Clinico-pathologic case: male with myocardiopathy and rapidly progressive cardiac failure

Se presenta el caso de un varón de 66 años, sin alergias medicamentosas conocidas. Fumó durante más de 40 años, actualmente exfumador. Sin antecedentes familiares de patología cardíaca- En diciembre de 2011 presenta disnea progresiva a los moderados- mínimos esfuerzos que le obliga a acudir en diversas ocasiones a los servicios de urgencias. Se le diagnostica de neumonía del lóbulo medio del pulmón derecho e inicia tratamiento antibiótico empírico. El paciente acude recientemente a Urgencias por edema en miembros inferiores y aumento de peso. Tras ingresar, la evolución inicial es buena y muestra mejora de la disnea y reducción del edema. Se realiza una prueba específica que proporciona el diagnóstico y se inicia el tratamiento correspondiente. El caso se presenta en el foro de las sesiones clinicopatológicas del Hospital Son EspasesThe case is that of a 66 year old male, with no known drug allergies. He is an ex smoker for over 40 years. He has no family history of heart disease. In December/2011 he present with progressive dyspnea at moderate-small efforts and is admitted several times to the ER. He is diagnosed with right middle lobe pneumonia, and an empiric antibiotic treatment is started. The patient is recently admitted to the ER for increased edema of the lower limbs and weight gain. After admission, the initial evolution is good, showing improvement of his dyspnea and reduction of the edema. An specific test is ordered that provides a diagnosis and treatment is established accordingly. The case is discussed in the context of a clinico-pathologic general session at Hospital Son Espase

A 3-biomarker 2-point-based risk stratification strategy in acute heart failure

[Abstract] Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715–0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747–0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.Instituto de Salud Carlos III; RD06-0003-0000Instituto de Salud Carlos III; RD12/0042/000

Caso clínicopatológico: Varón con miocardiopatía e insufiencia cardiaca rápidamente progresiva

The case is that of a 66 year old male, with no known drug allergies. He is an ex smoker for over 40 years. He has no family history of heart disease. In December/2011 he present with progressive dyspnea at moderate-small efforts and is admitted several times to the ER. He is diagnosed with right middle lobe pneumonia, and an empiric antibiotic treatment is started. The patient is recently admitted to the ER for increased edema of the lower limbs and weight gain. After admission, the initial evolution is good, showing improvement of his dyspnea and reduction of the edema. An specific test is ordered that provides a diagnosis and treatment is established accordingly. The case is discussed in the context of a clinico-pathologic general session at Hospital Son EspasesSe presenta el caso de un varón de 66 años, sin alergias medicamentosas conocidas. Fumó durante más de 40 años, actualmente exfumador. Sin antecedentes familiares de patología cardíaca- En diciembre de 2011 presenta disnea progresiva a los moderados- mínimos esfuerzos que le obliga a acudir en diversas ocasiones a los servicios de urgencias. Se le diagnostica de neumonía del lóbulo medio del pulmón derecho e inicia tratamiento antibiótico empírico. El paciente acude recientemente a Urgencias por edema en miembros inferiores y aumento de peso. Tras ingresar, la evolución inicial es buena y muestra mejora de la disnea y reducción del edema. Se realiza una prueba específica que proporciona el diagnóstico y se inicia el tratamiento correspondiente. El caso se presenta en el foro de las sesiones clinicopatológicas del Hospital Son Espase