DigitalUM :: Browsing by Subject "Heart failure"

Browsing by Subject "Heart failure"

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A contemporary picture of enterococcal endocarditis
(Elsevier, 2020-02-03) Pericàs, Juan M.; Llopis, Jaume; Muñoz, Patricia; Gálvez-Acebal, Juan; Kestler, Martha; Valerio, Maricela; Hernández-Meneses, Marta; Goenaga, Miguel Á.; Cobo-Belaustegui, Manuel; Montejo, Miguel; Ojeda-Burgos, Guillermo; Sousa-Regueiro, M. Dolores; Alarcón, Arístides de; Ramos-Martínez, Antonio; Miró, José M.; García-Vázquez, Elisa; GAMES Investigators; Medicina
BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p ¼ 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p ¼ 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs.45.9%; p ¼ 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p ¼ 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.
Open Access
Adaptación cultural del Cuestionario de autocuidado en pacientes con asistencia ventricular definitiva
(Universidad de Murcia. Servicio de Publicaciones, 2023) Achury Saldaña, Diana Marcela; Kato, Naoko P
Introducción. Con el fin de alcanzar una vida óptima, los pacientes con dispositivos de asistencia ventricular izquierda implantables de forma permanente se enfrentan a regímenes de tratamiento complejos; requieren adquirir conocimiento y desarrollar habilidades para orientar su cuidado. Esto hace necesario que el profesional de enfermería cuente con herramientas que permitan identificar el nivel de autocuidado como punto de partida para promover comportamientos positivos que permitan adherirse a su nuevo estilo de vida. Objetivo. Determinar la versión equivalente del cuestionario de autocuidado para pacientes con asistencia ventricular definitiva en Colombia. Material y métodos. Estudio de tipo metodológico. Se llevó a cabo en seis etapas, con el propósito de garantizar la equivalencia del instrumento adaptado por medio de traducción inicial, síntesis de las traducciones, traducción inversa, revisión por parte del comité de expertos, presentación del instrumento a los autores y prueba de la versión prefinal. Resultados. Se realizó la traducción y la retrotraducción del instrumento. El 77 % de los expertos mencionaron que todos los ítems eran comprensibles y claros, pero el 33 % refirieron que en los ítems 3,5,6,7,8,10 y 11 requerían ajustes de forma. Conclusión. Se obtuvo la adaptación transcultural del cuestionario de autocuidado en pacientes con asistencia ventricular definitiva para el medio colombiano, conservando la equivalencia experiencial, conceptual, idiomática y semántica del instrumento original
Open Access
Adherencia al tratamiento farmacológico y no farmacológico en pacientes con falla cardiaca
(Murcia: Servicio de Publicaciones de la Universidad de Murcia, 2014) Rojas Sánchez, Lydia Zoraya; Echeverría Correa, Luis Eduardo; Camargo Figuera, Fabio Alberto
Las consecuencias de la no adherencia al tratamiento se expresan en diversas esferas de la vida de la persona, en diversos componentes del sistema de salud y en el cuadro de morbilidad y mortalidad de la población, lo cual genera grandes repercusiones desde el punto de vista médico, económico y en la calidad de vida de la persona. Objetivo: Determinar la prevalencia de adherencia al tratamiento farmacológico y no farmacológico en pacientes con falla cardiaca. Métodos: Se realizó un estudio de corte transversal en pacientes con falla cardiaca en el 2012 en la Clínica de Falla Cardiaca y Trasplante Cardiaco de la Fundación Cardiovascular de Colombia. Se incluyeron 161 pacientes adultos con diagnóstico médico de falla cardiaca. Se evaluó la adherencia al tratamiento farmacológico y no farmacológico y el cumplimiento en los pacientes con falla cardiaca. Resultados: El 80.12% (n=129; IC 95% 73.11 - 85.98%) de los pacientes se encuentra frecuentemente adheridos al tratamiento farmacológico y no farmacológico, el cumplimiento al tratamiento farmacológico con el test de Morisky-Green fue de 53.42% (n=86; IC 95% 45.39 - 61.3%). Conclusiones: Los resultados del presente estudio son un acercamiento a la problemática de la adherencia al tratamiento farmacológico y no farmacológico de los pacientes con falla cardiaca. Se recomienda para futuras investigaciones, la realización de estudios multicéntricos con muestreos probabilísticos.
Open Access
Aerobic training attenuates nicotinic acetylcholine receptor changes in the diaphragm muscle during heart failure
(F. Hernández y Juan F. Madrid. Universidad de Murcia: Departamento de Biología Celular e Histología, 2015) de Souza, Paula Aiello Tomé; de Souza, Rodrigo Wagner Alves; Campos Soares, Luana; Piedade, Warlen Pereira; Campos, Dijon Henrique S.; Carvalho, Robson Francisco; Padovani, Carlos Roberto; Okoshi, Katashi; Cicogna, Antônio Carlos; Michelin Matheus, Selma Maria; Dal-Pai-Silva, Maeli
Introduction: Heart failure (HF) is a progressive myopathy, with clinical signs of fatigue and limb weakness that can damage the nerve-muscle interaction, altering synaptic transmission and nicotinic acetylcholine receptors (nAChR) in neuromuscular junctions (NMJs). The diaphragm is composed of a mixed proportion of muscle fibres, and during HF, this muscle becomes slower and can alter its function. As exercise training is an accepted practice to minimise abnormalities of skeletal muscle during HF, in this study, we evaluated the hypothesis that aerobic training attenuates alterations in the expression of nAChR subunits in NMJs diaphragm during heart failure. Objective: The aim of this study was to evaluate the distribution and expression of nAChR subunits in the diaphragm muscle fibres of rats subjected to an aerobic training programme during HF. Methods: Control (Sham), control training (ShamTR), aortic stenosis (AS) and aortic stenosis training (ASTR) groups were evaluated. The expression of nAChR subunits (γ, α1, ε, β1 and δ) was determined by qRT-PCR, and NMJs were analysed using confocal microscopy. Results: We observed increased expression of the γ, α1 and β1 subunits in the AS group compared with the ASTR group. The distribution of NMJs was modulated in these groups. Discussion: HF alters the mRNA expression of nAChR subunits and the structural characteristics of diaphragm NMJs. In addition, aerobic training did notalter NMJs morphology but attenuated the alterations in heart structure and function and in nAChR subunit mRNA expression. Our findings demonstrate the beneficial effects of aerobic exercise training in maintaining the integrity of the neuromuscular system in the diaphragm muscle during HF and may be critical for non-pharmacological therapy to improve the quality of life for patients with this syndrome.
Open Access
Atrial fibrillation management in older heart failure patients: a complex clinical problem
(Wichtig Publishing, 2016-09-22) Pulignano, Giovanni; Del Sindaco, Donatella; Tinti, Maria Denitza; Tolone, Stefano; Minardi, Giovanni; Lax Pérez, Antonio Manuel; Uguccioni, Massimo; Medicina
Background: Atrial fibrillation (AF) and heart failure (HF), two problems of growing prevalence as a consequence of the ageing population, are associated with high morbidity, mortality, and healthcare costs. AF and HF also share common risk factors and pathophysiologic processes such as hypertension, diabetes mellitus, ischemic heart disease, and valvular heart disease often occur together. Although elderly patients with both HF and AF are affected by worse symptoms and poorer prognosis, there is a paucity of data on appropriate management of these patients. Methods: PubMed was searched for studies on AF and older patients using the terms atrial fibrillation, elderly, heart failure, cognitive impairment, frailty, stroke, and anticoagulants.Results: The clinical picture of HF patients with AF is complex and heterogeneous with a higher prevalence of frailty, cognitive impairment, and disability. Because of the association of mental and physical impairment to non-administration of oral anticoagulants (OACs), screening for these simple variables in clinical practice may allow better strategies for intervention in this high-risk population. Since novel direct OACs (NOACs) have a more favorable risk-benefit profile, they may be preferable to vitamin K antagonists (VKAs) in many frail elderly patients, especially those at higher risk of falls. Moreover, NOACs are simple to administer and monitor and may be associated with better adherence and safety in patients with cognitive deficits and mobility impairments. Conclusions: Large multicenter longitudinal studies are needed to examine the effects of VKAs and NOACs on long-term cognitive function and frailty; future studies should include geriatric conditions.
Open Access
Capacidad funcional y autocuidado de pacientes con insuficiencia cardíaca: una revisión de alcance
(Universidad de Murcia : servicio de publicaciones, 2026) Santos, José Arthur Guimarães dos; Souza, Juliana Pessoa de; Lima, Danielly Farias Santos de; Mangueira, Suzana de Oliveira; Cabral, João Victor Batista; Sousa, Mailson Marques de; Sin departamento asociado
Objective: To map the scientific evidence on the relationship between functional capacity and self-care in patients with heart failure.Methods:Scoping review conducted in accordance with the Joanna Briggs Institute and guided by PRISMA-ScR. Seven electronic databases and gray literature were consulted. Primary studies with adults (aged 18 years or older) diagnosed with heart failure, published in any language, were included, with independent and double-blind selection.Results: 18 studies were included. Self-care was predominantly assessed using the Self-Care of Heart Failure Index. Functional capacity was primarily assessed using the New York Heart Association functional classification. The relationship between the two is complex and varied, with positive, negative, or absent correlations.Conclusion:The relationship between functional capacity and self-care in patients with heart failure is heterogeneous. Understanding the relationship between self-care and functional capacity can guide healthcare professionals in the assessment and development of personalized interventions (education, exercise support, motivation) for patients with heart failure
Open Access
Capacidad de agencia de autocuidado y factores relacionados con la agencia en personas con insuficiencia cardíaca de la ciudad de Medellín (Colombia)
(Murcia: servicio de publicaciones de la Universidad de Murcia, 2013) Rodríguez Gázquez, Mª de los Ángeles; Arredondo Holguín, Edith; Salamanca Acevedo, Yurany Andrea
Objetivo. Explorar la asociación entre la capacidad de agencia de autocuidado con algunos factores básicos condicionantes relacionados con la agencia en personas con IC de la ciudad de Medellín (Colombia). Material y Método. Estudio de corte transversal que se llevó a cabo en una muestra por conveniencia de 266 personas con IC de dos instituciones hospitalarias de la ciudad de Medellín (Colombia) desde 2007 a 2011. Se utilizó un instrumento en el que se incluyeron variables sociodemográficas, de apoyo social y clínicas. Para la evaluación de la capacidad de agencia de autocuidado se empleó la versión de la Appraisal of Self-care Agency Scale –ASA- de Evers, validada al castellano por Gallegos. Resultados. La capacidad de agencia de autocuidado fue deficiente en el 47,0% de los participantes. Los mayores puntajes de ASA se encontraron en las personas de 50 años, en los niveles socioeconómicos más altos, en los casados, en los que tenían educación tecnológica o universitaria, los que practicaban actividades recreativas, los que tenían cualquier tipo de apoyo social, estaban en clase funcional I y en la fracción de eyección de 40%. En análisis de regresión logística mostró que la agencia de autocuidado suficiente está relacionada con la fracción de eyección, la edad y el estado civil. Conclusión. Fue deficiente la capacidad de agencia de autocuidado en la mitad de los participantes. Los factores básicos condicionantes, como la fracción de eyección, edad y estado civil, están asociados a una mejor capacidad de agencia de autocuidado.
Open Access
Changes of inflammatory and oxidative stress biomarkers in dogs with different stages of heart failure
(BioMed Central (BMC), 2020-11-10) Peres Rubio, Camila; Saril, A.; Kocaturk, M.; Tanaka, R.; Koch, J.; Cerón, J.J.; Yilmaz, Z.; Medicina y Cirugía Animal
Background: Heart failure (HF) is associated with changes in inflammatory and oxidative stress biomarkers. This study aimed to evaluate the changes of a panel of inflammatory and oxidative stress biomarkers in dogs with different stages of HF and its relation with the severity of the disease and echocardiographic changes. A total of 29 dogs with HF as a result of myxomatous mitral valve degeneration or dilated cardiomyopathy were included and classified as stage-A (healthy), B (asymptomatic dogs), C (symptomatic dogs) and D (dogs with end-stage HF) according to the ACVIM staging system. In these dogs an ecnhocardiographic examination was performed and cytokines, and inflammatory and oxidative stress markers were evaluated in serum. Results: KC-like was significantly increased in dogs of stage-C (P<0.01) and -D (P < 0.05) compared with stage-A and -B. Stage-D dogs showed significantly higher serum CRP and Hp (P < 0.05) but lower serum antioxidant capacity (PON1, TEAC, CUPRAC, and thiol) compared to stage-A and -B (P < 0.05). After the treatment, serum levels of CRP, Hp and KClike decreased and serum antioxidant levels increased compared to their pre-treatment values. Left ventricular dimension and LA/Ao ratio correlated positively with CRP, MCP-1, and KC-like but negatively with PON1, GM-CSF, IL-7 and antioxidant biomarkers (P < 0.01). Conclusion: Our results showed that dogs with advanced HF show increases in positive acute-phase proteins and selected inflammatory cytokines such as KC-like, and decreases in antioxidant biomarkers, indicating that inflammation and oxidative stress act as collaborative partners in the pathogenesis of HF. Some of these biomarkers of inflammation and oxidative stress could have the potential to be biomarkers to monitor the severity of the disease and the effect of treatment.
Open Access
Clinical relevance of sST2 in cardiac diseases
(2015-05-09) Pascual Figal, Domingo A.; Lax, Antonio; Perez Martinez, Maria T.; Asensio Lopez, Maria del Carmen; Sanchez Mas, Jesus; Lax Pérez, Antonio Manuel; Medicina
ST2 has two main isoforms, ST2L and soluble isoform of ST2 (sST2), by alternative splicing. The interaction between interleukin (IL)-33 and the transmembrane isoform ST2L is up-regulated in response to myocardial stress and exerts cardio-protective actions in the myocardium by reducing fibrosis, hypertrophy and enhancing survival. The circulating isoform sST2, by sequestering IL-33, abrogates these favorable actions and will be elevated as a maladaptive response to cardiac diseases. Indeed, circulating sST2 concentrations correlate with a worse phenotype of disease including adverse remodeling and fibrosis, cardiac dysfunction, impaired hemodynamics and higher risk of progression. In patients with acute and chronic heart failure, sST2 concentrations are strongly predictive of death, regardless of the cause and left ventricle (LV) ejection fraction, and contribute relevant information in addition to other prognosticators and biomarkers, as natriuretic peptides or troponins. sST2 also retains prognostic information in the setting of acute myocardial infarction (AMI) and predicts cardiovascular death and risk of heart failure (HF) development in these patients. sST2 could also be a promising tool to stratify the risk of sudden cardiac death (SCD) in patients with depressed LV ejection fraction. Therefore, sST2 represents a clinically relevant biomarker reflecting pathophysiological processes and contributing predictive information in the setting of several cardiovascular diseases, and especially in patients with HF.
Open Access
Conocimiento de los enfermeros sobre la insuficiencia cardíaca: un estudio comparativo
(Murcia: Servicio de publicaciones de la Universidad de Murcia, 2018) Azevedo, Priscylla Rique de; Sousa, Mailson Marques de; Oliveira, Jacira dos Santos; Freire, Maria Eliane Moreira; Matos, Suellen Duarte de Oliveira; Oliveira, Simone Helena dos Santos
Objetivo: Verificar el conocimiento de las enfermeras sobre la insuficiencia cardiaca en diferentes hospitales. Método: Participaron 74 enfermeros de dos hospitales públicos, general y especializado en cardiología, de una capital brasileña del noreste. Se utilizó el Cuestionario de Conocimiento de Enfermeros sobre Insuficicena Cardiaca (Q-CENIC). Los datos se analizaron de forma descriptiva e inferencial. Resultados: Se encontraron índices satisfactorios de respuestas correctas (70%) en términos de conocimientos básicos sobre la insuficiencia cardíaca como la restricción de sodio y líquidos, los cambios en el estilo de vida y la actividad sexual. No hubo diferencias estadísticas entre los profesionales del hospital general y los de atención especializada en cardiología. Conclusión: Se encontró que el conocimiento de los enfermeros sobre la insuficiencia cardíaca fue satisfactorio en el hospital general e insatisfactorio en el servicio especializada en cardiología. Se identificaron los temas que necesitan de intervención educativa, junto con los participantes investigados.
Open Access
Efecto de un programa de paciente experto en insuficiencia cardiaca
(Murcia: Servicio de Publicaciones de la Universidad de Murcia, 2020) Achury Saldaña, Diana Marcela; Restrepo, Laura; Munar, María Kamila; Rodríguez, Indira; Cely, María Camila; Abril, Natalia; Toledo, Lina
Introducción: Una estrategia que ha mostrado ser efectiva para promover el autocuidado en los pacientes con falla cardiaca es la formación de diadas y grupos que brinden apoyo de pares para favorecer el logro de metas individuales. Objetivo general: Determinar el efecto de un programa de paciente experto en falla cardiaca en los conocimientos relacionados con la adherencia al tratamiento y en la satisfacción. Método: Se realizó un estudio piloto descriptivo de corte transversal en pacientes con diagnósticos de falla cardiaca en una institución de cuarto nivel. El tamaño de la muestra correspondió a toda la población con los criterios de restricción (N: 20 sujetos). Se implementó un programa de paciente experto durante 6 meses y se midieron los desenlaces de nivel de conocimientos y satisfacción. Para la recolección de la información se utilizó un test de conocimientos sobre adherencia al tratamiento y una encuesta de satisfacción. La información se procesó a través del programa IBM SPSS Statistics 23.0, y se realizó un análisis descriptivo con distribución de frecuencias absolutas y relativas. Resultados: Más del 95% de los pacientes mostró mejoría significativa en el nivel de conocimientos y el 85% refirió el nivel de satisfacción global más alto (muy satisfechos), reflejado en la dimensión de fidelización y efectividad. Conclusiones: El programa del paciente experto en insuficiencia cardiaca se constituye en una intervención costo-efectiva que proporciona capacidades para ayudar a otros pacientes a adquirir autoconfianza y habilidades en el manejo de su condición de salud.
Open Access
Fomento del autocuidado en la insuficiencia cardiaca
(Murcia : Servicio de Publicaciones de la Universidad de Murcia, 2012) Olivella Fernández, M.; Patricia Bonilla, C.; Bastidas, C.V.
Este artículo aborda analíticamente aspectos conceptuales del Modelo de Autocuidado de Orem, como estrategia que apunta a demostrar que el autocuidado es la forma más eficaz, pertinente, económica y oportuna para enfrentar la cronicidad y particularmente la insuficiencia cardiaca. Fenómenos específicos como el envejecimiento poblacional y el uso de nuevas tecnologías, han repercutido en el aumento de la Insuficiencia Cardiaca. El perfil epidemiológico del país muestra cómo las dos primeras causas de mortalidad, al sumarlas, superan tasas del 300 %, se refieren a eventos que afectan la salud cardiovascular. Esta alarmante situación lleva a reflexionar cómo la investigación disciplinar puede identificar lagunas en la literatura, en un tema específico y propio como es el autocuidado y formular recomendaciones para futuras investigaciones, que contribuyan al enfrentamiento de este flagelo
Open Access
Galectin-3 expression in cardiac remodeling after myocardial infarction
(2014-03) Sanchez Mas, Jesus; Lax Pérez, Antonio Manuel; Asensio Lopez, Maria del Carmen; Fernandez del Palacio, Maria J; Caballero, Luis; Garrido, Iris P; Pastor, Francisco; Januzzi, James L; Pascual Figal, Domingo A.; Medicina
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Mineralocorticoid receptor antagonists modulate galectin-3 and interleukin-33/ST2 signaling in left ventricular systolic dysfunction after acute myocardial infarction
(Elsevier, 2015-01) Lax Pérez, Antonio Manuel; Sánchez Mas, Jesús; Asensio Lopez, Maria del Carmen; Fernandez del Palacio, Maria J; Caballero, Luis; Garrido, Iris P; Pastor Pérez, Francisco J; Januzzi, James L; Pascual Figal, Domingo A; Medicina
Objectives: This study aimed to evaluate the specific role of the 2 available mineralocorticoid receptor antagonists (MRAs), eplerenone and spironolactone, on the modulation of galectin-3 (Gal-3) and interleukin (IL)-33/ST2 signaling in an experimental model of left ventricular systolic dysfunction after acute myocardial infarction (MI). Background: The molecular mechanisms of benefits of MRAs in patients with left ventricular systolic dysfunction after MI not well understood. Methods: MI and left ventricular systolic dysfunction were induced by permanent ligation of the anterior coronary artery in 45 male Wistar rats, randomly assigned to no therapy (MI group, n = 15) or to receive MRAs (100 mg/kg/day) for 4 weeks; either eplerenone (n = 15) or spironolactone (n = 15) was used. A sham group was used as a control (n = 8). Elements of the pathway for Gal-3 including transforming growth factor (TGF)-β and SMAD3, as well as that for IL-33/ST2 (including IL-33 and soluble ST2 [sST2]) were analyzed in the infarcted and noninfarcted myocardium by quantitative real-time reverse transcription polymerase chain reaction. Expression of markers of fibrosis (collagen types I and III, tissue inhibitor of metalloproteinase-1) and inflammation (IL-6, tumor necrosis factor-α, monocyte chemotactic protein-1) was also examined. Results: In the infarcted myocardium, compared with sham animals, the MI group had higher concentrations of Gal-3, TGF-β, SMAD3, IL-33, and sST2, as well as higher concentrations of markers of fibrosis and inflammation. Treatment with MRAs down-regulated Gal-3, TGF-β, and SMAD3 and enhanced IL-33/ST2 signaling with lower expression of sST2; protective IL-33 up-regulation was unaffected by MRAs. Modulation of Gal-3 and IL-33/ST2 signaling induced by MRAs correlated with lower expression levels of fibrosis and inflammatory markers. No differences were found between eplerenone and spironolactone. In the noninfarcted myocardium, compared with sham animals, the MI group exhibited a higher expression of Gal-3 and IL-33, but no signs of inflammation or fibrosis were observed; in the presence of MRAs, IL-33 expression was significantly up-regulated, but Gal-3 was unaffected. Conclusions: MRAs play a pivotal role in the Gal-3 and IL-33/ST2 modulation in post-MI cardiac remodeling.
Open Access
Non-compaction of the ventricular myocardium, a cardiomyopathy in search of a pathoanatomical definition
(Murcia : F. Hernández, 2010) Val-Bernal, José Fernando; Garijo, M.F.; Rodriguez-Villar, Diana; Val, D.
Ventricular non-compaction is a rare cardiomyopathy characterized by numerous, excessively prominent ventricular trabeculations and deep intertrabecular recesses communicating with the ventricular cavity. The lesion is postulated to result from an intrauterine developmental arrest that stops compaction of the myocardial fiber meshwork. This cardiomyopathy affects the left ventricle, with or without concomitant right ventricular involvement. The disease is now seen with increasing frequency and it is clinically diagnosed by imaging techniques such as echocardiography or cardiac magnetic resonance. Current diagnostic criteria are considered too sensitive, particularly in black individuals. Therefore, this condition has generated considerable controversy and demands a new definition. Non-compaction cardiomyopathy shows variability of hereditary patterns, genetic heterogeneity, diversity in associated phenotypes and a wide spectrum of clinical presentation and pathophysiological findings. Non-compaction can be simply a variant of normal maturation of the ventricular myocardium with only the most severe forms producing a distinct clinical-pathological entity. Ventricular noncompaction most probably is a secondary consequence of an underlying molecular derangement produced by a pathogenetic mutation. It is likely that surgical pathologists will find this entity more frequently due to involvement in transplantation teams.
Open Access
Oxigenación con membrana extracorpórea en el paciente COVID-19: resultados del Registro Español ECMO-COVID de la Sociedad Española de Cirugía Cardiovascular y Endovascular
(Sociedad Española de Cirugía Cardiovascular y Endovascular, 2022-02-01) Castaño, María; Sbraga, Fabrizio; Pérez de la Sota, Enrique; Arribas, José M.; Cámara, M. Luisa; Voces, Roberto; Donado, Alicia; Sandoval, Elena; Morales, Carlos A.; González Santos, José M.; Barquero Alemán, Miguel; Fletcher-San Feliu, Delfina; Rodríguez Roda, Jorge; Molina, Daniel; Bellido, André; Vigil-Escalera, Carlota; Tena, M. Ángeles; Reyes, Guillermo; Gómez, Félix; Rivas, Jorge; Guevara, Audelio; Tauron, Manel; Borrego, José Miguel; Castillo, Laura; Miralles, Albert; Cánovas López, Sergio; Berastegui, Elisabet; Aramendi, José I.; Aldámiz, Gonzalo; Pruna, Robert; Silva, Jacobo; Sáez de Ibarra, José I.; Legarra, Juan J.; Ballester, Carlos; Rodríguez Lecoq, Rafael; Daroca, Tomás; Paredes, Federico; Cirugía, Pediatría y Obstetricia y Ginecología
Introducción y objetivos: La oxigenación con membrana extracorpórea (ECMO) ha resultado ser una opción terapéutica en los pacientes con insuficiencia respiratoria o cardiaca severa por COVID-19. Las indicaciones y manejo de estos pacientes están aún por determinar. Nuestro objetivo es evaluar los resultados de la terapia ECMO en pacientes con COVID-19 incluidos en un registro prospectivo e intentar optimizar los resultados. Métodos: En marzo de 2020 se inició un registro multicéntrico anónimo prospectivo de pacientes con COVID-19 tratados mediante ECMO veno-arterial (V-A) o veno-venosa (V-V). Se registraron las variables clínicas, analíticas y respiratorias preimplante, datos de implante y evolución de la terapia. El evento primario fue la mortalidad hospitalaria de cualquier causa y los eventos secundarios fueron la recuperación funcional y el evento combinado de recuperación funcional y mortalidad de cualquier causa a partir de los 3 meses de seguimiento tras el alta. Resultados: Se analizó a un total de 365 pacientes procedentes de 25 hospitales, 347 V-V y 18 V-A (edad media de 52,7 y 49,4 años, respectivamente). Los pacientes con ECMO V-V fueron más obesos, presentaban menos fracaso orgánico diferente al pulmonar y precisaron menos terapia inotrópica previa al implante. El 33,3% y el 34,9% de los pacientes con ECMO V-A y V-V, respectivamente, fueron dados de alta del hospital (p = NS) y la mortalidad fue similar, del 56,2% y 50,9% de los casos respectivamente, la inmensa mayoría durante la ECMO y sobre todo por fracaso multiorgánico. El 14,0% (51 pacientes) permanecían ingresados. El seguimiento medio fue de 196 ± 101,7 días. En el análisis multivariante, resultaron protectores de evento primario en pacientes con ECMO V-V el peso corporal (OR 0,967; IC 95%: 0,95-0,99; p = 0,004) y la procedencia del propio hospital (OR 0,48; IC 95%: 0,27-0,88; p = 0,018), mientras que la edad (OR 1,063; IC 95%: 1,005-1,12; p = 0,032), la hipertensión arterial (3,593; IC 95%: 1,06-12,19; p = 0,04) y las complicaciones en ECMO globales (2,44; IC 95%: 0,27-0,88; p = 0,019), digestivas (OR 4,23, IC 95%: 1,27-14,07; p = 0,019) y neurológicas (OR 4,66; IC 95%: 1,39-15,62; p = 0,013) fueron predictores independientes de mortalidad. El único predictor independiente de aparición de los eventos secundarios resultó el momento de seguimiento del paciente. Conclusiones: La terapia con ECMO permite supervivencias hospitalarias hasta del 50% en pacientes con COVID-19 grave. La edad, la hipertensión arterial y las complicaciones en ECMO son los predictores de mortalidad hospitalaria en pacientes con ECMO V-V. Un mayor peso corporal y la procedencia del propio hospital son factores protectores. La recuperación funcional solo se ve influida por el tiempo de seguimiento transcurrido tras el alta. La estandarización de los criterios de implante y manejo del paciente con COVID grave mejoraría los resultados y la futura investigación clínica.
Embargo
Pulmonary production of soluble ST2 in heart failure
(Wolters Kluwer Health, Inc., 2018-12-13) Pascual Figal, Domingo Andrés; Pérez Martínez, María T; Asensio López, María del Carmen; Sánchez Mas, Jesús; García García, María E; Martínez, Carlos M; Lencina, Miriam; Jara, Ruben; Januzzi, James L; Lax Pérez, Antonio Manuel; Medicina
Background: Serum concentrations of ST2 (interleukin-1 receptor-like 1) represent a meaningful prognostic marker in cardiac diseases. Production of soluble ST2 (sST2) may be partially extracardiac. Identification of sST2 sources is relevant to design strategies for modulating its signaling. Methods and results: An experimental model of ischemic heart failure was used. sST2, membrane-bound ST2 (ST2L), and IL-33 were measured in lungs, heart, kidney, and liver by quantifying mRNA and protein expression in tissue samples obtained at different times (1, 2, 4, and 24 weeks). Primary human type II pneumocyte cell cultures were subjected to strain. sST2 was measured in samples of bronchial aspirate and serum obtained from patients treated with invasive respiratory support. In the experimental model, sST2 increased significantly from the first week in both lungs and myocardium, whereas ST2L/IL-33 response was unfavorable in lungs (decrease) and favorable in myocardium (increase). No changes were observed in liver and kidneys. ST2 immunostaining was intensely observed in alveolar epithelium, and sST2 was secreted by primary human type II pneumocytes in response to strain. sST2 levels in lung aspirates were substantially higher in the presence of cardiogenic pulmonary edema (median, 228 [interquartile range, 28.4-324.0] ng/mL; P<0.001) than bronchopneumonia (median, 5.5 [interquartile range, 1.6-6.5]) or neurological disorders (median, 2.9 [interquartile range, 1.7-10.1]), whereas sST2 concentrations in serum did not differ. Conclusions: The lungs are a relevant source of sST2 in heart failure. These results may have implications for the progression of disease and the development of therapies targeting the ST2 system in patients with heart failure.
Open Access
Red blood cell distribution width predicts new-onset anemia in heart failure patients
(2012-10) Pascual Figal, Domingo A.; Manzano Fernandez, Sergio; Garrido, Iris P; Lax Pérez, Antonio Manuel; Januzzi, James L; Medicina
Background: Hematologic abnormalities such as elevated red blood cell distribution width (RDW) as well as anemia are prognostically meaningful among heart failure (HF) patients. The inter-relationship between these hematologic abnormalities in HF is unclear, however. We therefore aimed to assess whether RDW is predicting changes in hemoglobin concentrations as well as onset of anemia. Methods: 268 consecutive non-anemic patients with acutely decompensated HF (ADHF) were enrolled at hospital discharge and RDW was measured. At 6 month follow-up, change in hemoglobin as well as new-onset anemia was studied as a function of RDW at discharge. Results: RDW at discharge correlated negatively with hemoglobin values at 6 months (r=-0.220; p<0.001); a greater decrease in hemoglobin concentration occurred in those with higher values of RDW at discharge (p=0.004), independently of baseline hemoglobin concentration and other risk factors. At 6 months, 54 patients (20%) developed new-onset anemia. RDW values at discharge were significantly higher among patients who developed new-onset anemia (15.1 ± 2.2 vs. 14.2 ± 1.4, p=0.005). In integrated discrimination improvement analyses, the addition of RDW measurement improved the ability to predict new-onset anemia (IDI 0.0531, p<0.001), beyond known risk factors as hemoglobin, renal function, age, diabetes mellitus, sex and HF symptom severity. In adjusted analyses, patients with RDW>15% (derived from receiver operating characteristic analysis) had a tripling of the risk of new-onset anemia (OR=3.1, 95% CI 1.5-5.1, p=0.002). Conclusion: Among non-anemic patients with ADHF, RDW measurement at the time of hospital discharge independently predicts lower hemoglobin concentrations and new-onset anemia over a 6-month follow up period.
Open Access
Structural and functional alterations in the atrioventricular node and atrioventricular ring tissue in ischaemia-induced heart failure
(F. Hernández y Juan F. Madrid. Universidad de Murcia. Departamento de Biología Celular e Histología, 2014) Yanni, Joseph; Maczewski, MIchal; Mackiewicz, Urszula; Siew, Samuel; Fedorenko, Olga; Atkinson, Andrew; Price, Marcus; Beresewicz, Andrzej; Anderson, Robert H.; Boyett, Mark R.; Dobrzynski, Halina
Heart failure (HF) causes dysfunction of the atrioventricular node (AVN) – first or second-degree heart block is a risk factor for sudden cardiac death in HF patients. The aim of the study was to determine if HF causes remodelling of the AVN and right atrioventricular ring (RAVR). HF was induced in rats (n=4) by ligation of the proximal left coronary artery, which resulted in a large infarct of the left ventricle. Sham-operated rats (n=4) were used as controls. Eight weeks after surgery, functional experiments were performed and the hearts were frozen. The body weight of HF rats was similar to control rats, but the mean heart weight of HF rats was significantly enlarged. In HF rats compared to controls, the left ventricle was dilated, left ventricular enddiastolic pressure elevated (21.0±0.6 and 5.4±0.2 mm Hg), left ventricular ejection fraction reduced (0.2±0.02 and 0.5±0.02) and left ventricular end-systolic pressure reduced (102±4.2 and 127±3.1 mm Hg). In HF rats, the in vivo and in vitro PR intervals were increased (41% and 20%), as was the Wenckebach cycle length, indicative of AVN dysfunction. The collagen content was significantly increased in the AVN and RAVR indicating fibrosis. Immunolabelling of caveolin3 (cell membrane marker) showed that there was hypertrophy in HF (cell diameter was increased by 63%, 39% in AVN, RAVR). The TUNEL assay showed that the myocytes of the AVN and RAVR in HF undergo apoptotic cell death. Immunolabelling showed that expression of HCN4 was significantly decreased in the AVN and RAVR (43% and 47%) in HF. We conclude that in HF there is remodelling of the AVN and RAVR and this remodelling may explain the AVN dysfunction.
Open Access
Validez y confiabilidad de un instrumento evaluativo de adherencia en pacientes con falla cardiaca
(Murcia : Servicio de Publicaciones de la Universidad de Murcia, 2012) Achury Saldaña, Diana; Sepúlveda Carrillo, GJ.; Rodríguez Colmenares, SM.; Giraldo, IC.
Se describe la construcción y validación de un instrumento para evaluar la adherencia al tratamiento en pacientes con falla cardiaca, usando como referencia teórica los factores asociados con la adherencia y sus respectivos indicadores taxonomía NOC. Consta de 30 ítems agrupados en diez dimensiones. El Objetivo fue establecer los indicadores iniciales de fiabilidad y validez de constructo del instrumento de “evaluación de comportamientos de adherencia al tratamiento farmacológico y no farmacológico en pacientes con falla cardíaca”. El instrumento fue aplicado a 192 personas con diagnóstico de falla cardíaca y se estableció la validez de constructo mediante análisis factorial y la consistencia interna mediante la prueba estadística Alfa de Cronbach. El análisis psicométrico de este estudio mostró un índice de fiabilidad de 0,7213 lo que se considera adecuado, este instrumento se convierte en una herramienta de valoración de enfermería que puede ser útil para evaluar la adherencia al tratamiento en pacientes con falla cardíaca.