Implante percutáneo de la válvula autoexpandibleCerevalve en pacientes con estenosis aórtica severa y aorta en porcelana; seguimiento a medio plazo

El primero de los objetivos de este estudio es comparar las características clínicas, hemodinámicas, ecocardiográficas y propias, de dos grupos de pacientes (con y sin aorta de porcelana) con estenosis aórtica severa sintomática sometidos a IVAT. El segundo de los objetivos es presentar los resultados de mortalidad global obtenidos con el IVAT, e identificar los predictores independientes relacionados, en pacientes con estenosis aórtica severa sintomática y aorta de porcelana y compararlos con los obtenidos en pacientes sin esta patología de la pared aórtica.Departamento de Biología Célular, Histología y FarmacologíaMáster en Investigación en Ciencias de la Salu

Valoración global de la cardiomiopatía cirrótica y su evolución después del trasplante hepático

HIPÓTESIS 1. En el paciente afecto de una hepatopatía en fase de CH existen unos cambios hemodinámicos y cardiológicos, que se caracterizan principalmente por la presencia de síndrome hiperdinámico y disfunción diastólica en reposo. Estas alteraciones se correlacionarán con el estadio de la hepatopatía. 2. La substitución del hígado cirrótico por uno sano comportará una normalización de las alteraciones hemodinámicas y cardiológicas. OBJETIVOS 1. Determinar la prevalencia, el grado y las características del trastorno cardiaco en la CH mediante estudio hemodinámico de corazón derecho, ecocardiograma y determinación de NT-proBNP y Cistatina C. 2. Determinar la prevalencia, el grado y las características del trastorno cardiaco en los pacientes trasplantados hepáticos. 3. Averiguar si el trastorno cardiaco es reversible y desaparece tras el TH comparando el estudio ecocardiográfico y los valores de NTproBNP y Cistatina C. 4. Investigar si dichas alteraciones cardiacas se correlacionan con el grado de insuficiencia hepática. 5. Investigar si la presencia de síndrome hiperdinámico comporta un mayor trastorno cardiaco. 6. Evaluar la utilidad del NT-proBNP y la Cistatina C en la cardiomiopatía cirrótica CONCLUSIONES 1. Un alto porcentaje de pacientes cirróticos presenta alteraciones en la función y en la estructura cardiaca, definidas mediante estudio hemodinámico, ecocardiograma y niveles de NT-proBNP. 2. Estas alteraciones cardiacas se correlacionan con el grado de deterioro hepático, definido por la clasificación de Child y el índice MELD. 3. Un alto porcentaje de pacientes trasplantados hepáticos presenta alteraciones en la función y en la estructura cardiaca, existiendo un empeoramiento respecto a los valores basales previos al trasplante hepático. 4. Los pacientes con síndrome hiperdinámico presentan una cirrosis más avanzada con un mayor índice cardiaco y un mayor desarrollo de hipertrofia ventricular izquierda. 5. Los niveles de NT-proBNP se correlacionan con la clase Child, el índice cardiaco y el índice de masa ventricular izquierda. 6. Los niveles de NT-proBNP presentan una especificidad elevada para el diagnóstico de insuficiencia cardiaca de alto gasto cardiaco. 7. Los niveles de Cistatina C se correlacionan con la clase Child, la creatinina sérica y la fracción de acortamiento ventricular izquierdo

Sustained benefit of left ventricular remodelling after valve replacement for aortic stenosis

Background: Valve replacement for aortic stenosis (AS) determines negative ventricular remodelling. We used cross sectional and Doppler echocardiography to check how rapidly it occurs and to assess if these changes are sustained over time. Methods: We evaluated in 34 patients subjected to aortic valve replacement for AS morphological and functional (ejection fraction and E:A ratio) left ventricular data by echocardiography prior to surgery and 2 postoperative studies: early after surgery (pQ1) and at mid-term evolution (pQ2). Results: Left ventricular mass index was reduced at pQ1 (from 152 &#177; 47 g/m2 to 113 &#177; 31 g/m2; p < 0.01) as well as end-diastolic (from 51.3 mm to 48.3 mm; p < 0.03), end-systolic (from 32.2 mm to 29.4 mm; p < 0.02), interventricular septum (from 12.9 mm to 10.3 mm; p < 0.01), and posterior wall (from 12.5 mm to 11 mm; p < 0.01) dimensions. Left ventricular ejection fraction (from 61.2% to 65.2%; p < 0.04) and E:A ratio (from 0.94 to 0.98; p < 0.01) increased significantly at pQ1. There were no significant differences in measurements between pQ1 and pQ2. Conclusions: Aortic valve replacement surgery leads to a rapid negative left ventricular remodelling during the first 7 months, including a decrease in myocardial hypertrophy and an improvement in systolic and diastolic function. These beneficial hemodynamic changes are sustained for at least 3 years

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Estudio sistemático de una población de pacientes con hipertensión pulmonar

La hipertensión pulmonar (HTP) es una enfermedad poco frecuente y conoctaga pero de elevada morbi-mortaltagad. Presenta etiologías y comorbiltagades diversas por lo que es valorada por múltiples especialtagades, lo que dificulta que existan expertos en el tema y la realización de estudios sistemáticos que lleven al origen de la patología. Planteamos un estudio sistemático, siguiendo las guías de práctica clínica actuales, de pacientes menores de 75 años diagnosticados de HTP severa (PAPs>60 mmHg) mediante ecocardiografía desde enero 1995 a agosto 2007 en el área 3 del Servicio Aragonés de Salud. Recogemos 58 casos de HTP severa a los que en una primera entrevista se les atribuye un diagnóstico de sospecha en base a los datos clínicos hasta ese momento. Posteriormente se les realizan las pruebas diagnósticas recomendadas por las guías y en una segunda entrevista se informa de los resultados y se da un diagnóstico definitivo de su HTP si se ha consegutago. Pulmonary hypertension (PHT) is an unusual and unknown illness but with high morbi-mortality. It shown different etiology and comorbtagity so its studied by many specialities, this is a reason for existing experts about this pathology and a lot of complementary test for doing a correct diagnosis. We suggest a systematic study, following the actual practical clinical gutagelines, about patients less than 75 years old with severe PHT (PBPS >60 mmHg) with echocardiography from January 1995 through august 2007 in area 3 of Aragones Health Service. We compiled 58 cases of severe PHT with suspected diagnosis based only in clinical details. Later we realize tests recommended in gutagelines and in a second interview we report the results and give them a definitive diagnosis if we would have achieved it