The doors remain open Ordás, Jara Gayán; Izurieta, Carlos Eduardo; Crespo, Eva María Pueo ...
European heart journal cardiovascular imaging,
01/2023, Letnik:
24, Številka:
2
Journal Article
The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. The aim of the study was to evaluate the impact of ...admission HR, discharge HR, HR difference (admission-discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes.
We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission.
The mean age of the study population was 72 ± 12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one year all-cause mortality (Relative risk (RR) = 1.182, confidence interval (CI) 95% 1.024–1.366, p = 0.022) in SR. In AF patients discharge HR was associated with one year all cause mortality (RR = 1.276, CI 95% 1.115–1.459, p ≤ 0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction.
In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients.
Endothelial dysfunction and platelet activation have been highlighted as possible mediators in Takotsubo syndrome (TTS). Nevertheless, to date, evidence on the usefulness of antiplatelet therapy in ...TTS remains controversial. The aim of our study is to evaluate long-term prognosis in TTS patients treated with antiplatelet therapy (APT) at hospitalization discharge.
An ambispective cohort study from the Spanish National Takotsubo Registry database was performed (June 2002 to March 2017). Patients were divided into two groups: those who received APT at hospital discharge (APT cohort) and those who did not (non-APT cohort). Primary endpoint was all-cause death. Secondary endpoints included the composite of recurrence or readmission and a composite of death, recurrence or readmission.
From a total of 741 patients, 728 patients were alive at discharge. Follow-up was performed in 544 patients, who were included in the final analysis: 321 patients (59.0%) in the APT cohort and 223 patients (41.0%) in the non-APT cohort. The APT cohort had a better clinical presentation and received more heart failure and acute coronary syndrome-like therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers: 75.1% vs. 51.1%; p<0.001, betablockers: 71.3% vs. 50.7%; p<0.001, statins: 67.9% vs. 33.2%; p<0.001). After adjusting for confounder factors, APT at discharge was a protective factor for all-cause death (adjusted hazard ratio (HR) 0.315, 95% confidence interval (CI): 0.106-0.943; p=0.039) and the composite endpoint of all-cause death, recurrence or readmission (adjusted HR 0.318, 95% CI: 0.164-0.619; p=0.001) at month 25 of follow-up.
Patients with TTS receiving APT at discharge presented better prognosis up to two-years of follow-up compared with their counterparts not receiving APT.
A disfunção endotelial e a ativação plaquetária são possíveis mediadores na síndrome de Takotsubo (STT). Até ao momento, a utilidade da terapia antiplaquetária no STT é controversa. O nosso objetivo é avaliar o prognóstico a longo prazo em pacientes com STT tratados com tratamento antiplaquetário (TAP) na alta da internação.
Foi realizado um estudo de coorte ambidirecional do banco de dados do Registro Nacional de Takotsubo da Espanha (junho-2002 a março-2017). Os pacientes foram divididos em aqueles que receberam TAP na alta hospitalar (cohorte-TAP) e aqueles que não receberam (cohorte não-TAP). O endpoint primário foi a morte global. Os endpoints secundários incluíram um composto de recorrência ou readmissão e um composto de morte, recorrência ou readmissão.
De 741 pacientes, 728 estavam vivos na alta. O acompanhamento foi realizado em 544 pacientes, que foram incluídos na análise final: 321 (59,0%) na cohorte-TAP e 223 (41%) na cohorte não TAP. A cohorte TAP mostrou melhor apresentação clínica e recebeu mais tratamentos de insuficiência cardíaca e (IECA/ARB: 75,1% versus 51,1%; p<0,001, betabloqueadores: 71,3% versus. 50,7%; p<0,001, estatinas: 67,9% versus 33,2%; p<0,001). Após o ajuste para fatores de confundimento, o TAP na alta foi um fator de proteção para a morte global (HR ajustado 0,315, IC95%: 0,106-0,943; p=0,039) e o composto de morte global, recorrência ou readmissão (HR ajustado 0,318, IC95%: 0,164-0, 619; p=0,001) até aos 25 meses.
Pacientes com STT recebendo TAP na alta apresentaram melhor prognóstico até aos dois anos de acompanhamento em comparação com seus homólogos que não receberam TAP.
Abstract Background The intermediate group of patients with heart failure (HF) and mid-range left ventricular ejection fraction (HFmrEF) may constitute a specific phenotype, but a direct evidence is ...lacking. This study aimed to know whether this HF category is accompanied by a particular clinical phenotype and prognosis. Methods and results This study includes 3446 ambulatory patients with chronic HF from two national registries. According to EF at enrollment, patients were classified as reduced (HFrEF, < 40%), mid-range (HFmrEF, 40–49%) or preserved (HFpEF, ≥ 50%). Patients were followed-up for a median of 41 months and the specific cause of death was prospectively registered. Patients with HFmrEF represented 13% of population and they exhibited a phenotype closer to HFrEF, except for a higher rate of coronary revascularization and diabetes, and a less advanced HF syndrome. The observed all-cause mortality was higher among HFrEF (33.0%), and similar between HFmrEF (27.8%) and HFpEF (28.0%) (p = 0.012); however, the contribution of each cause of death differed significantly between categories (p < 0.001). After propensity score matching, the risk of cardiovascular death, HF death or sudden cardiac death did not differ between HFmrEF and HFrEF in paired samples; however, patients with HFmrEF were at higher risk of cardiovascular death (sHR 1.71, 95% CI 1.13–2.57, p = 0.011) and sudden cardiac death (sHR 2.73, 95% CI 1.07–6.98, p = 0.036) than patients with HFpEF. Conclusions Patients in the intermediate category of HFmrEF conform a phenotype closer to the clinical profile of HFrEF, and associated to higher risk of sudden cardiac death and cardiovascular death than patients with HFpEF.
Introduction and objectives
Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory ...heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population.
Methods
The Vaccine–Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented.
Results
From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality).
Conclusions
In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.
Graphical abstract
En pacientes con insuficiencia cardiaca y fracción de eyección reducida (IC-FEr), se ha demostrado en ensayos clínicos que diferentes terapias reducen la mortalidad, pero hay pocos datos de la ...práctica real acerca del efecto en los distintos tipos de muerte.
Se estudió a 2.351 pacientes ambulatorios con IC-FEr (FE <40%) procedentes de los registros prospectivos multicéntricos MUSIC (n=641, años 2003-2004) y REDINSCOR I (n=1.710, años 2007-2011). Las variables se registraron a la inclusión, y el seguimiento fue de 4 años. Un comité independiente adjudicó la mortalidad y sus causas.
Los pacientes en el registro más contemporáneo recibieron con mayor frecuencia bloqueadores beta (el 85 frente al 71%; p <0,001), antialdosterónicos (el 64 frente al 44%; p <0,001), desfibrilador automático implantable (el 19 frente al 2%; p <0,001) y resincronización (el 7,2 frente al 4,8%; p=0,04). La población más contemporánea presentó menos muerte súbita (el 6,8 frente al 11,4%; p <0,001). Tras emparejar por puntuación de propensión, se obtuvieron 2 poblaciones comparables que solo diferían en los tratamientos (575 frente a 575 pacientes): la población más contemporánea presentó menor riesgo de muerte total (HR=0,70; IC95%, 0,57-0,87; p=0,001) y de muerte súbita (sHR=0,46; IC95%, 0,30-0,70; p <0,001), con una tendencia de muerte por IC (sHR=0,73; IC95%, 0,53-1,01; p=0,059) y sin diferencias por otras causas (sHR=1,17; IC95%, 0,78-1,75; p=0,445), independientemente de la clase funcional.
En pacientes ambulatorios con IC-FEr, la mejora terapéutica se asoció con un menor riesgo de muerte, principalmente debido a la significativa reducción de las muertes súbitas.
In patients with heart failure and reduced ejection fraction (HFrEF), several therapies have been proven to reduce mortality in clinical trials. However, there are few data on the effect of the use of evidence-based therapies on causes of death in clinical practice.
This study included 2351 outpatients with HFrEF (< 40%) from 2 multicenter prospective registries: MUSIC (n=641, period: 2003-2004) and REDINSCOR I (n=1710, period: 2007-2011). Variables were recorded at inclusion and all patients were followed-up for 4 years. Causes of death were validated by an independent committee.
Patients in REDINSCOR I more frequently received beta-blockers (85% vs 71%; P <.001), mineralocorticoid antagonists (64% vs 44%; P <.001), implantable cardioverter-defibrillators (19% vs 2%; P <.001), and resynchronization therapy (7.2% vs 4.8%; P=.04). In these patients, sudden cardiac death was less frequent than in those in MUSIC (6.8% vs 11.4%; P <.001). After propensity score matching, we obtained 2 comparable populations differing only in treatments (575 vs 575 patients). In patients in REDINSCOR I, we found a lower risk of total mortality (HR, 0.70; 95%CI, 0.57-0.87; P=.001) and sudden cardiac death (sHR, 0.46; 95%CI, 0.30-0.70; P <.001), and a trend toward lower mortality due to end-stage HF (sHR, 0.73; 95%CI, 0.53-1.01; P=.059), without differences in other causes of death (sHR, 1.17; 95%CI, 0.78-1.75; P=.445), regardless of functional class.
In ambulatory patients with HFrEF, implementation of evidence-based therapies was associated with a lower risk of death, mainly due to a significant reduction in sudden cardiac death.
Exercise‐related severe cardiac events Vicent, L.; Ariza‐Solé, A.; González‐Juanatey, J. R. ...
Scandinavian journal of medicine & science in sports,
April 2018, Letnik:
28, Številka:
4
Journal Article
Recenzirano
Physical activity has benefits on health. However, there is a small risk of effort‐related adverse events. The aim of this study is to describe exercise‐related severe cardiovascular events and to ...relate them with the type of sport performed. We performed a ten‐year retrospective study in eight Spanish cardiac intensive care units. Adverse cardiac events were defined as acute myocardial infarction, cardiac arrest or syncope related to physical activity. From 117 patients included, 109 were male (93.2%), and mean age was 51.6 ± 12.3 years; 56 presented acute myocardial infarction without cardiac arrest (47.9%), 55 sudden cardiac death (47.0%) and six syncope (5.1%). The sports with higher number of events were cycling (33%‐28.2%), marathon or similar running competitions (19%‐16.2%), gymnastics (18%‐15.3%) and soccer (17%‐14.5%). Myocardial infarction was observed more frequently in cyclists compared to other sports (69.7% vs 39.3%, P = .001). The most common cause of sudden cardiac death was myocardial infarction in those >35 years (23%‐63.9%) and idiopathic ventricular fibrillation in younger patients (5%‐62.5%). Significant coronary artery disease was present in 85 (79.4%). Only one patient with cardiac arrest presented with a non‐shockable rhythm (asystole). Eleven patients (9.4%) died during hospitalization; in all cases, they had presented cardiac arrest. All discharged patients were alive at the end of follow‐up. Exercise‐related severe cardiac events are mainly seen in men. Coronary heart disease is very frequent; about half present acute myocardial infarction and the other half cardiac arrest. In our cohort, prognosis was good in patients without cardiac arrest.
European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and ...prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry).
A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%. Baseline patient characteristics were examined, and outcome measures were mortality and readmission for heart failure at 1-, 6-, and 12-month follow-up. Propensity score matching was used to compare the HFmrEF group with the other ejection fraction groups.
Among the study participants, 583 (41%) had HFrEF, 227 (16%) HFmrEF, and 610 (43%) HFpEF. HFmrEF patients had a clinical profile similar to that of HFpEF patients in terms of age, blood pressure, and atrial fibrillation prevalence, but shared with HFrEF patients a higher proportion of male participants and ischemic etiology, and use of class I drugs targeting HFrEF. All other features were intermediate, and comorbidities were similar among the 3 groups. There were no significant differences in all-cause mortality, cause of death, or heart failure readmission. The similar outcomes were confirmed in the propensity score matched cohorts.
The HFmrEF patient group has characteristics between the HFrEF and HFpEF groups, with more similarities to the HFpEF group. No between-group differences were observed in total mortality, cause of death, or heart failure readmission.
Resumen Introducción y objetivos La guía de insuficiencia cardiaca de la Sociedad Europea de Cardiología define un nuevo grupo de pacientes con fracción de eyección del ventrículo izquierdo ...intermedia (40-49%) (ICFEi) cuyas características y pronóstico no están bien definidos. Nuestro objetivo es analizar este grupo en pacientes hospitalizados por insuficiencia cardiaca (Registro REDINSCOR II ). Métodos Estudio observacional prospectivo de 1.420 pacientes clasificados según la fracción de eyección: deprimida (ICFEd), < 40%; intermedia (ICFEi), 40-49% y conservada (ICFEc), ≥ 50%. Se comparan entre los 3 grupos las características clínicas, la mortalidad y sus causas y los ingresos por insuficiencia cardiaca al mes, a los 6 meses y al año. Se obtuvo la puntuación de propensión emparejando según grupo de fracción de eyección. Resultados La distribución de pacientes fue: 583 (41%) con ICFEd, 227 (16%) con ICFEi y 610 (43%) con ICFEc. El grupo con ICFEi se parece más al de ICFEc en cuanto a edad, prevalencia de hipertensión arterial y fibrilación auricular, aunque comparte con la ICFEd el predominio de varones, la etiología isquémica y el mayor uso de fármacos clase I para ICFEd. Las demás características fueron intermedias. No se detectaron diferencias entre los 3 grupos en la mortalidad total, las causas de muerte y los reingresos por insufiencia cardiaca. Esta similitud en el pronóstico se confirmó en el análisis ajustado por puntuación de propensión. Conclusiones El grupo de pacientes con ICFEi comparte características con los de ICFEc e ICFEd, aunque está más próximo al de ICFEc. La mortalidad total, las causas de muerte o las rehospitalizaciones por insuficiencia cardiaca eran similares en los 3 grupos.
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