Absceso tricuspídeo abierto a pericardio. Una complicación excepcional de la endocarditis infecciosa

The case of a patient who develops tricuspid abscess as a complication of infective endocarditis is presented. This is an example of an exceptional complication in which for diagnosis usually need transesophageal echocardiography and requires surgery as treatment.Se presenta el caso de un paciente que desarrolla un absceso tricuspídeo como complicación de una endocarditis infecciosa. Éste es un ejemplo de una complicación excepcional en la que para el diagnóstico se suele necesitar una ecocardiografía  transesofágica y que precisa tratamiento con cirugía

Pulse wave velocity and arterial aging in subjects with and without type 2 diabetes mellitus

Introducción y Objetivos: La velocidad de onda de pulso (VOP) es un procedimiento para evaluar la rigidez arterial con utilidad pronostica cardiovascular. En este estudio comparamos la VOP entre sujetos con y sin Diabetes Mellitus tipo 2 (DM2) para conocer sus diferencias y cuáles son los factores que las ocasionan. Métodos y Materiales: Estudio de cohorte en 39 sujetos (12 con DM2 y 27 sin DM2). Después de reposo de 15 minutos, se midió en la arteria braquial en forma oscilométrica la VOP mediante dispositivo Mobil-O-Graph, y con dos tomas consecutivas se obtuvo el promedio. El valor obtenido se comparó contra los valores normales esperados de referencia de acuerdo con la edad. Se calculó la edad arterial aproximada. Se utilizó SPSS para Mac versión 24 para hacer los análisis y se consideró significancia estadística a una p<0.05. Resultados: Los sujetos con DM2 tuvieron mayor VOP que los sujetos sin DM2 (p=0.02); a mayor tiempo de evolución de la DM2 mayor fue la VOP (p=0.01). La correlación bivariada bilateral (correlación de Pearson) entre edad cronológica y edad arterial aproximada calculada por el Mobil-O-Graph fue 0,957 (p=0.00) y entre la VOP y la edad cronológica fue de 0,914 (p=0,000). Conclusiones: La VOP aumentada está relacionada con el tiempo de evolución de la DM2 y existió correlación positiva con la edad cronológica. Más estudios se necesitan para definir valores de referencia y de normalidad del VOP y debería ser una herramienta de evaluación cardiovascular en el sujeto con DM2.Introduction and Objectives: Pulse wave velocity (PWV) is a measure of arterial stiffness which has been used to determine cardiovascular prognosis. In this study, we compared PWV between patients with and without Diabetes Mellitus type 2 (DM2) in order to identify their differences and associated factors. Methods and Materials: This was a cohort study where 39 subjects were enrolled (12 with DM2 and 27 without DM2). PWV was measured in the brachial artery through oscillometry using a Mobil-O-Graph device after 15 minutes of rest. An average value was obtained from two consecutive measurements. We compared this measurement with the normal expected values of reference according to patient’s age. The approximate arterial age was also calculated. SPSS for Mac version 24 was used to make the analyzes and statistical significance was considered a p value <0.05. Results: Subjects with DM2 had higher PWV than subjects without DM2 (p = 0.02). Additionally, the longer time with DM2 a higher PWV was seen (p = 0.01). Bilateral bivariate correlation (Pearson correlation) between chronological age and approximate arterial age was 0.957 (p = 0.00) whereas between PWV and chronological age was 0.914 (p = 0.000). Conclusions: We concluded that higher levels of PWV are correlated to the time of evolution of DM2. PWV has also a positive correlation with chronological age. More studies with bigger populations are yet needed to determine reference and normal values of PWV, as it may be used as a tool for cardiovascular assessment in patients with DM2

La velocidad de onda de pulso y el envejecimiento arterial en sujetos con y sin diabetes mellitus tipo 2

Introducci&oacute;n y Objetivos: La velocidad de onda de pulso(VOP) es un procedimiento para evaluar la rigidez arterialcon utilidad pronostica cardiovascular. En este estudiocomparamos la VOP entre sujetos con y sin Diabetes Mellitustipo 2 (DM2) para conocer sus diferencias y cu&aacute;les sonlos factores que las ocasionan.M&eacute;todos y Materiales: Estudio de cohorte en 39 sujetos(12 con DM2 y 27 sin DM2). Despu&eacute;s de reposo de 15 minutos,se midi&oacute; en la arteria braquial en forma oscilom&eacute;tricala VOP mediante dispositivo Mobil-O-Graph, y condos tomas consecutivas se obtuvo el promedio. El valorobtenido se compar&oacute; contra los valores normales esperadosde referencia de acuerdo con la edad. Se calcul&oacute; laedad arterial aproximada. Se utiliz&oacute; SPSS para Mac versi&oacute;n24 para hacer los an&aacute;lisis y se consider&oacute; significancia estad&iacute;sticaa una p&lt;0.05.Resultados: Los sujetos con DM2 tuvieron mayor VOPque los sujetos sin DM2 (p=0.02); a mayor tiempo deevoluci&oacute;n de la DM2 mayor fue la VOP (p=0.01). La correlaci&oacute;nbivariada bilateral (correlaci&oacute;n de Pearson) entreedad cronol&oacute;gica y edad arterial aproximada calculadapor el Mobil-O-Graph fue 0,957 (p=0.00) y entre la VOP yla edad cronol&oacute;gica fue de 0,914 (p=0,000).Conclusiones: La VOP aumentada est&aacute; relacionada conel tiempo de evoluci&oacute;n de la DM2 y existi&oacute; correlaci&oacute;n positivacon la edad cronol&oacute;gica. M&aacute;s estudios se necesitanpara definir valores de referencia y de normalidad del VOPy deber&iacute;a ser una herramienta de evaluaci&oacute;n cardiovascularen el sujeto con DM2

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally