, and pressure amplification loop through the day with high pulse wave velocity and pressure amplification but low systolic augmentation in the evening and opposite trends in the morning.

Quality of the blood pressure phenotype in the GEnotipo, Fenotipo y Ambiente de la hipertensión arterial en UruguaY (GEFA-HT-UY) study.

BACKGROUND: In the ongoing GEnotipo, Fenotipo y Ambiente de la HiperTensión Arterial en UruguaY (GEFA-HT-UY) study, we applied standardized epidemiological methods to determine complex phenotypes including blood pressure (BP). In this report, we present the quality control of the conventionally measured BP. METHODS: Three trained observers measured BP five times consecutively in the seated position at each of two home visits and one clinic visit according to the guidelines of the European Society of Hypertension. On 1 December 2013, 4379 single BP readings in 170 participants were available for analysis. RESULTS: Fewer BP readings than the five planned per contact occurred only at one home visit. Among observers, the frequency of identical consecutive readings for systolic or diastolic BP varied from 0 to 4.2%. The occurrence of odd readings ranged from 0.1 to 0.6%. Only 21.6% of the systolic and diastolic BP readings ended on zero (expected 20%). At home visits, there was a progressive decline in BP from the first to the fifth reading. The average of the five BP readings also decreased from the first to the second home visit (-5.63/-2.34 mmHg). CONCLUSIONS: Our study highlighted the necessity to implement a stringent quality control of the conventionally measured BP. The procedures set up in the GEFA-HT-UY study are resulting in a well-defined BP phenotype, which is consistent with that in other population studies.

Estimation of Glomerular Filtration Rate Based on Serum Cystatin C versus Creatinine in a Uruguayan Population.

Background. Estimation of glomerular filtration rate (eGFR) from biomarkers has evolved and multiple equations are available to estimate renal function at bedside. Methods. In a random sample of 119 Uruguayans (54.5% women; 56.2 years (mean)), we used Bland and Altman's method and Cohen's kappa statistic to assess concordance on a continuous or categorical (eGFR < 60 versus ≥60 mL/min/1.73 m(2)) scale between eGFRcys (reference) and eGFR derived from serum creatinine according to the Modification of Diet in Renal Disease (eGFRmdrd) or the Chronic Kidney Disease Epidemiology Collaboration equations (eGFRepi) or from both serum cystatin C and creatinine (eGFRmix). Results. In all participants, eGFRmdrd, eGFRepi, and eGFRmix were, respectively, 9.7, 11.5, and 5.6 mL/min/1.73 m(2) higher (P < 0.0001) than eGFRcys. The prevalence of eGFR <60 mL/min/1.73 m(2) was the highest for eGFRcys (21.8%), intermediate for eGFRmix (11.8%), and the lowest for eGFRmdrd (5.9%) and eGFRepi (3.4%). Using eGFRcys as reference, we found only fair agreement with the equations based on creatinine (Cohen's kappa statistic 0.15 to 0.23). Conclusion. Using different equations we reached clinically significant differences in the estimation of renal function. eGFRcys provides lower estimates, resulting in higher prevalence of eGFR <60 mL/min/1.73 m(2).

51. Endocarditis infecciosa primaria mural del ventrículo izquierdo

Historia clínica: paciente de 16 años, sexo masculino, sin antecedentes patológicos. Cuadro de dos semanas de evolución de fiebre hasta 41 ºC, sin otros fenómenos acompañantes. Del examen se destaca: hemorragias en astilla. Temperatura axilar 39 ºC. Cardiovascular: ritmo regular de 92 cpm, ruidos cardiacos normales, sin soplos. Resto del examen sin alteraciones. Pruebas complementarias: estudios paraclínicos: hemograma: hemoglobina 10 g/dl, leucocitos: 241.000/ml (neutrófilos: 90%), velocidad de eritrosedimentacion 120 s. Proteína C reactiva 214 mg/l. TAC tórax-abdómen-pelvis: infarto esplénico. Hemocultivos: Staphylococcus aureus meticilino resistente. ETT: masa hiperecogénica con movilidad independiente a nivel del ápex del VI, pediculada, plilobulada, de 22 por 10 mm. Evolución clínica: se realiza resección quirúrgica de la masa y tratamiento antibiótico con vancomicina y gentamicina, con buena evolución posoperatoria. El estudio patológico de la masa resecada fue compatible con una vegetación, y el cultivo de la misma desarrolló Staphylococcus aureus meticilino resistente. Diagnóstico: endocarditis infecciosa aguda primaria mural del ventrículo izquierdo. Discusión: presentamos un caso de endocarditis infecciosa primaria mural del ventrículo izquierdo en un paciente sin cardiopatía predisponente ni endocarditis valvular concomitante. Esta es una entidad infrecuente y existen pocos casos reportados. Habitualmente su diagnóstico es tardío, presentándose muchas veces con fenómenos embólicos al momento del diagnóstico. Son factores de riesgo la inmunodepresión, la adicción a drogas intravenosas y la cirugía reciente. La ecocardiografía precoz es una herramienta de suma importancia para su diagnóstico, ya sea transtorácica o transesofágica, mientras que el diagnóstico por resonancia nuclear magnética se realiza en aquellos casos en que la ecocardiografía no es concluyente. El germen más frecuentemente implicado es el Staphylococcus aureus. Dada la escasa evidencia, se plantea una conducta similar a la de la endocarditis infecciosa.