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Resumo Fundamento Os limiares de corte para a “relação do ciclo completo de repouso” (RFR) oscilam em diferentes séries, sugerindo que as características da população podem influenciá-los. Da mesma forma, foram documentados preditores de discordância entre a RFR e a reserva de fluxo fracionado (FFR). O Estudo RECOPA, mostrou que a capacidade diagnóstica está reduzida na “zona cinzenta” da RFR, tornando necessária a realização de FFR para descartar ou confirmar isquemia. Objetivos Determinar os preditores de discordância, integrar as informações que eles fornecem em um índice clínico-fisiológico: a “RFR Ajustada”, e comparar sua concordância com o FFR. Métodos Usando dados do Estudo RECOPA, os preditores de discordância em relação à FFR foram determinados na “zona cinzenta” da RFR (0,86 a 0,92) para construir um índice (“RFR Ajustada”) que pesaria a RFR juntamente com os preditores de discordância e avaliar sua concordância com a FFR. Resultados Foram avaliadas 156 lesões em 141 pacientes. Os preditores de discordância foram: doença renal crônica, cardiopatia isquêmica prévia, lesões não envolvendo a artéria descendente anterior esquerda e síndrome coronariana aguda. Embora limitada, a “RFR Ajustada” melhorou a capacidade diagnóstica em comparação com a RFR na “zona cinzenta” (AUC-RFR = 0,651 versus AUC-“RFR Ajustada” = 0,749), mostrando também uma melhora em todos os índices diagnósticos quando foram estabelecidos limiares de corte otimizados (sensibilidade: 59% a 68%; especificidade: 62% a 75%; acurácia diagnóstica: 60% a 71%; razão de verossimilhança positiva: 1,51 a 2,34; razão de verossimilhança negativa: 0,64 a 0,37). Conclusões Ajustar a RFR integrando as informações fornecidas pelos preditores de discordância para obter a “RFR Ajustada” melhorou a capacidade diagnóstica em nossa população. Mais estudos são necessários para avaliar se os índices clínico-fisiológicos melhoram a capacidade diagnóstica da RFR ou de outros índices coronarianos. Abstract Background Cutoff thresholds for the “resting full-cycle ratio” (RFR) oscillate in different series, suggesting that population characteristics may influence them. Likewise, predictors of discordance between the RFR and fractional flow reserve (FFR) have been documented. The RECOPA Study showed that diagnostic capacity is reduced in the RFR “grey zone”, requiring the performance of FFR to rule out or confirm ischemia. Objectives To determine predictors of discordance, integrate the information they provide in a clinical-physiological index, the “Adjusted RFR”, and compare its agreement with the FFR. Methods Using data from the RECOPA Study, predictors of discordance with respect to FFR were determined in the RFR “grey zone” (0.86 to 0.92) to construct an index (“Adjusted RFR”) that would weigh RFR together with predictors of discordance and evaluate its agreement with FFR. Results A total of 156 lesions were evaluated in 141 patients. Predictors of discordance were: chronic kidney disease, previous ischemic heart disease, lesions not involving the anterior descending artery, and acute coronary syndrome. Though limited, the “Adjusted RFR” improved the diagnostic capacity compared to the RFR in the “grey zone” (AUC-RFR = 0.651 versus AUC-“Adjusted RFR” = 0.749), also showing an improvement in all diagnostic indices when optimal cutoff thresholds were established (sensitivity: 59% to 68%; specificity: 62% to 75%; diagnostic accuracy: 60% to 71%; positive likelihood ratio: 1.51 to 2.34; negative likelihood ratio: 0.64 to 0.37). Conclusions Adjusting the RFR by integrating the information provided by predictors of discordance to obtain the “Adjusted RFR” improved the diagnostic capacity in our population. Further studies are required to evaluate whether clinical-physiological indices improve the diagnostic capacity of RFR or other coronary indices.

espanolIntroduccion. Uno de los microorganismos mas agresivos en la endocarditis infecciosa (EI) es Staphylococcus aureus. Analizamos la resistencia de S. aureus a los antibioticos y su repercusion en el curso clinico de la EI en un periodo reciente de 15 anos. Material y metodos. Estudio retrospectivo de los pacientes diagnosticados de EI en un hospital universitario desde 2005 hasta 2019. Analisis bivariado y multivariado de la gravedad al ingreso, comorbilidades, concentraciones minimas inhibitorias (CMI) y mortalidad. Resultados. De los 293 casos de EI, 66 (22,5%) fueron por S. aureus, y 21 (7,2%) eran S. aureus resistentes a meticilina (SARM). La prevalencia de cepas con CMI a vancomicina ≥ 1mg/L paso del 4,8% al 63,6% (p IC 95%= 1,01-2,35; p= 0,04). Conclusion. Hemos experimentado un incremento de casos de EI con CMI a vancomicina ≥ 1mg/L, sin variacion significativa en infecciones por SARM. La resistencia antimicrobiana no se asocio a mortalidad. Si lo hicieron la comorbilidad y la afectacion izquierda. EnglishIntroduction. One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. Methods. Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. Results. Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p Conclusion. We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.

Cutoff thresholds for the "resting full-cycle ratio" (RFR) oscillate in different series, suggesting that population characteristics may influence them. Likewise, predictors of discordance between the RFR and fractional flow reserve (FFR) have been documented. The RECOPA Study showed that diagnostic capacity is reduced in the RFR "grey zone", requiring the performance of FFR to rule out or confirm ischemia.To determine predictors of discordance, integrate the information they provide in a clinical-physiological index, the "Adjusted RFR", and compare its agreement with the FFR.Using data from the RECOPA Study, predictors of discordance with respect to FFR were determined in the RFR "grey zone" (0.86 to 0.92) to construct an index ("Adjusted RFR") that would weigh RFR together with predictors of discordance and evaluate its agreement with FFR.A total of 156 lesions were evaluated in 141 patients. Predictors of discordance were: chronic kidney disease, previous ischemic heart disease, lesions not involving the anterior descending artery, and acute coronary syndrome. Though limited, the "Adjusted RFR" improved the diagnostic capacity compared to the RFR in the "grey zone" (AUC-RFR = 0.651 versus AUC-"Adjusted RFR" = 0.749), also showing an improvement in all diagnostic indices when optimal cutoff thresholds were established (sensitivity: 59% to 68%; specificity: 62% to 75%; diagnostic accuracy: 60% to 71%; positive likelihood ratio: 1.51 to 2.34; negative likelihood ratio: 0.64 to 0.37).Adjusting the RFR by integrating the information provided by predictors of discordance to obtain the "Adjusted RFR" improved the diagnostic capacity in our population. Further studies are required to evaluate whether clinical-physiological indices improve the diagnostic capacity of RFR or other coronary indices.Os limiares de corte para a “relação do ciclo completo de repouso” (RFR) oscilam em diferentes séries, sugerindo que as características da população podem influenciá-los. Da mesma forma, foram documentados preditores de discordância entre a RFR e a reserva de fluxo fracionado (FFR). O Estudo RECOPA, mostrou que a capacidade diagnóstica está reduzida na “zona cinzenta” da RFR, tornando necessária a realização de FFR para descartar ou confirmar isquemia.Determinar os preditores de discordância, integrar as informações que eles fornecem em um índice clínico-fisiológico: a “RFR Ajustada”, e comparar sua concordância com o FFR.Usando dados do Estudo RECOPA, os preditores de discordância em relação à FFR foram determinados na “zona cinzenta” da RFR (0,86 a 0,92) para construir um índice (“RFR Ajustada”) que pesaria a RFR juntamente com os preditores de discordância e avaliar sua concordância com a FFR.Foram avaliadas 156 lesões em 141 pacientes. Os preditores de discordância foram: doença renal crônica, cardiopatia isquêmica prévia, lesões não envolvendo a artéria descendente anterior esquerda e síndrome coronariana aguda. Embora limitada, a “RFR Ajustada” melhorou a capacidade diagnóstica em comparação com a RFR na “zona cinzenta” (AUC-RFR = 0,651 versus AUC-“RFR Ajustada” = 0,749), mostrando também uma melhora em todos os índices diagnósticos quando foram estabelecidos limiares de corte otimizados (sensibilidade: 59% a 68%; especificidade: 62% a 75%; acurácia diagnóstica: 60% a 71%; razão de verossimilhança positiva: 1,51 a 2,34; razão de verossimilhança negativa: 0,64 a 0,37).Ajustar a RFR integrando as informações fornecidas pelos preditores de discordância para obter a “RFR Ajustada” melhorou a capacidade diagnóstica em nossa população. Mais estudos são necessários para avaliar se os índices clínico-fisiológicos melhoram a capacidade diagnóstica da RFR ou de outros índices coronarianos.

Resumen Introduccion y objetivos Canarias tiene la mortalidad por diabetes mas elevada de Espana. El objetivo es averiguar si existen diferencias con las restantes comunidades autonomas en la mortalidad hospitalaria por infarto agudo de miocardio (IAM), en los factores asociados con esta mortalidad y la fraccion poblacional atribuible a la diabetes. Metodos Estudio descriptivo de los ingresos hospitalarios por IAM en Espana desde 2007 hasta 2014, registrados en el Conjunto Minimo Basico de Datos. Resultados Se identificaron 415.798 IAM. Los pacientes canarios (16.317) eran mas jovenes que los del resto de Espana (63,93 ± 13,56 frente a 68,25 ± 13,94 anos; p Conclusiones Canarias presenta una situacion muy desfavorable respecto al resto de Espana en la mortalidad hospitalaria por IAM.

Background. The resting full‐cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods. Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR “grey zone” in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results. A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; P < 0.001 ) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the “grey zone” (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions. Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use.

BACKGROUND Invasive coronary procedures involve the administration of iodinated contrast and the exposure to ionising radiations, increasing morbidity and mortality. The rotational coronary angiography (RCA) allows acquiring multiple projections with a unique injection of iodinated contrast. To date, there are no meta-analyses specifically comparing RCA and conventional coronary angiography (CCA) in patients undergoing invasive coronary procedures, whether diagnostic or diagnostic and therapeutic. The aim of this meta-analysis is to assess the impact of RCA on the amount of iodinated contrast and the exposure to ionising radiations during invasive coronary procedures. METHODS A search in PubMed and Ovid databases was conducted to identify studies, including diagnostic and diagnostic and therapeutic studies, comparing RCA and CCA. The manuscripts were evaluated on quality and biases, and were included if they analysed any of the following endpoints: volume of contrast and exposure to ionising radiations measured as dose-area product, and Kerma-air or fluoroscopy time. RESULTS Sixteen studies, with a total of 2,327 patients, were included in the final analysis (1,146 patients underwent RCA and 1,181 patients underwent CCA), with significant differences being detected in volume of contrast (standard difference in means [95% confidence interval] -1.887 [-2.472 to -1.302]; P

Introduction and objectives: Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine â¥0.5 mg/dL or â¥25%) after an acute coronary syndrome. Methods: From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups. Results: Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0 ± 11.8 years vs. 59.7 ± 12.1 years; p = 0.006), a higher proportion of women (44.8 vs. 17.6%; pÂ

Resumen Introduccion Los pacientes con cancer pueden constituir un especial grupo de riesgo para el desarrollo de endocarditis infecciosa (EI) debido a que frecuentemente estan sometidos a maniobras invasivas. Nuestro objetivo es conocer cual es el perfil diferencial y el pronostico de los pacientes con EI y cancer. Metodos Estudio observacional retrospectivo de todos los pacientes con EI diagnosticados consecutivamente en un hospital entre 2005 y 2015. Se realiza un analisis comparativo entre los pacientes con enfermedad oncologica y sin ella, asi como un seguimiento a largo plazo. Resultados Se diagnosticaron 208 casos de EI, de los cuales 32 sufrian enfermedad oncologica. No hubo diferencias significativas en cuanto a la edad (67,5 [59,2-74] vs. 64 [51-74] anos), y la comorbilidad estimada por el indice de Charlson fue similar cuando no se considero el propio diagnostico de cancer (4 [2,2-5] vs. 3,9 [2-5]). Se relaciono principalmente con la asistencia sanitaria (59,5% vs. 24,4%, p Conclusiones La EI en pacientes con cancer esta predominantemente causada por estafilococos y presenta una elevada mortalidad precoz. A pesar de que se relaciona frecuentemente con la asistencia sanitaria, los pacientes se ven limitados desde el punto de vista terapeutico.

Objective Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI >= 75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI >= 75 years. Methods We included 979 patients with STEMI >= 75 years, from the ATencion HOspitalaria del Sindrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. Results Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). Conclusions Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older., Supported by: MARATO TV3 (081630), de AGAUR (2014SGR240); del Instituto de Salud Carlos III: Red de Investigacion Cardiovascular RD12/0042 (Programa HERACLES); Red RedIAPP RD06/0018; CP12/03287; CIBER Epidemiologia y Salud Publica; CIBERCV de enfermedades Cardiovasculares, Fondo Europeo de Desarrollo Regional (FEDER) (European Regional Development Funds - ERDF-); FIS CP12/03287, FIS 14/00449, FIS PI081327, FIS INTRASALUD PI1101801.

INTRODUCTION AND OBJECTIVES The Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes. METHODS Cross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set. RESULTS A total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. CONCLUSIONS Mortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.

Background: To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis. Methods: Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1). Outcome variables: Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors. Results: Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, pvs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, pvs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome. Conclusion: Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.

Resumen Objetivos Comprobar si existen diferencias en la presentacion clinica, microbiologia y morbimortalidad intrahospitalaria de la endocarditis infecciosa entre 2 centros espanoles, uno peninsular y con cirugia cardiaca y otro en Canarias que debe derivar a los pacientes quirurgicos. Metodo Estudio retrospectivo de 229 pacientes con endocarditis, incluidos pediatricos, ingresados de forma consecutiva en los hospitales Reina Sofia de Cordoba (n = 119) y Nuestra Senora de Candelaria, en Tenerife (n = 110), entre 2005 y 2012. Se compararon las variables clinicas, microbiologicas y ecocardiograficas y se analizaron las diferencias de mortalidad mediante un analisis de regresion logistica binaria. Resultados No hubo diferencias en la cardiopatia predisponente, en la proporcion de casos intervenidos ni en el perfil microbiologico. En el hospital canario la proporcion de infecciones por cateter fue mayor (13,6% vs 3,4%), asi como la mortalidad global (31,8% vs 18,5%; p = 0,020). Esta diferencia de mortalidad entre hospitales dejo de resultar significativa en el analisis multivariable (OR = 1,85; IC 95%, 0,70-4,87; p = 0,213), siendo la edad (OR por ano = 1,04; IC 95%, 1,01-1,07; p = 0,006), las complicaciones cardiacas (OR = 5,05; IC 95%, 1,78-14,34; p = 0,002), la sepsis persistente (OR = 4,89; IC 95%, 2,09-11,46; p Conclusiones Existen diferencias en la presentacion de la endocarditis entre 2 hospitales espanoles distantes. La ausencia de servicio quirurgico no puede relacionarse directamente con la distinta evolucion intrahospitalaria.

Resumen Introduccion Las complicaciones vasculares derivadas del cateterismo cardiaco por via femoral prolongan la estancia hospitalaria y ponen en peligro la integridad de los pacientes. Conocer la anatomia angiografica podria ayudar a predecir la aparicion de complicaciones. Objetivos Averiguar los factores relacionados con una anatomia angiografica femoral desfavorable para el acceso vascular y si esta se asocia a una mayor frecuencia de complicaciones derivadas del cateterismo cardiaco. Metodos Estudio observacional prospectivo de todos los pacientes a los que se les realizo cateterismo por via femoral entre mayo de 2011 y abril de 2012 en un hospital universitario. Se analizaron las variables relacionadas con una anatomia vascular desfavorable y con la aparicion de complicaciones derivadas del procedimiento. Resultados Entre 917 procedimientos se produjeron 35 complicaciones (3,8%). Los pacientes con una angiografia femoral de riesgo presentaban mayor edad (67 [60-76] vs 65 [55-73] anos, p Conclusiones La edad, la diabetes y la funcion renal se asocian a un acceso femoral desfavorable. Las complicaciones del cateterismo no se relacionan con la anatomia angiografica, aunque esta es util para el manejo del punto de acceso.

Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5mg/dl or ≥25%) after an acute coronary syndrome.From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups.Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0±11.8 years vs. 59.7±12.1 years; p=0.006), a higher proportion of women (44.8 vs. 17.6%; p0.001), patients with a lower estimated glomerular filtration rate (76±25 vs. 86±27ml/min/1.73 mRCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA.

Resumen Introduccion y objetivos La distrofia miotonica tipo 1 se caracteriza por afeccion muscular y manifestaciones sistemicas, entre ellas las cardiacas. Nuestro objetivo es documentar la frecuencia y la gravedad de la afeccion cardiovascular (aparicion de disfuncion ventricular izquierda y trastornos del ritmo o conduccion), la necesidad de implantar marcapasos o desfibrilador o de realizar estudio electrofisiologico y la aparicion de muerte subita durante el seguimiento. Metodos Estudio observacional retrospectivo de los pacientes con distrofia miotonica tipo 1 remitidos a una consulta monografica de cardiologia y sometidos a seguimiento clinico, electrocardiografico (con registro Holter) y ecocardiografico. Resultados Se incluyo a 81 pacientes (el 51,9% varones; media de edad, 29,9 ± 14,8 anos). El seguimiento medio fue de 5,7 ± 3,9 (1-20) anos y se documento bradicardia sinusal en el 48,8%, disfuncion sinusal en el 13,8%, arritmias supraventriculares en el 10%, intervalo PR ≥ 220 ms en el 31,3%, taquicardia ventricular el 5%, intervalo QT corregido largo en el 5%, bloqueo auriculoventricular de segundo o tercer grado en el 8,8% e intervalo QRS ≥ 120 ms en el 7,5%. Solo 1 paciente presento disfuncion ventricular grave. Durante el seguimiento se implantaron 15 marcapasos y 2 desfibribladores y se realizaron 5 estudios electrofisiologicos, la mayoria por taquicardia ventricular. Solo se produjo 1 muerte subita. Conclusiones Los trastornos de conduccion y del ritmo son frecuentes durante la evolucion de dichos pacientes, y un porcentaje considerable requiere estudio electrofisiologico e implante de dispositivos (marcapasos o desfibrilador). La disfuncion sistolica y la muerte subita son excepcionales en nuestra experiencia.

Introduction and objectives Myotonic dystrophy type 1 is characterized by muscle damage and systemic manifestations, including cardiac involvement. Our aim was to document the frequency and severity of cardiac involvement (left ventricular dysfunction and arrhythmia or conduction disorders), the need for a pacemaker, implantable cardioverter-defibrillator, or electrophysiological study, and the development of sudden death during follow-up. Methods Retrospective observational study of myotonic dystrophy type 1 patients referred to a specialized cardiac unit. Patients received clinical, electrocardiographic (Holter monitoring), and echocardiographic follow-up. Results We included 81 patients (51.9% men; mean age, 29.9 [14.8] years). The mean follow-up was 5.7 (3.9) years (range: 1-20 years). During this period sinus bradycardia was documented in 48.8%, PR interval≥220 ms in 31.3%, long corrected QT interval in 5%, and QRS interval≥120 ms in 7.5%. A total of 13.8% of patients developed sinus node dysfunction, 10% of patients had supraventricular arrhythmias, 5% had ventricular tachycardia, and 8.8% developed second- or third- degree atrioventricular block. Only 1 patient had severe ventricular dysfunction. During the follow-up, 15 pacemakers and 2 implantable cardioverter-defibrillators were implanted and 5 electrophysiological studies were performed (mainly due to ventricular tachycardia). There was only 1 sudden death. Conclusions Arrhythmia or conduction disorders are frequent during the course of myotonic dystrophy type 1 patients. A significant percentage of patients require electrophysiological study and the use of a device (pacemaker or implantable cardioverter-defibrillator). In our experience, systolic dysfunction and sudden death are rare.

Invasive coronary procedures involve the administration of iodinated contrast and the exposure to ionising radiations, increasing morbidity and mortality. The rotational coronary angiography (RCA) allows acquiring multiple projections with a unique injection of iodinated contrast. To date, there are no meta-analyses specifically comparing RCA and conventional coronary angiography (CCA) in patients undergoing invasive coronary procedures, whether diagnostic or diagnostic and therapeutic. The aim of this meta-analysis is to assess the impact of RCA on the amount of iodinated contrast and the exposure to ionising radiations during invasive coronary procedures.A search in PubMed and Ovid databases was conducted to identify studies, including diagnostic and diagnostic and therapeutic studies, comparing RCA and CCA. The manuscripts were evaluated on quality and biases, and were included if they analysed any of the following endpoints: volume of contrast and exposure to ionising radiations measured as dose-area product, and Kerma-air or fluoroscopy time.Sixteen studies, with a total of 2,327 patients, were included in the final analysis (1,146 patients underwent RCA and 1,181 patients underwent CCA), with significant differences being detected in volume of contrast (standard difference in means [95% confidence interval] -1.887 [-2.472 to -1.302]; P.001), dose-area product (-0.726 [-1.034 to -0.418]; P.001), Kerma-air (-0.842 [-1.104 to -0.581]; P.001), and fluoroscopy time (0.263 [-0.496 to -0.030]; P=.027).RCA reduces the volume of contrast and the exposure to radiation, evaluated as dose-area product, Kerma-air, and fluoroscopy time, in patients undergoing invasive coronary procedures.

Cancer patients may constitute a special risk group for the development of infective endocarditis (IE) because they are often subjected to invasive procedures. The aim of this study is to determine the differential clinical profile and prognosis of patients with IE and cancer.A retrospective observational study was conducted on all patients consecutively diagnosed with IE in a single centre between 2005 and 2015. A comparative analysis was performed between patients with cancer and those free of disease, as well as a long-term follow-up.There were 208 IE cases, of which 32 had a cancer diagnosis. There were no significant differences in age (67.5 [59.2-74] vs. 64 [51-74] years). The Charlson comorbidity index was same whether cancer was diagnosed or not (4 [2.2-5] vs. 3.9 [2-5]). IE in cancer patients was mainly associated with health care (59.5% vs 24.4%, P.001). Staphylococcus aureus was the main causative agent (35%), and the tricuspid location was three times more common (18.8% vs. 6.2%). Surgery was not performed in 18.7% of patients, despite having an indication, compared with 7.4% of patients without cancer. In-hospital mortality for cancer patients was 45.5%, and the probability of survival at one year was 40%.IE in patients with cancer is predominantly caused by staphylococci, and has high early mortality. Although it is often related to health care, patients are limited from the therapeutic point of view.

Objetivo: Conocer las características, evolución y pronóstico de los pacientes con endocarditis infecciosa que requieren tratamiento en la Unidad de Medicina Intensiva. Diseño: Estudio observacional de cohortes prospectivo en pacientes ingresados por endocarditis infecciosa. Ámbito: Hospital Universitario Nuestra Señora de Candelaria, centro con 824 camas y población asignada de 493.145 personas. Pacientes: Todos los pacientes diagnosticados de endocarditis siguiendo los criterios de Duke entre el 1 de enero de 2005 y el 31 de julio de 2011. Variables de interés: Variables demográficas, clínicas, scores de gravedad, hallazgos microbiológicos y ecocardiográficos, mortalidad intrahospitalaria y complicaciones. Resultados: De 102 pacientes diagnosticados de endocarditis, 38 (37%) ingresaron en Medicina Intensiva. Comparándolos con los que no lo hicieron, sufrieron con más frecuencia afectación mitral (OR= 7,13; IC del 95%, 2,12-24; p= 0,002) y embolia cerebral (OR= 3,89; IC del 95%, 1,06-14,3; p= 0,041). La mortalidad fue mayor (42,1 vs 18,8%, p= 0,011), así como la proporción de cirugías urgentes (45,8 vs 5,9%, p

Objectives To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis. Methods Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable. Results The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1-10.5), but these patients accounted for 56.6% (95% CI = 47.4-65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9-36.0) for in-hospital death, and 51.4% (95% CI = 44.8-58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3-53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8-31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9-8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2-18.1) for in-hospital death at the highest severity level. Conclusions The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.

Introduccion y objetivos Hay poca informacion sobre la evolucion clinica y funcional de los pacientes con insuficiencia cardiaca secundaria a miocardiopatia dilatada de origen hipertensivo. Los objetivos de nuestro trabajo son estudiar la evolucion clinica y funcional de estos pacientes, asi como identificar los posibles factores predictores de esta evolucion. Pacientes y metodo Para ello, hemos evaluado a una serie de 57 pacientes diagnosticados en nuestro centro entre 1994 y 2003 con dicho problema. La edad media de los pacientes fue de 63 ± 11 anos, y el 40% eran mujeres. La fraccion de eyeccion ventricular izquierda era del 30,1 ± 4,8%. El tiempo de seguimiento fue de 45 ± 23 meses (mediana, 41 meses). Resultados La supervivencia a los 4 anos fue 0,84, la tasa de reingresos por insuficiencia cardiaca, 0,12 y la supervivencia libre de reingresos, 0,80. La fraccion de eyeccion aumento desde el 30,1 ± 4,8% hasta el 57,6 ± 13,5% (p Conclusiones La evolucion de los pacientes con miocardiopatia dilatada hipertensiva severa es buena en el 60% de los casos. El control de la presion arterial fue el unico predictor independiente de buena evolucion clinica.

Congenital anomalies of coronary arteries are a group of diseases that are infrequently found. Their prevalence has been reported from 0.6% to 1.3%. Most clinical manifestations are benign and asymptomatic. Congenital absence of the left circumflex artery is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report a case of a 51-year-old man who underwent a cardiac catheterisation. Coronary angiography showed a left anterior descending coronary artery with no circumflex and a dominant right coronary artery.

Resumen Fundamento y objetivo La cocaina esta directamente relacionada con la aparicion de sindrome coronario agudo (SCA). Analizamos las caracteristicas diferenciales de los consumidores que presentan un SCA en nuestro medio. Material y metodos Estudio retrospectivo de 914 pacientes con SCA que ingresaron de forma consecutiva en nuestro hospital. Resultados Un total de 34 pacientes refirieron ser consumidores (3,7%, intervalo de confianza del 95% [IC del 95%], 2,7–5,2), con edad media (desviacion estandar [DE]) de 40,1 (9,1) anos, significativamente menor que en los no consumidores (63,6 [12,15] anos; p Conclusiones El enfermo con SCA y consumidor de cocaina es generalmente un varon joven, que con frecuencia consume otras drogas y con una menor prevalencia de factores de riesgo clasico, datos a tener en cuenta a la hora de tomar medidas preventivas y terapeuticas.

The patient was a 32 year old male of Moroccan origin, diagnosed with Behcet’s disease 2 years earlier after suffering cerebral venous thrombosis. During that episode, oral and painful genital ulcers had appeared and oral anticoagulation with acenocoumarol was started. He came to the emergency room due to persistent and oppressive chest pain with ST segment elevation in the precordial leads, so we decided to perform emergency coronary angiography which revealed the existence of a stenosis of the distal left main coronary artery, which communicated through a narrow passage with a cavity which in turn compressed the proximal left anterior descending artery, occluding it (Fig. 1A and B). The patient underwent urgent cardiac surgery, demonstrating the presence of a pseudoaneurysm with fresh thrombi inside (Fig. 1C and D). CABG was performed with off-pump mammary arteries. Currently, the patient has moderate left ventricular systolic dysfunction and is in functional class II of the New York Heart Association.

An 83-year-old woman with a suspected coronary atherosclerotic disease in the setting of severe left ventricular dysfunction underwent a coronary angiography at our institution. Prior to catheterisation, Allen test was performed, which showed normal bilateral circulation. Using a 5 Fr catheter sheath through the right radial artery, we found a guide wire blockage at the axillary artery level. Recanalisation of prior arterial occlusion with collateral …

To assess possible differences in clinical presentation, microbiology, morbidity and mortality of infective endocarditis between two Spanish hospitals, one on the mainland that has cardiac surgery and one in the Canary Islands without this service.A total of 229patients consecutively diagnosed of endocarditis between 2005 and 2012, including pediatric population, were studied in the Reina Sofía Hospital (Córdoba, n=119) and Nuestra Señora de Candelaria Hospital (Tenerife, n=110). We compared the clinical, microbiological and echocardiographic data and analyzed mortality differences by binary logistic regression analysis.There were no differences in underlying heart disease, proportion of surgery, or the microbiological profile. The proportion of infections attributable to catheter was higher in the Canary Islands hospital (13.6% vs 3.4%). Mortality was also higher (31.8% vs 18.5%, P=.020), although this difference was no longer significant in the multivariate analysis (OR=1.85; 95%CI, 0.70-4.87; P=.213). Age (OR=1.04/year; 95%CI, 1.01-1.07; P=.006), cardiac complications (OR=5.05; 95%CI, 1.78-14.34; P=.002), persistent sepsis (OR=4.89; 95%CI, 2.09-11.46; P.001), and emergent surgery (OR=4.43, 95%CI, 1.75-11.19; P=.002) were independent predictors of death. Time to surgery, length of stay in the hospital without a surgical service (20 [13-30.5] vs 13 [6-25] days; P=.019) was not associated with outcome.There are differences in the presentation of endocarditis between two distant hospitals in Spain. The different hospital mortality can not be directly related to the presence of a surgery service.

Objetivo: Conocer las características, evolución y pronóstico de los pacientes con endocarditis infecciosa que requieren tratamiento en la Unidad de Medicina Intensiva. Diseño: Estudio observacional de cohortes prospectivo en pacientes ingresados por endocarditis infecciosa. Ámbito: Hospital Universitario Nuestra Señora de Candelaria, centro con 824 camas y población asignada de 493.145 personas. Pacientes: Todos los pacientes diagnosticados de endocarditis siguiendo los criterios de Duke entre el 1 de enero de 2005 y el 31 de julio de 2011. Variables de interés: Variables demográficas, clínicas, scores de gravedad, hallazgos microbiológicos y ecocardiográficos, mortalidad intrahospitalaria y complicaciones. Resultados: De 102 pacientes diagnosticados de endocarditis, 38 (37%) ingresaron en Medicina Intensiva. Comparándolos con los que no lo hicieron, sufrieron con más frecuencia afectación mitral (OR= 7,13; IC del 95%, 2,12-24; p= 0,002) y embolia cerebral (OR= 3,89; IC del 95%, 1,06-14,3; p= 0,041). La mortalidad fue mayor (42,1 vs 18,8%, p= 0,011), así como la proporción de cirugías urgentes (45,8 vs 5,9%, p

The N-terminal brain natriuretic peptide (NT-proBNP) is a new tool for the diagnosis of patients with evidence of heart failure (HF). The diagnosis of HF is improbable in patients with a level of NT-proBNP300 pg/ml. Our objective is to determine the validity of the cut-off points proposed by literature (inclusion/exclusion) regarding the age for NT-proBNP in patients admitted to our service.We gathered consecutively the data of 76 patients admitted to our service with the diagnosis of HF (n=37) and with other diseases (n=39), taking a sample of plasma to determine NT-proBNP. We studied the sensitivity, specificity and predictive values of this test, as well as the relation between the levels of that marker and the clinical and echocardiographic variables.The ventricular diameter was larger and the ejection fraction was lower in patients with HF. Sensitivity for the diagnosis of exclusion reached a value of 97% and the negative predictive value was 94%.The cut-off point proposed for exclusion (300 pg/ml) shows high sensitivity and negative predictive value in the diagnosis of HF in patients admitted to our service.

Cocaine is directly related to the occurrence of acute coronary syndromes (ACS). We analyzed the differential characteristics of consumers who suffer an ACS in our environment.A retrospective study of 914 patients with ACS who entered consecutively to our hospital.Thirty four patients were consumers (3.7%, CI95%: 2.7-5.2), with an average age of 40.1+/-9.1 years, significantly lower than non-consumers (63.6+/-12.15 years, P.001). The prevalence increased progressively in younger groups. Most were men (82.4%), with higher consumption of tobacco (88.2% vs. 34.2%, P.001) and other illegal drugs (35.3% vs 0.9%, P.001). By contrast, they had less frequently hypertension (26.5 vs. 60.5%, P.001) or diabetes (11.7 vs. 39.8%, P.001). There was single vessel disease in 44.1%, and a coronary angiography without significant lesions in 20.6% cases.The typical patient with ACS who consumes cocaine is usually a young man, who often takes other drugs and with a lower prevalence of classic risk factors. These data have to be taken into account when considering preventive and therapeutic manoeuvres.

Introduction and objectives. There is little information on the clinical and functional course of patients with heart failure secondary to dilated cardiomyopathy due to hypertension. The objectives of our study were to assess the clinical and functional course of these patients, and to identify possible predictors of prognosis. Patiens and method. We evaluated a series of 49 patients with this condition diagnosed in our hospital from 1994 to 2003. Mean age was 63 (11) years, and 40% were women. Left ventricular ejection fraction was 30.1 (4.8)%. Follow-up was 45 (23) months (median, 41 months). Results. Four-year survival was 0.84, the 4-year rate of hospitalization due to heart failure was 0.12, and likelihood of readmission-free survival was 0.80 at 4 years. Left ventricular ejection fraction increased from 30.1 (4.8)% to 57.6 (13.5)% (P

Fundamento y objetivo El fragmento N-terminal del propeptido natriuretico cerebral o tipo B (NT-proBNP) se utiliza para el diagnostico de pacientes con sospecha de insuficiencia cardiaca (IC). Los valores de NT-proBNP inferiores a 300 pg/ml indican un diagnostico improbable de IC. Nuestro objetivo ha sido determinar la validez de los puntos de corte del NT-proBNP segun la edad, propuestos en la bibliografia medica (inclusion/exclusion), en los pacientes ingresados en nuestro servicio. Pacientes y metodo Hemos recogido de forma prospectiva los datos de 90 pacientes que ingresaron en nuestro servicio con diagnostico de IC (n = 37) y de otras enfermedades (n = 39), y en quienes se determino la concentracion de NT-proBNP. Se estudiaron la sensibilidad, la especificidad y los valores predictivos de este analisis, asi como la relacion de los valores de dicho marcador con las variables clinicas y ecocardiograficas. Resultados En los pacientes con IC el diametro ventricular era mayor y la fraccion de eyeccion, menor. La sensibilidad para el diagnostico de exclusion fue del 97% y el valor predictivo negativo, del 94%. Conclusiones El punto de corte de exclusion ropuesto (300 pg/ml) posee una alta sensibilidad y valor predictivo negativo para el diagnostico de IC en los pacientes ingresados en nuestro servicio.