Utility intervention programs in the evolutional control of patients with heart failure / Utilidad de los programas de intervención en el control evolutivo de los pacientes con insuficiencia cardiaca.

Acute heart failure (HF) is a prevalent disease with important socio-economic repercussions. Due to the aging of population, these values will increase in the coming years, so it may be useful to the implementation of intervention programs in these patients to decrease morbidity and mortality. A quasi-experimental prospective study (n = 262) of patients admitted at the Internal Medicine Department of the Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain, diagnosed of HF between November 2013 and October 2014 (both dates inclusive) (n = 108) followed up for 1 year was performed. Within this group, a subgroup with an intensive intervention (n = 30) was performed. The data were compared with a historical cohort of patients admitted to the same department during the same time in the previous year (from November 2012 to October 2013) (n = 154). Statistically significant differences between groups attending to the therapeutical adherence to clinical guidelines (p < 0.011) were observed. Considering the intensive intervention subgroup, statistically significant differences were observed in the rate of exitus (p < 0.032) and survival (log rank <0.030) compared to the control group. The close monitoring of patients with HF improves adherence, reduces mortality and improves survival. This May result in a decline in the use of health resources, which entails significant socio-economic benefits.

Propeptide of procollagen type I (PIP) and outcomes in decompensated heart failure.

BACKGROUND: Changes in extracellular matrix are recognized as a contributing factor in the cardiac remodeling process. Several studies have addressed the value of turnover markers of collagen as predictors of death or new heart failure episodes. The aim of the present study was to evaluate the relationship between peripheral serum concentration of propeptide of procollagen type I (PIP) and outcomes in patients with decompensated heart failure. METHODS: A total of 111 patients admitted to our Unit between September 2000 and May 2003 for decompensated heart failure were analyzed. Death from any cause or due to heart failure and readmission were considered primary endpoints. RESULTS: The mean PIP concentration was 80.84+/-36.40 ng/mL. The PIP serum level was significantly higher among those patients who suffered some endpoint during follow-up (88.12+/-37.31 ng/mL vs 73.13+/-34.06 ng/mL; p=0.029). Twenty-five (22.52%) of the 111 patients died during the 21 months of follow-up, and 54 (48.6%) were readmitted with new bouts of heart failure. Using Cox proportional hazards regression analyses, serum PIP levels, systolic dysfunction, and diabetes mellitus were identified as independent predictors of death. Serum PIP levels, age, and sex were independent predictors of new heart failure episodes and readmission. CONCLUSION: A single serum measurement of PIP seems to have prognostic value in patients with decompensated heart failure. Accordingly, patients with higher values of PIP at decompensation are at a higher risk of death or readmission during follow-up.

Disección aneurismática del tronco celíaco, una entidad infrecuente / Isolated celiac trunk aneurysm dissection: A rare entity / Dissecção aneurismática do tronco celíaco, uma entidade infrequente

RESUMEN La disección aislada y espontánea de la arteria celíaca es una entidad clínica rara. Es la cuarta causa de aneurismas abdominales por detrás de los que ocurren en las arterias esplénica, hepática y mesentérica superior. Es importante sospechar el diagnóstico de esta enfermedad cuyos síntomas son inespecíficos. Presentamos el caso de un varón de 60 años de edad atendido en nuestro hospital por esta enfermedad, y hacemos una revisión del tema con énfasis en el diagnóstico y en los diferentes tratamientos disponibles.

SUMMARY Spontaneous and isolated celiac artery dissection is a rare clinical disease. It is the fourth cause of abdominal aneurysms behind those that occur in the splenic, hepatic, and superior mesenteric arteries. It is important to suspect the diagnosis of this entity whose clinical symptoms are unspecific. We report the case of a 60 year-old male treated in our hospital because of this illness, and present a review of this pathology, specially focused on the diagnosis and the different treatments available.

RESUMO A dissecção isolada e espontânea da artéria celíaca é uma entidade clínica rara. É a quarta causa de aneurismas abdominais por detrás dos que ocorrem nas artérias esplénica, hepática e mesentérica superior. É importante suspeitar o diagnóstico desta doença cujos sintomas são inespecíficos. Apresentamos o caso de um homem de 60 anos de idade atendido no nosso hospital por esta doença, e fazemos uma revisão do assunto com ênfase no diagnóstico e nos diferentes tratamentos disponíveis.