Heart Failure with Recovered Ejection Fraction in a Cohort of Elderly Patients with Chronic Heart Failure.

OBJECTIVE: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as 'Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). METHODS: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). RESULTS: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. CONCLUSION: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this 'new HF syndrome'.

[Descriptive study of alcohol detoxifications in an Internal Medicine Service]. / Estudio descriptivo de las desintoxicaciones de alcohol en un Servicio de Medicina Interna.

Alcohol dependence is a chronic disease whose treatment begins with detoxification, followed by rehabilitation. We present a descriptive and retrospective study of 147 patients admitted to our unit during the period 2003-2005. Median age was 46.07 years, with 77.6% men and 22.4% women. Admission diagnosis was alcohol withdrawal syndrome in 31 patients (21.1%) and programmed alcohol detoxification in 116 patients (78.9%). On the CIWA-Ar scale: mild withdrawal, 100 patients (68.5%), moderate, 35 patients (24%), severe, 11 patients (7.5%). Mild group showed a statistically significantly lower proportion of hepatopathy, by comparison with the moderate and severe groups. Statistically significant differences were found between the mild and severe groups on comparing mean age, duration of stay, quantity of alcohol and parameters of chronic consumption (ferritine, fe, VCM, UBE, AST, bilirubin and Mg) for AST and bilirubin. There were 11 seizures: 4 patients from the programmed group, with mild withdrawal on the CIWA-Ar scale, and 7 patients with moderate-severe withdrawal. No relationship was found between patients intensity of withdrawal syndrome, age or sex. There was higher intensity on the CIWA-Ar score (moderate and severe) among patients who had already begun withdrawal syndrome, compared to those admitted on a planned detoxification programme. The CIWA-Ar is a useful tool for assessing withdrawal symptoms and risks of complication and for planning treatment. Clinical practice must provide patients with access to health resources for the appropriate treatment of their addiction, with standardized assistance during their stay in hospital.

Influence of renal dysfunction phenotype on mortality in decompensated heart failure with preserved and mid-range ejection fraction.

BACKGROUND: Natriuretic peptides or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk renal impairment (RI) in patients with heart failure and reduced ejection fraction (HF-REF). However, the situation in HF patients with preserved ejection fraction (HF-PEF) and mid-range ejection fraction (HF-MREF) remains unclear. METHODS: We evaluated patients from the Spanish National Registry of Heart Failure (RICA) that were admitted to Internal Medicine units with acute decompensated HF. Median admission values were used to define elevated NT-proBNP and BUN/creat. RESULTS: A total of 935 patients were evaluated, 743 with HF-PEF and 192 with HF-MREF). In patients with both NT-proBNP and BUN/creat below median admission values, RI was not associated with mortality (HR 1.15; 95% CI 0.7-1.87, p=0.581 in HF-PEF and HR 1.27; 95% CI 0.58-2.81, p=0.548 in HF-MREF). However, in patients with both elevated NT-proBNP and BUN/creat, those with RI had worse survival than those without RI (HR 2.01, 95% CI 1.33-3.06, p<0.001 in HF-PEF and HR 2.79, 95% CI 1.37-5.67, p=0.005 in HF-MREF). In HF-PEF even patients with RI with only 1 of the 2 parameters elevated, had a substantially higher risk of death compared to patients without RI (HR 1.53; 95% CI 1.04 to 2.26; p=0.031). CONCLUSIONS: In this clinical cohort of acute decompensated HF-PEF and HF-MREF patients, the combined use of NT-proBNP and BUN/creat stratifies patients with RI into groups with significantly different prognoses.

[Involvement of cocaine in cerebral vascular pathology]. / Implicación de la cocaína en la patología vascular cerebral.

AIM: To describe the involvement of cocaine in cerebral vascular pathology in young patients. PATIENTS AND METHODS: The work consists in a descriptive study of the role of cocaine in patients with acute stroke under the age of 50 years admitted to the neurology service over a period of four years. Eighteen patients with positive levels of cocaine on admission and 79 patients with negative levels were analysed. Different variables that define the profile of vascular risk, characteristics of the stroke and the morbidity and mortality associated to them are collected and analysed. RESULTS: Males were predominant and there was a non-significant higher proportion of vascular risk factors in the control group (55.6% versus 64.6%). The group of consumers presented a significantly lower mean age (35.2 ± 8.9 versus 41.5 ± 7.7 years), higher consumption of toxic substances (tobacco, alcohol and cannabis), hyperCKemia (27.8% versus 5.1%) and psychiatric disorders (16.7% versus 3.8%) (p < 0.05). The ischaemic stroke in the anterior territory subtype was predominant in both groups. There was a clear tendency towards normality in complementary tests and a higher rate of complications (33.3% versus 15.2%) and mortality (11.1% versus 3.8%) among consumers (p > 0.05). CONCLUSIONS: Cocaine is a risk factor that must be taken into account in young adults: it is associated to stroke at earlier ages than is considered normal, with a tendency towards normality in complementary tests and a higher rate of hospital morbidity and mortality.