Presentación clínica y evolución a medio plazo del primer episodio de fibrilación y flúter auricular

Tesis inédita presentada en la Universidad Europea de Madrid. Facultad de Salud y Ciencias Biomédicas. Programa de Doctorado en Biomedicina y Ciencias de la SaludIntroducción: Se cree que la Fibrilación auricular (FA) progresa desde la forma paroxística a persistente, pero esto no está sustentado en datos específicos. Nuestro objetivo fue estudiar la evolución de la fibrilación/flúter auricular (FA/FLA) después del primer episodio, en una población general ambulatoria. Métodos: Desde 2008 a 2010 se registraron los pacientes atendidos con primer episodio de FA/FLA en las Urgencias de un hospital general. Se excluyeron aquellos que requirieron cardioversión u hospitalización por enfermedad severa o pobre tolerancia. Los pacientes fueron seguidos 2 semanas después del alta y cada 3 a 6 meses durante 32+/-12 meses Resultados: Se registraron 169 pacientes (86 varones), con edad 63,813,9 años, 149 tenían FA y 20 flúter (FLA). En 76 la duración de los síntomas fue 48h, pero en 92 era incierta. Un paciente fue excluido por precisar cardioversión eléctrica en Urgencias. Tras el alta (48h), 83 se encontraban en RS, y 85 en FA/FLA. 2 semanas después, 98 estaban en sinusal, y 70 (41%) en FA/FLA. De 70 pacientes con arritmia persistente, 48 (69%) desarrollaron FA persistente-crónica. De 98 pacientes en RS a las 2 semanas, 65 no presentaron recurrencias clínicas, 24 desarrollaron FA/FLA paroxística, y 6 (6%) evolucionaron a formas persistentes. Conclusiones: Contrariamente a los conceptos mantenidos, la mayoría de las FA/FLA persistentes se presentan clínicamente como persistentes desde el primer diagnóstico, mientras muchos primeros episodios autolimitados no recurren en un seguimiento a medio plazo. La presentación inicial podría reflejar diferentes mecanismos y estrategias de manejo [Resumen Teseo]UE

Different evolution of atrial fibrillation after the first documented episode

Sin financiación1.125 JCR (2016) Q3, 91/155 Medicine, General and InternalUE

Sex Influence on the Efficacy and Safety of Sacubitril/Valsartan

BACKGROUND: Women are underrepresented in sacubitril/valsartan (SV) clinical trials. The aim of this study was to assess sex-specific differences in efficacy, tolerability, and safety of SV in real-world heart failure with reduced ejection fraction (HFrEF) patients. METHODS: A prospective registry in 10 centers including all patients who started SV during the last 6 months was analyzed in this study. RESULTS: A total of 427 patients were included, 126 (29.5%) were women. There were no substantial differences in HFrEF treatment before SV initiation, although fewer women than men carried an implantable cardioverter defibrillator (57 [45.2%] vs. 173 [58.1%], p = 0.02). SV starting dose was 24/26 mg b.i.d. in 206 patients (48.2%), 49/51 mg b.i.d. in 184 (43.1%), and 97/103 mg b.i.d. in 34 (8.2%), without relevant differences associated to sex. There were no losses during a mean follow-up of 7.0 ± 0.1 months. The proportion of patients who discontinued the drug (16 [12.7%] women vs. 33 [11.0%] men, p = 0.66) or presented SV-related adverse effects (31 [24.6%] women vs. 79 [26.5%] men, p = 0.72) was also similar in both sexes. However, female sex was an independent predictor of functional class improvement in the multivariate analysis (odds ratio 2.33, 95% confidence interval: 1.24-4.38, p = 0.04). CONCLUSIONS: SV in women with HFrEF has a similar tolerability as in men. Females seem to have a more frequent functional class improvement than males.Sin financiación1.791 JCR (2019) Q3, 93/138 Cardiac & Cardiovascular Systems0.559 SJR (2019) Q2, 166/362 Cardiology and Cardiovascular Medicine, 125/263 Pharmacology (medical)No data IDR 2019UE

Sacubitril/Valsartan in Daily Clinical Practice: Data From a Prospective Registry

Sacubitril/valsartan (SV) is a new therapy in heart failure with reduced ejection fraction. Our aim was to determine the efficacy and safety of this drug daily clinical practice. We performed a multicenter registry in 10 hospitals. All patients who started SV from October 2016 to March 2017 on an outpatient basis were included. A total of 427 patients started treatment with SV. Mean follow-up was 7.0 ± 0.1 months. Forty-nine patients (11.5%) discontinued SV, and 12 (2.8%) died. SV discontinuation was associated with higher cardiovascular (hazard ratio 13.22, 95% confidence interval, 6.71-15.73, P < 0.001) and all-cause mortality (hazard ratio 13.51, 95% confidence interval 3.22-56.13, P < 0.001). Symptomatic hypotension occurred in 71 patients (16.6%). Baseline N-terminal pro-B-type natriuretic peptide levels, functional class, and left ventricular ejection fraction improved at the end of follow-up in patients who continued with SV (all P values ≤0.001). This improvement was not significant in patients with SV discontinuation. SV has a good tolerability in patients from daily clinical practice. SV withdrawal in patients with heart failure and reduced ejection fraction was independently associated with increased all-cause mortality. Patients who continued with SV presented an improvement in functional class left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide levels.Sin financiación2.598 JCR (2019) Q2, 62/138 Cardiac & Cardiovascular Systems; Q3, 147/270 Pharmacology & Pharmacy0.800 SJR (2019) Q2, 110/362 Cardiology and Cardiovascular Medicine, 112/331 PharmacologyNo data IDR 2019UE