Masa en aurícula derecha

A 61 year-old man, with previous history of ischemic heart disease and atrial fibrillation was admitted due to shortness of breath, being a right atrium mass detected by echocardiography.Varón de 61 años con antecedentes de cardiopatía isquémica y fibrilación auricular que ingresa por insuficiencia cardíaca. En el estudio ecocardiográfico se detecta una masa en la aurícula derecha

Long term clinical outcomes in survivors after out-of-hospital cardiac arrest

Introduction and objectives: Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events. Methods: Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up. Results: A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9–69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578–7.777)], non-shockable rhythm [HR 2.926 (1.390–6.163)], time to onset of CPR [HR 1.063 (0.997–1.134)], older age [1.036 (1.008–1.064)) and worse ejection fraction at discharge [1.033 (1.009–1.058)]. Conclusions: Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of car

Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications

Aims: Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization. Methods and results: Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality. Conclusions: Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortalit

Outpatient Parenteral Antibiotic Treatment vs Hospitalization for Infective Endocarditis: Validation of the OPAT-GAMES Criteria

Abstract Background Outpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used. Methods This was a prospective multicenter nationwide cohort study (2008–2018). Rates of readmission, recurrences, and 1-year mortality were compared between hospital-based antibiotic treatment (HBAT) and OPAT. Risk factors for readmission and mortality in OPAT patients were investigated by logistic regression. Patients did not fulfill OPAT-GAMES (Grupos de Apoyo al Manejo de la Endocarditis en ESpaña) criteria if they had any of the following: cirrhosis, severe central nervous system emboli, undrained abscesses, severe conditions requiring cardiac surgery in nonoperable patients, severe postsurgical complications, highly difficult-to-treat microorganisms, or intravenous drug use. Results A total of 2279 HBAT patients and 1268 OPAT patients were included. Among OPAT patients, 307 (24.2%) did not fulfill OPAT-GAMES criteria. Overall, OPAT patients presented higher rates of readmission than HBAT patients (18.2% vs 14.4%; P = .004), but no significant differences were found in the propensity analysis. Patients not fulfilling OPAT-GAMES criteria presented significantly higher rates of readmission than HBAT and OPAT-GAMES (23.8%, 14.4%, 16.4%; P &amp;lt; .001), whereas no significant differences were found in mortality (5.9%, 8%, 7.4%; P = .103) or recurrences (3.9%, 3.1%, 2.5%; P = .546). Not fulfilling OPAT-GAMES criteria was associated with higher risk of readmission (odds ratio [OR], 1.43; 95% CI, 1.03–1.97; P = .03), whereas cardiac surgery was associated with lower risk (OR, 0.72; 95% CI, 0.53–0.98; P = .03). Conclusions OPAT-GAMES criteria allow identification of IE patients at higher risk of long-term complications to whom OPAT cannot be safely administered. </jats:sec

A debate: El ECMO en pacientes con shock cardiogénico por infarto de miocardio. Perspectiva del clínico

PREGUNTA: ¿En qué pacientes con shock cardiogénico por infarto se está indicando actualmente el oxigenador extracorpóreo de mem- brana (ECMO) en su centro? RESPUESTA: En el proceso de toma de decisiones sobre qué pacientes se pueden beneficiar de un dispositivo de asistencia circulatoria tipo ECMO cuando ingresan por un infarto agudo de miocardio (IAM) que se complica con shock cardiogénico intervienen muchos factores. Los que hacen referencia a la gravedad del shock son cuantificables y se pueden identificar mediante una valoración clínica detallada, en conjunto con parámetros analíticos y hemodinámicos que se pueden obtener al ingreso mediante pruebas sencillas y accesibles incluso a pie de cama, como el ecocardiograma. Es en estos factores en los que el soporte con ECMO puede ejercer un efecto relevante (presión arterial media, niveles de lactato, ritmo de diuresis), constituyéndose como una terapia puente al tratamiento específico de la causa y la mejoría, o bien al implante de dispositivos de asistencia ventricular de larga duración o al trasplante cardiaco. Sin embargo, existen otros factores relevantes para el pronóstico general del paciente cuya interpretación debe ser lo más objetiva posible, y que ciertamente no podremos modificar mediante el uso de una asistencia circulatoria. Entre ellos destacan la edad..

Debate: ECMO in patients with cardiogenic shock due to myocardial infarction. A clinician’s perspective

QUESTION: In your center, which patients with cardiogenic shock due to myocardial infarction are currently considered candidates for extracorporeal membrane oxygenation (ECMO)? ANSWER: Several factors influence the decision to use an ECMO-type mechanical circulatory support device in patients admitted for acute myocardial infarction (AMI) complicated by cardiogenic shock. When we’re dealing with shock, we can quantify its severity through a detailed clinical assessment and by analyzing various hemodynamic parameters. These can be easily obtained at admission using straightforward imaging techniques like echocardiography, even at the bedside. Key factors such as mean arterial pressure, lactate levels, and urine output are crucial here. ECMO support can make a real difference in these cases, acting as a bridge therapy until we can treat the underlying cause, see improvement, or until we move to long-term ventricular assist devices or heart transplantation. However, it’s important to remember that some factors cannot be modified by mechanical circulatory support devices. These include the patient’s biological age, overall frailty, severe comorbidities, and the depth of coma following cardiac arrest. These elements should be assessed as objectively as possible because they play a significant role in determining the patient’s overall prognosis. In clinical practice, if we could focus purely on high hemodynamic..

Neumonía de inicio precoz y tardío en pacientes con parada cardíaca tratados con control de la temperatura corporal: Factores relacionados con el riesgo y el pronóstico

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de Lectura: 09-10-2023Esta tesis tiene embargado el acceso al texto completo hasta el 09-04-202