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Introducción: Varios estudios han evaluado la asociación entre los niveles plasmáticos de lipoproteína (a) [Lp(a)] y la aparición de eventos relacionados con la estenosis valvular aórtica, aunque los resultados fueron contradictorios. Objetivo: El objetivo de esta revisión fue analizar la capacidad predictiva de los niveles elevados de Lp(a) sobre los eventos clínicos relacionados con la estenosis valvular aórtica. Material y métodos: Esta revisión sistemática se realizó de acuerdo con las recomendaciones PRISMA y STROBE. Se realizó una búsqueda en diferentes bases de datos con el objetivo de identificar estudios de cohorte que evaluaran la asociación entre los niveles de Lp(a) y los eventos de interés. El punto final primario fue la incidencia de eventos clínicos relacionados con la estenosis aórtica (reemplazo valvular aórtico, muerte u hospitalización). Esta revisión fue registrada en PROSPERO. Resultados: Se consideraron elegibles para el análisis siete estudios observacionales con un total de 58 783 pacientes. Los valores elevados de Lp(a) se asociaron con un mayor riesgo de eventos relacionados con la estenosis valvular aórtica en la mayoría de los estudios evaluados (entre un 70% y aproximadamente 3 veces más riesgo), a pesar de ajustar por otros factores de riesgo. Conclusión: Esta revisión sugiere que los niveles elevados de Lp(a) se asocian con una mayor incidencia de eventos clínicos relacionados con la estenosis valvular aórtica. Sin embargo, y considerando las limitaciones de este estudio, la utilidad clínica de la Lp(a) como marcador pronóstico en la enfermedad valvular aórtica deberá confirmarse en futuras investigaciones.

Background: Several studies have evaluated the association between lipoprotein(a) plasma levels [Lp(a)] and the occurrence of aortic valve stenosis related events, with contradictory results. Objective: The main objective of this systematic review was to analyze the predictive capacity of elevated Lp(a) levels on major clinical events associated with aortic valve stenosis. Methods: This systematic review was conducted in accordance with PRISMA and STROBE recommendations. A search was carried out in order to identify studies with a cohort design evaluating the association between Lp(a) levels and the events of interest. The primary endpoint was the incidence of clinical events related with aortic valve stenosis (aortic valve replacement, death or hospitalization). This review was registered in PROSPERO. Results: Seven observational studies with a total of 58 783 patients were eligible for analysis. Our findings showed that the presence of elevated Lp(a) levels was associated with an increased risk of events related with aortic valve stenosis in most of the studies evaluated (between 70% and approximately 3-fold higher risk), despite adjusting for other risk factors. Conclusion: This review suggests that elevated Lp(a) levels are associated with a higher incidence of aortic valve stenosis related clinical events. However, considering the limitations of this study, the clinical usefulness of Lp(a) as a prognostic marker in aortic valve disease should be confirmed in future investigations.

Background and objectives Weight mismatch has been a controversial issue in the literature and there is also no agreement on the anthropometric parameter that best predicts outcome in such cases. The purpose of this study was to correlate anthropometric and echocardiographic variables to adequately select donors for cardiac transplant. Methods A total of 399 adult patients with normal echocardiograms were prospectively and consecutively included. Patients with coronary risk factors, systemic diseases and poor acoustic windows were excluded. Results The mean age of the population was 43 ± 17 years and 39% were male. All anthropometric variables were associated in a linear, positive and statistically significant manner with each of the echocardiographic variables. Marked variations in weight were accompanied by lesser variations in end-diastolic diameter in both men and women. End-diastolic diameter was greater in patients with normal weight compared to low-weight patients (4.46 ± 0.83 cm vs 4.09 ± 0.68 cm), p = 0.013, and in overweight compared to normal weight patients (4.61 ± 0.88 cm vs 4.46 ± 0.83 cm), p = 0.010, whereas there was no difference between obese and overweight patients (4.74 ± 1.14 cm vs 4.61 ± 0.88 cm), p = 0.760. Conclusion Although anthropometric variations are associated with changes in heart size, such changes are not echocardiographically relevant. This exploratory study opens the door to further investigations to define the donor-recipient anthropometric threshold for accepting an organ in cardiac transplantation.

Resumen Introduccion La colocacion inadecuada de los cateteres de un marcapasos es una rara causa de accidente cerebrovascular isquemico de origen cardioembolico. Observacion clinica y resultados Presentamos el caso de una mujer de 70 anos a la que se ha colocado un marcapasos bicameral en otro centro hace 3 meses, y presento un accidente cerebrovascular isquemico hace 2 meses, no encontrando la causa. Consulta a nuestro hospital por mareos, disnea y malestar general. El electrocardiograma evidenciaba ritmo sinusal e imagen de bloqueo completo de rama derecha. La radiografia de torax mostraba un trayecto del cateter ventricular que sugeria la ubicacion en el ventriculo izquierdo. El ecocardiograma y la tomografia computarizada confirmaron el hallazgo de que los 2 cateteres se encontraban en la aorta, penetrando el cateter ventricular a traves de la valvula aortica. Conclusion La colocacion anomala de los cateteres de un marcapasos es infrecuente, pero puede asociarse a complicaciones con una elevada morbimortalidad como el accidente cerebrovascular. La pesquisa en el electrocardiograma de una imagen de bloqueo completo de rama derecha, puede ayudarnos a identificar esta situacion en nuestros pacientes.

Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy and there is no available information on baseline characteristics and outcome of patients with this disease in our country. Objectives: To know the clinical profile of patients with hypertrophic cardiomyopathy and to identify predictors of adverse outcome. Methods: One hundred and forty-three patients with hypertrophic cardiomyopathy at the Hospital Italiano of Buenos Aires between 2005 and 2011 were included in the study. Results: Median age was 66 years and 52% were women. Most patients presented an asymmetric distribution (92%) and 60% had dynamic obstruction. Mortality was 5.59% at a median follow-up of 2.11-years (25-75 IQR: 0.75-3.70). The most prevalent symptom was dyspnea (36%), followed by angina (17%) and syncope (14%). Dynamic obstruction, moderate or severe mitral regurgitation, left atrial diameter and female gender were independently associated with dyspnea. Dynamic obstruction was independently associated with angina. Maximum wall thickness was directly and independently associated with syncope, while ejection fraction and left ventricular hypertrophy or negative T in the electrocardiogram presented an inverse relationship. Mortality was independently associated with hospitalization for decompensated heart failure. Conclusions: Similar to previous studies, our population shows that hypertrophic cardiomyopathy is a heterogeneous disease. A prospective study is necessary to validate the risk predictors assessed in this study.

Resumen es: Introduccion. El tracto de salida del ventriculo izquierdo (TSVI) suele estar implicado con relativa frecuencia en alteraciones anatomicas y anatomofunci...

Acute decompensated heart failure (ADHF) is a common cause of hospital admission and is associated with an increased risk of worsening renal function (WRF). The aims of this study were to investigate the incidence and predictors of WRF in patients admitted for ADHF and to assess the prognostic significance of WRF at 1 year.A retrospective analysis of data on 200 consecutive patients admitted with ADHF was carried out. By definition, WRF occurred when the serum creatinine level increased during hospitalization by 0.3 mg/dL and byor =25% from admission.Overall, 23% of patients developed WRF. On multivariate analysis, age80 years (odds ratio [OR]=2.72; 95% confidence interval [CI], 1.86-3.42), admission glomerular filtration rate60 mL/min per 1.73 m2 (OR=2.05; 95% CI, 1.53-2.27) and admission systolic pressure90 mmHg (OR=1.61, 95% CI, 1.17-3.22) were independently associated with WRF. The rate of mortality or readmission for heart failure (HF) at 1 year was higher in the WRF group (P.01 by log-rank test). The median hospital stay was 9 days for patients with WRF and 4 days for those without (P.05). On multivariate analysis, WRF remained independently associated with mortality or HF rehospitalization (hazard ratio=1.65; 95% CI, 1.12-2.67; P=.003).In patients admitted for ADHF, WRF was a common complication and was associated with a longer hospital stay and an increased risk of mortality or HF hospitalization. Clinical characteristics at admission can help identify patients at an increased risk of WRF.

Insuficiencia cardiaca. Volumen 63, Numero 03, Marzo 2010 Sumario Imprimir Texto completo Anterior | Siguiente Descargar PDF Buscar en medline articulos de: Cesar A. Belziti Rodrigo Bagnati Paola Ledesma Norberto Vulcano Sandra Fernandez Buscar: Busqueda avanzada Empeoramiento de la funcion renal en pacientes hospitalizados por insuficiencia cardiaca aguda descompensada: incidencia, predictores y valor pronostico Cesar A. Belzitia; Rodrigo Bagnatia; Paola Ledesmaa; Norberto Vulcanoa; Sandra Fernandeza a Servicio de Cardiologia. Hospital Italiano de Buenos Aires. Buenos Aires. Argentina. Rev Esp Cardiol.2010; 63(03) :294-302 Introduccion y objetivos. La insuficiencia cardiaca aguda descompensada (ICAD) es causa frecuente de hospitalizacion y se asocia con riesgo de empeoramiento de la funcion renal (EFR). El objetivo fue determinar la incidencia, los predictores y el pronostico a 1 ano de los pacientes ingresados por ICAD con EFR. Metodos. Se analizaron de forma retrospectiva los datos de 200 pacientes consecutivos ingresados por ICAD. Se considero EFR cuando la creatinina serica aumento durante la hospitalizacion 0,3 mg/dl y = 25% con respecto al valor al ingreso. Resultados. El 23% de los pacientes sufrio un EFR. En el analisis multivariable, ser mayor de 80 anos �odds ratio (OR) = 2,72; intervalo de confianza (IC) del 95%, 1,86-3,42�, la tasa de filtrado glomerular < 60 ml/min/1,73 m2 �OR = 2,05; IC del 95%, 1,53-2,27� y la presion arterial sistolica al ingreso < 90 mmHg �OR = 1,61; IC del 95%, 1,17-3,22� se asociaron independientemente con el EFR. La mortalidad o reingreso por ICAD a 1 ano, analizada por la prueba de rangos logaritmicos, fue mayor en el grupo con EFR (p < 0,01). La mediana de hospitalizacion fue 9 dias para los pacientes con EFR y 4 dias para aquellos sin EFR (p < 0,05). En el analisis multivariable, el EFR se mantuvo asociado independientemente con mortalidad o reingreso por ICAD (hazard ratio = 1,65; IC del 95%, 1,12-2,67; p = 0,003). Conclusiones. El EFR es una complicacion frecuente en los pacientes ingresados por ICAD, se asocia con internaciones mas prolongadas, mayor mortalidad o reingreso por ICAD. Existen variables clinicas para identificar al ingreso hospitalario a la poblacion con mayor riesgo de EFR.

RESUMENLa amiloidosis es una enfermedad infiltrativa sistémica que compromete al corazón y representauna causa importante de miocardiopatía restrictiva.Se describe el caso de un paciente masculino de 35 años con insuficiencia cardíaca avanzadasecundaria a miocardiopatía infiltrativa por depósito amiloide. Durante su evaluación serealizó diagnóstico de neoplasia de células plasmáticas. Debido a la rápida progresión de lossíntomas, el deterioro de la función ventricular y la incapacidad para tolerar el tratamientoadecuado para su enfermedad hematológica, se realizó trasplante cardíaco seguido de trasplanteautólogo de médula ósea sin complicaciones. La presentación de este caso constituyela primera comunicación en nuestro país de trasplante cardíaco seguido de trasplante demédula ósea como tratamiento de la amiloidosis cardíaca.REV ARGENT CARDIOL 2009;77;309-311.