Lower heart rate in patients with acute heart failure: the role of left ventricular ejection fraction.

BACKGROUND: The clinical impact of heart rate (HR) in heart failure with preserved ejection fraction (HFpEF) is a matter of debate. Among those with HFpEF, chronotropic incompetence (CI) has emerged as a pathophysiological mechanism linked to the severity of the disease. In this study, we sought to evaluate whether admission heart rate in acute heart failure differs along left ventricular ejection fraction (LVEF). METHODS: We included retrospectively 3,712 consecutive patients admitted for acute heart failure (AHF) in the Cardiology department of a third level center. HR values were assessed at presentation. LVEF was assessed by transthoracic echocardiogram during the index admission and stratified into four categories: reduced ejection fraction (≤40%), mildly reduced ejection fraction (41-49%), preserved ejection fraction (50-64%) and supranormal ejection fraction (≥65%). The association between HR and LVEF was assessed by multivariate linear and multinomial regression analyses. RESULTS: The mean age of the sample was 73,9 ± 11.3 years, 1,734 (47,4%) were women, and 1,214 (33,2%), 570 (15,6%), 1,229 (33,6%) and 648 (17,7%) patients showed LVEF ≤40%, 41-49%, 50-64%, and ≥65% respectively. The median HR at admission was 95 (IQR 78-120) beats per minute and 1,653 were on atrial fibrillation (45.2%). There was an inverse relationship between HR at admission and LVEF. Lower HR was significantly associated with a higher LVEF in the whole sample (p < 0,001). This inverse relationship was found in sinus rhythm but not in patients with atrial fibrillation. CONCLUSION: HR at admission for AHF is a predictor of LVEF but only in patients with sinus rhythm.

Association between N-terminal pro-brain natriuretic peptide and maximal functional capacity in heart failure with preserved ejection fraction: The modifying role of obesity.

This study investigates the association between maximal functional capacity (peakVO2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in 133 ambulatory patients with heart failure with preserved ejection fraction (HFpEF), focusing on patients with obesity. Across all participants, NT-proBNP inversely correlated with peakVO2. However, this association varied based on obesity status. In patients without obesity, there was an inverse relationship between NT-proBNP and peakVO2, while no significant correlation was observed in patients with obesity. These findings suggest that in stable ambulatory HFpEF, NT-proBNP did not predict peakVO2 in patients with obesity.

Role of spot urinary sodium in outpatients with heart failure.

INTRODUCTION AND OBJECTIVES: Spot determination of urinary sodium (UNa+) has emerged as a useful tool for monitoring diuretic response in patients with acute heart failure (AHF). However, the evidence in outpatients is scarce. We aimed to examine the relationship between spot UNa+ levels and the risk of mortality and worsening heart failure (WHF) events in individuals with chronic HF. METHODS: This observational and ambispective study included 1145 outpatients with chronic HF followed in a single center specialized HF clinic. UNa+ assessment was carried out 1-5 days before each visit. The endpoints of the study were the association between UNa+ and risk of a) long-term death and b) AHF-hospitalization and total WHF events (including AHF-hospitalization, emergency department visits or parenteral loop-diuretic administration in HF clinic), assessed by multivariate Cox and negative binomial regressions. RESULTS: The mean±standard deviation of age was 73±11 years, 670 (58.5%) were men, 902 (78.8%) were on stable NYHA class II, and 595 (52%) had LFEF ≥50%. The median (interquartile range) UNa+ was 72 (51-94) mmol/L. Over a median follow-up of 2.63 (1.70-3.36) years, there were 293 (25.6%) deaths and 382 WHF events (244 AHF-admissions) in 233 (20.3%) patients. After multivariate adjustment, baseline UNa+ was inverse and linearly associated with the risk of total WHF (IRR, 1.07; 95%CI, 1.02-1.12; P=.007) and AHF-admissions (IRR, 1.08; 95%CI, 1.02-1.14; P=.012) and borderline associated with all-cause mortality (HR, 1.04; 95%CI, 0.99-1.09; P=.068). CONCLUSIONS: In outpatients with chronic HF, lower UNa+ was associated with a higher risk of recurrent WHF events.

Áreas problemáticas del ambiente educacional en estudiantes de Odontología según el cuestionario DREEM. Una revisión bibliográfica / Problematic areas of the educational environment in d entistry students according to the DREEM questionnaire. A bibliographic review

Introducción: El ambiente educacional (AE) se define como todo lo que rodea al estudiante en la academia. Conocer la percepción de los estudiantes sobre el AE es relevante para crear planes de estudios de calidad. El AE puede medirse con distintos instrumentos, uno de los cuales es el Dundee Ready Education Environment Measure (DREEM). En Odontología, este aspecto tiene un sentido especial, porque sus estudiantes se enfrentan a un AE complejo que varía durante los años. Por todo lo anterior, el objetivo de esta investigación fue identificar, basándonos en la bibliografía, las áreas más problemáticas del ambiente educacional según la percepción de los estudiantes de Odontología según el cuestionario DREEM.Materiales y métodos.Se realizó una revisión bibliográfica, con estrategias de búsquedas relacionadas con DREEM y educación dental en las bases de datos PubMed, EBSCO, Scielo y Web of Science, en el período comprendido entre enero de 2010 y octubre de 2020.Resultados.De 305 estudios, 11 cumplieron con los criterios de elegibilidad y fueron seleccionados para su análisis. La totalidad de los estudios examinó el AE con el cuestionario DREEM en estudiantes de Odontología de pregrado. De esto se extrajo que los ítems más problemáticos (puntuación menor de 2) fueron los ítems 3, 4, 42, 48, 25 y 9.Conclusión.Los estudiantes percibieron como áreas problemáticas aspectos relacionados con el estrés académico, docentes y el método de enseñanza. Estas dificultades son comunes dentro de las facultades de Odontología y la bibliografía ha propuesto múltiples soluciones con el fin de mejorar el AE. (AU)

Introduction: The educational environment (AE) is defined as everything that surrounds the student in the academy. Knowing the perception of students about AE is relevant to create quality study plans, this can be measured with different instruments, one of them is the Dundee Ready Education Environment Measure (DREEM). In dentistry this aspect has a special meaning because its students face a complex AE that changes over the years. Therefore, the objective of this research was to identify, based on the literature, the most problematic areas of the AE according to the perception of dental students based on the DREEM questionnaire.Materials and methods.A bibliographic review was carried out, with search strategies related to DREEM and dental education in the PubMed, EBSCO, Scielo and Web of Science databases; with articles published from January 2010 to October 2020.Results.Of 305 studies, 11 fulfilled the eligibility criteria and were selected for analysis. All the studies examined EA with the DREEM questionnaire in undergraduate dental students. From this it was extracted that the most problematic items (score less than 2) were items 3,4,42,48,25 and 9.Conclusion.Students perceived aspects related to academic stress, teachers and the teaching method as problem areas. These difficulties are common in dental schools and the literature has proposed multiple solutions in order to improve EA. (AU)

Estudio preliminar sobre el fenotipo de acetilador de los amerindios Teribes / Preliminar study on the phenotype of acetylator of Teribe Amerindians

El estudio de la capacidad de acetilación en 62 voluntarios teribes, procedentes de Sieykin, Sieyic y Santa Rosa, demonstró que 48.4% eran acetiladores rápidos y 51.6%, acetiladores lentos. Al comprobar estos resultados con los que obtuvimos en una población cuna, en la cual encontramos que el 78% era de acetiladores rápidos, se observa que tanto la distribución de los sujetos estudiados, según el porcentaje de isoniacida que acetilaron, como el porcentaje de acetiladores lentos y rápidos indican que, en ambos grupos, existen diferencias en la actividad de la N-acetiltransferasa. Estos resultados sugieren que pueden existir diferencias fundamentales entre los diferentes grupos amerindios, en la habilidade de biotransformar los medicamentos