Prevalencia y valor diagnóstico de ondas Q, ondas T negativas y duración del QRS, en pacientes con Miocardiopatía Hipertrófica y con hipertrofia ventricular y relación entre las técnicas de imagen en el diagnóstico de estas entidades

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 5-07-201

The role of bioimpedance analysis in overweight and obese patients with acute heart failure: a pilot study.

AIMS Residual congestion at the time of hospital discharge is an important readmission risk factor, and its detection with physical examination and usual diagnostic techniques have strong limitations in overweight and obese patients. New tools like bioelectrical impedance analysis (BIA) could help to determine when euvolaemia is reached. The aim of this study was to investigate the usefulness of BIA in management of heart failure (HF) in overweight and obese patients. METHODS AND RESULTS Our study is a single-centre, single-blind, randomized controlled trial that included 48 overweight and obese patients admitted for acute HF. The study population was randomized into two arms: BIA-guided group and standard care. Serum electrolytes, kidney function, and natriuretic peptides were followed up during their hospital stay and at 90 days after discharge. The primary endpoint was development of severe acute kidney injury (AKI) defined as an increase in serum creatinine by >0.5 mg/dL during hospitalization, and the main secondary endpoint was the reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during hospitalization and within 90 days after discharge. The BIA-guided group showed a remarkable lower incidence of severe AKI, although no significant differences were found (41.4% vs. 16.7%; P = 0.057). The proportion of patients who achieved levels of NT-proBNP < 1000 pg/mL at 90 days was significantly higher in the BIA-guided group than in the standard group (58.8% vs. 25%; P = 0.049). No differences were observed in the incidence of adverse outcomes at 90 days. CONCLUSIONS Among overweight and obese patients with HF, BIA reduces NT-proBNP levels at 90 days compared with standard care. In addition, there is a trend towards lower incidence of AKI in the BIA-guided group. Although more studies are required, BIA could be a useful tool in decompensated HF management in overweight and obese patients.This research received no external funding.S

NT-proBNP Levels Influence the Prognostic Value of Mineral Metabolism Biomarkers in Coronary Artery Disease

Background. Mineral metabolism (MM) system and N-terminal pro-brain natriuretic peptide (NT-ProBNP) have been shown to add prognostic value in patients with stable coronary artery disease (SCAD). However, the influence of NT-ProBNP on the prognostic role of MM in patients with SCAD has not been shown yet. The objective of this study is to assess the influence of NT-ProBNP on the prognostic role of MM markers in patients with SCAD. Methods: We analyzed the prognostic value of MM markers (parathormone (PTH), klotho, phosphate, calcidiol (25-hydroxyvitamin D3), and fibroblast growth factor-23) in 964 patients with SCAD and NT-ProBNP &gt; 125 pg/mL vs. patient with NT-ProBNP &le; 125 pg/mL included in five hospitals in Spain. The main outcome was the combination of death, heart failure, and ischemic events (any acute coronary syndrome, ischemic stroke, or transient ischemic attack). Results: A total of 622 patients had NT-proBNP &gt; 125 pg/mL and 342 patients had NT-ProBNP &le; 125 pg/mL. The median follow-up was 5.1 years. In the group of NT-proBNP &gt; 125 pg/mL, the patients were older, and there were more females and smokers than in the group of patients with normal NT-proBNP. Additionally, the proportion of patients with hypertension, atrial fibrillation, ejection fraction &lt; 40%, cerebrovascular attack, or prior coronary artery bypass graft was higher in the high NT-proBNP group. In the high NT-proBNP patients, the predictors of poor prognosis were PTH (HR = 1.06 (1.01&ndash;1.10), p &lt; 0.001) and NT-proBNP (HR = 1.02 (1.01&ndash;1.03), p = 0.011), along with age (HR = 1.039 (1.02&ndash;1.06), p &lt; 0.001), prior coronary artery bypass graft (HR = 1.624 (1.02&ndash;2.59), p = 0.041), treatment with statins (HR = 0.32 (0.19&ndash;0.53), p &lt; 0.001), insulin (HR = 2.49 (1.59&ndash;4.09), p &lt; 0.001), angiotensin receptor blockers (HR = 1.73 (1.16&ndash;2.56), p = 0.007), nitrates (HR = 1.65 (1.10&ndash;2.45), p = 0.014), and proton pump inhibitors (HR = 2.75 (1.74&ndash;4.36), p &lt; 0.001). In the NT-proBNP &le; 125 pg/mL subgroup, poor prognosis predictors were plasma levels of non-high-density lipoprotein (non-HDL) cholesterol (HR = 1.01 (1.00&ndash;1.02), p = 0.014) and calcidiol (HR = 0.96 (0.92&ndash;0.99), p = 0.045), as well as treatment with verapamil (HR = 11.28 (2.54&ndash;50.00), p = 0.001), and dihydropyridines (HR = 3.16 (1.63&ndash;6.13), p = 0.001). Conclusion: In patients with SCAD and NT-ProBNP &gt; 125 pg/mL, PTH and NT-ProBNP, which are markers related to ventricular damage, are predictors of poor outcome. In the subgroup of patients with NT-ProBNP &le; 125 pgm/L, calcidiol and non-HDL cholesterol, which are more related to vascular damage, are the independent predictors of poor outcome. Then, in patients with SCAD, baseline NT-ProBNP may influence the type of biomarker that is effective in risk prediction