A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted

Coexisting ecosystem states in a tropical coastal lagoon under progressive eutrophication in the northern Cuban keys

Through a nested suite of methods here we contrast the coexistence of different ecosystem states in a tropical coastal lagoon, the Laguna Larga, with increasing eutrophication stress between 2007 and 2009. Water temperature averaged 27.4°C in the lagoon and showed a slight positive trend during the study period. Salinity averaged 35.0±6.2, exhibiting high spatial and temporal variability, and also a slight positive trend in time. In contrast, dissolved oxygen showed a substantial decreasing trend (–0.83 ml L–1 y–1; –13.3% y–1) over the period, while nutrients increased dramatically, particularly total phosphorus (2.6 µM y–1), in both cases sustaining the progression of eutrophication in the lagoon during the three years we sampled. The Karydis nutrient load-based trophic index showed that the lagoon has a spatial pattern of increasing eutrophication from the sea and the outer sector (oligotrophic-mesotrophic) to the central (mesotrophic) and the inner sector (mesotrophic-eutrophic). Two ecosystem states were found within the lagoon. In the outer oligotrophic sector, the dominant primary producers were macroalgae, seagrasses and benthic diatoms, while mollusc assemblages were highly diverse. In the inner and central sectors (where trophic status increased toward the inner lagoon) a phytoplankton-dominated ecosystem was found where mollusc assemblages are less diverse. In spite of the progression of eutrophication in the lagoon, these two different ecosystems coexisted and remained unchanged during the study period. Apparently, the effect of water residence time, which increases dramatically toward the inner lagoon, dominated over that of nutrient loadings, which is relatively more homogeneously distributed along the lagoon. Therefore, we consider that actions that reduce the water residence time are likely the most effective management options for this and other similarly choked lagoons

Implante del cardiodesfibrilador automático: Registro en Cuba (2017)

Introduction: The implantable cardioverter-defibrillator (ICD) has proven useful in the primary and secondary prevention of sudden cardiac death. The increase of its use motivates interest on its effectiveness outside the clinical trials. The first registration of an ICD implantation in Cuba is performed.Objective: To know the current situation of an ICD implantation in Cuba, regarding clinical data, indication, type of implant, device and complications of the procedure.Method: The registration’s data were obtained through the collection form, which was completed voluntarily by each implantation team during or after the implant.Results: The total number of implants was 121, and the rate of 10.76 per million inhabitants. The procedure was performed in 5 medical institutions in the country, and 69.4% of the devices were implanted at the «Instituto de Cardiología y Cirugía Cardiovascular». The mean age was 58.05 ± 14.83, with a predominance of men (71.1%). The 52.1% were primo-implantation, dual-chamber devices represented 43.8% and triple-chamber 16.5%. In the primoimplants predominated patients with ejection fraction ≤35% (42.9%), in sinus rhythm (92.1%), with functional class III-IV (49.2%) and ischemic heart disease (41.3%). The 79.4% of the first implants were secondary prevention, and sudden death (42.9%), the most common clinical presentation. Complications were infrequent (4.1%) and the hematoma predominated.Conclusions: The implantation rate of the ICD per million inhabitants is comparable with that of Latin American countries. The implants of triple-chamber systems and in primary prevention are still modest.Introducción: El cardiodesfibrilador automático implantable (CDAI) ha demostrado utilidad en la prevención primaria y secundaria de la muerte súbita cardíaca. El incremento de su utilización motiva interés sobre su eficacia fuera de los ensayos clínicos. Se realiza el primer registro del implante de CDAI en Cuba.Objetivo: Conocer la situación actual del implante de CDAI en Cuba, respecto a datos clínicos, indicación, tipo de implante, de dispositivo y complicaciones del procedimiento.Método: Los datos del registro se obtuvieron a través de la planilla de recolección, que fue cumplimentada de forma voluntaria por cada equipo implantador durante o después del implante. Resultados: El número de implantes fue 121 y la tasa de 10,76 por millón de habitantes. El procedimiento se realizó en 5 instituciones médicas del país, y en el Instituto de Cardiología y Cirugía Cardiovascular se implantó el 69,4% de los dispositivos. La media de la edad fue de 58,05±14,83, con predominio de hombres (71,1%). El 52,1% fue primoimplante, los dispositivos bicamerales representaron el 43,8% y los tricamerales el 16,5%. En los primoimplantes predominaron los pacientes con fracción de eyección ≤35% (42,9%), en ritmo sinusal (92,1%), con clase funcional III-IV (49,2%) y cardiopatía isquémica (41,3%). El 79,4% de los primoimplantes fue prevención secundaria, y la muerte súbita (42,9%), la forma clínica de presentación más común. Las complicaciones fueron infrecuentes (4,1%) y predominó el hematoma.Conclusiones: La tasa de implante del CDAI por millón de habitantes es comparable con los países de américa latina. Los implantes de sistemas tricamerales y en prevención primaria son aún modestos