Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction

<p><b>Background:</b> The purpose of this study was to examine the prevalence of abnormalities in cardiac structure and function present in patients with heart failure and a preserved ejection fraction (HFPEF) and to determine whether these alterations in structure and function were associated with cardiovascular morbidity and mortality.</p> <p><b>Methods and Results:</b> The Irbesartan in HFPEF trial (I-PRESERVE) enrolled 4128 patients; echocardiographic determination of left ventricular (LV) volume, mass, left atrial (LA) size, systolic function, and diastolic function were made at baseline in 745 patients. The primary end point was death or protocol-specific cardiovascular hospitalization. A secondary end point was the composite of heart failure death or heart failure hospitalization. Associations between baseline structure and function and patient outcomes were examined using univariate and multivariable Cox proportional hazard analyses. In this substudy, LV hypertrophy or concentric remodeling was present in 59%, LA enlargement was present in 66%, and diastolic dysfunction was present in 69% of the patients. Multivariable analyses controlling for 7 clinical variables (including log N-terminal pro-B–type natriuretic peptide) indicated that increased LV mass, mass/volume ratio, and LA size were independently associated with an increased risk of both primary and heart failure events (all P<0.05).</p> <p><b>Conclusions:</b> Left ventricular hypertrophy or concentric remodeling, LA enlargement, and diastolic dysfunction were present in the majority of patients with HFPEF. Left ventricular mass and LA size were independently associated with an increased risk of morbidity and mortality. The presence of structural remodeling and diastolic dysfunction may be useful additions to diagnostic criteria and provide important prognostic insights in patients with HFPEF.</p&gt

Hydrochlorothiazide Is Superior to Isradipine for Reduction of Left Ventricular Mass: Results of a Multicenter Trial fn1fn1This study was supported by an unrestricted grant from Sandoz Pharmaceuticals, East Hanover, New Jersey.fn2fn2To discuss this article on-line, visit the ACC Home Page at http://www.acc.org/membersand click on the JACC Forum

AbstractObjectives. We sought to determine the efficacy of isradipine in reducing left ventricular (LV) mass and wall thickness in hypertensive patients.Background. LV hypertrophy on the echocardiogram is a strong predictor of cardiovascular events. Reduction of LV mass may be a desirable goal of drug therapy for hypertension. However, although thiazide diuretic drugs have been advocated as first-line therapy for hypertension, their efficacy in reducing LV mass has been questioned.Methods. Patients with mild to moderate diastolic hypertension and LV mass in excess of 1 SD of normal values were randomized to isradipine (n = 89) or hydrochlorothiazide therapy (n = 45). Evaluations were obtained at baseline, after 3 and 6 months of treatment and 2 weeks after treatment was stopped.Results. At 6 months, LV mass decreased by 43 ± 45 g (mean ± SD) with hydrochlorothiazide (p < 0.001) but only by 11 ± 48 g with isradipine (p = NS; between-group comparison, p < 0.001). Two weeks after drug therapy was stopped, LV mass remained 24 ± 41 g lower than that at baseline in the hydrochlorothiazide group (p = 0.003) but only 7 ± 50 g lower in the isradipine group (p = NS). Septal and posterior wall thicknesses were significantly and equally reduced with both isradipine and hydrochlorothiazide. Greater LV mass reduction with hydrochlorothiazide was related to a 2.8 ± 3.3-mm reduction of LV cavity size with hydrochlorothiazide but no reduction with isradipine. At 6 months of treatment, diastolic blood pressure (BP) by design was equally reduced in both treatment groups. At 3 months, systolic BP was reduced by 17 ± 15 mm Hg with isradipine and by 26 ± 15 and 25 ± 17 mm Hg at 3 and 6 months, respectively, with hydrochlorothiazide (p = 0.003, between-group comparison). However, on stepwise multivariable regression analysis, treatment selection (partial r2= 0.082, p = 0.001), change in average 24-h systolic BP (partial r2= 0.032, p = 0.029) and change in average sitting systolic BP (partial r2= 0.017, p = 0.096) were predictive of LV mass reduction.Conclusions. Despite an equivalent reduction of diastolic BP, 6 months of therapy with hydrochlorothiazide is associated with a substantial reduction of LV mass, greater than that with isradipine. The superior efficacy of hydrochlorothiazide for LV mass reduction is associated with a greater reduction of systolic BP as well as drug selection itself. These data may have important therapeutic implications

Sistema de evaluación de riesgo y prevención de abandono escolar en el nivel de estudios superiores

En un trabajo anterior (Gottdiener, 2002) se abordó el problema de la elevada reprobación de ciertas materias entre los estudiantes de la carrera de física de la Facultad de Ciencias y se mencionaron algunas de sus causas. Aquí se trata la cuestión del abandono de manera más integral y se propone la construcción de un sistema de evaluación de riesgo y acción que busca reducir el abandono y consta de cuatro pasos esenciales: 1) Definir cuántos y cuáles parámetros se usarán como predictores del abandono. 2) Con base en ellos, determinar una probabilidad de abandono Pa para un estudiante dentro de un lapso determinado de tiempo futuro. 3) Obtener los valores de los parámetros establecidos en (1) para cada estudiante, a fin de calcular las Pa(i) correspondientes, donde i designa a un estudiante dado. 4) Definir las medidas remediales que se pondrán en práctica para un estudiante cuando su Pa exceda de cierto límite L. Cada uno de los pasos (1) - (4) anteriores presenta problemas en su implementación. La selección de los parámetros en (1) no es evidente, y se proponen algunas posibilidades. Los parámetros pueden estar basados en datos que la institución ya posee, o bien requerir de una ampliación de sus bases de datos. El paso (2) tampoco es inmediato, y una posibilidad es usar los datos de abandono disponibles para proponer relaciones tentativas con los predictores. En cuanto a la etapa (4), requerirá primeramente de un diagnóstico de cada estudiante de alto riesgo detectado, y después la aplicación de acciones remediales que sean viables dados sus costos y las posibilidades de la institución. Se comentan algunas acciones factibles, y un punto de discusión será si éstas deberán ser obligatorias para el estudiante o no. Finalmente, al cabo de varios semestres de aplicar (1) - (4) se podrán realizar los pasos últimos: 5) establecer el impacto que están teniendo las medidas remediales, y 6) realizar los ajustes necesarios en todas las etapas anteriores. Adicionalmente, de la información generada en (3) podrían detectarse dificultades relacionadas no con alumnos individuales, sino con los planes de estudio de cada carrera

A Comparative Study of Twenty Patients Who Returned Within Six Months, and Twenty Patients Who Remained Out Two Years or More.

Thesis (M.S.)--Boston Universit

NT -pro BNP as a Mediator of the Racial Difference in Incident Atrial Fibrillation and Heart Failure.

Background Blacks harbor more cardiovascular risk factors than whites, but experience less atrial fibrillation ( AF ). Conversely, whites may have a lower risk of heart failure ( CHF ). N-terminal pro-B-type natriuretic peptide ( NT -pro BNP) levels are higher in whites, predict incident AF , and have diuretic effects in the setting of increased ventricular diastolic pressures, potentially providing a unifying explanation for these racial differences. Methods and Results We used data from the CHS (Cardiovascular Health Study) to determine the degree to which baseline NT -pro BNP levels mediate the relationships between race and incident AF and CHF by comparing beta estimates between models with and without NT -pro BNP . The ARIC (Atherosclerosis Risk in Communities) study was used to assess reproducibility. Among 4731 CHS (770 black) and 12 418 ARIC (3091 black) participants, there were 1277 and 1253 incident AF events, respectively. Whites had higher baseline NT -pro BNP ( CHS : 40% higher than blacks; 95% CI , 29-53; ARIC : 39% higher; 95% CI , 33-46) and had a greater risk of incident AF compared with blacks ( CHS : adjusted hazard ratio, 1.60; 95% CI , 1.31-1.93; ARIC : hazard ratio, 1.93; 95% CI , 1.57-2.27). NT -pro BNP levels explained a significant proportion of the racial difference in AF risk ( CHS : 36.2%; 95% CI , 23.2-69.2%; ARIC : 24.6%; 95% CI , 14.8-39.6%). Contrary to our hypothesis, given an increased risk of CHF among whites in CHS (adjusted hazard ratio, 1.20; 95% CI , 1.05-1.47) and the absence of a significant association between race and CHF in ARIC (adjusted hazard ratio, 1.07; 95% CI , 0.94-1.23), CHF -related mediation analyses were not performed. Conclusions A substantial portion of the relationship between race and AF was statistically explained by baseline NT -pro BNP levels. No consistent relationship between race and CHF was observed

Estudio de los enfoques de enseñanza en docentes de educación media y superior de la región citrícola en el estado de Nuevo León.

El profesorado es el bastión de la educación, tanto pública como privada, ya que son los docentes quienes forman el referente que tendrá el educando durante el proceso de aprendizaje que vive a lo largo de su etapa formativa. Este estudio busca conocer la forma en que los docentes comparten el conocimiento con sus alumnos, pues, existen investigaciones que demuestran la relación existente entre el aprendizaje y la forma en que los profesores transmiten la información. El objetivo fue analizar los enfoques de enseñanza imperantes en los profesores del nivel medio y superior en la Región Citrícola del Estado de Nuevo León. Como metodología se utilizó el ATI (Approaches to Teaching Inventory) en su versión adaptada al español (Monroy Hernández, 2013) y se analizó la muestra en general, en función del sexo, por nivel educativo de desempeño y por su experiencia docente. Resultados: Se encontró que el grueso de la población entrevistada tiende hacia los enfoques centrados en el profesor y no hacia el estudiante. Conclusiones: Este estudio de caso, permitió conocer los enfoques de enseñanza imperantes entre los profesores de la Región Citrícola, dejando así la pauta para futuras investigaciones que lleven a las Instituciones formadoras a que busquen estrategias para modelar al profesorado buscando transformar los enfoques de enseñanza. Palabras clave: enfoques de enseñanza, Región Citrícola, Nuevo León, enfoques centrados en el profesor