Publications by authors named "Eduardo R Perna"

17 Publications

  • Page 1 of 1

PULSE-HF: A simple clinical and geriatric score to predict systolic dysfunction in the elderly without heart failure.

Curr Probl Cardiol 2021 Nov 21:101066. Epub 2021 Nov 21.

Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina; Geriatric Unit, Hospital Alemán, Buenos Aires, Argentina.

Objective: To develop a clinical score to determine preclinical predictors of systolic dysfunction in an outpatient elderly population without a diagnosis of heart failure (HF).

Patients And Methods: PULSE-HF is a cross-sectional study in elderly at-risk (coronary artery disease, diabetes or hypertension) outpatients without a diagnosis of HF. Clinical and geriatric variables were analyzed; independent predictive factors in the logistic regression analysis were included for the score calculation.

Results: Of the 722 subjects enrolled, 47 (6.5%) had a left ventricular ejection fraction (LVEF) < 50% and 15 (2.1%) a LVEF < 40%. Mean age was 76.5 years (5.18) and 445 (61.6%) were female. Multiple logistic regression analysis identified abnormal Q waves (odds ratio [OR]: 4.36; p=0.003), cardiomegaly (OR: 3.32; p < 0.001), right bundle branch block (OR: 2.84; p=0.011), cognitive dysfunction (OR: 2.14; p=0.027) and NT-proBNP (OR 5.43; p < 0.001) as independent predictors of LVEF < 50%. Two prediction scores were built, without and with NT-proBNP inclusion; the area under ROC curves were 0.70 and 0.76, respectively. As the score increased, the sensitivity decreases but increases specificity and accuracy (97.17% and 91.64% respectively in ≥ 6 points). NT-proBNP was associated with an increment in the performance (accuracy of 93.18% for score ≥ 10).

Conclusion: A simple score using clinical information might be useful to predicting asymptomatic systolic dysfunction in the elderly.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.101066DOI Listing
November 2021

[Relevance of right ventricle in the clinical management of pulmonary arterial hypertension].

Medicina (B Aires) 2021 ;81(4):624-636

Hospital de Alta Complejidad en Red EL Cruce - Néstor Kirchner, Instituto FLENI e Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina.

Pulmonary arterial hypertension (PAH) requires structured processes of diagnosis and risk stratification, being the function of the right ventricle (RV) a hallmark prognosis determinant. The main therapeutic goals in PAH are to improve and try to revert RV dysfunction and maintaining a low risk. Currently, there are multiple treatments with different mechanisms of action, the combination of which in double or triple therapy has shown improved results compared to monotherapy. Recent clinical evidence shows the importance of early incorporation of parenteral prostanoids to the scheme, improving RV function and survival. In this review, we discuss the role of the RV function in the diagnosis, prognosis, and follow-up of PAH. We recommend the systematic and standardised evaluation of the RV as well as the early initiation of combined treatment in cases of intermediatehigh risk to try to reach and keep the patient with PAH at a low risk and / or avoid the progression of PAH.
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August 2021

Collaborative registry of pulmonary hypertension in Argentina (RECOPILAR). Final analysis.

Medicina (B Aires) 2021 ;81(2):180-190

Asociación Argentina de Medicina Respiratoria (AAMR), Argentina.

The epidemiology of pulmonary hypertension (PH), especially pulmonary arterial hypertension (PAH), has not been evaluated in our country, therefore there is no reference parameter to establishing the representativeness of this information in the national order. This registry represents the first collaborative effort to provide a knowledge base of this disease, including 5 scientific societies that represent different specialties (pediatrics, rheumatology, pulmonology and cardiology) with data from 23 Argentine provinces. These efforts involved five societies of various adult (cardiology, rheumatology, and pulmonology) and pediatric (cardiology) specialties. Subjects were grouped (1-5) in accord with the 2013 Nice classification. A total of 627 patients (mean age, 50.8 ± 18 years; women, 69.2%) were recruited. Incident cases accounted for 53%. Functional class III-IV accounted for 69% at time of diagnosis and 33.4% at time of inclusion. Distributions in groups 1-5 were 63.6%, 15.9%, 8.3%, 9.7%, and 2.4%, respectively. Treatment consisted of diuretics (51.2%), mineralocorticoid receptor antagonists (44.7%), digoxin (16.6%), anticoagulants (39.2%), renin-angiotensin antagonists (15.5%), beta blockers (15.6%), and calcium channel blockers (8%). Rates of specific therapies usage in PAH vs. non-PAH group were 80.5% vs. 40.8% (phosphodiesterase-5 inhibitors: 71% vs. 38.6%; endothelin receptor antagonists: 54.4% vs. 14.5%; prostanoids: 14.3 vs. 3.1%; all p < 0.001). Three-year survival in PAH and non-PAH differed significantly (82.8% vs. 73.3%; p = 0.001). In the Argentine RECOPILAR registry, the clinic-epidemiologic profile was that of advanced-stage disease. Diagnostic workups and therapeutics interventions, including use of specific therapy for PAH, were consistent with current recommendations. Despite delays in diagnosis, survival was aligned with other contemporary registries.
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April 2021

Latin-American Registry of Cardiovascular Disease and COVID-19: Rationale and Design of the CARDIO COVID 19-20 Registry.

Glob Heart 2021 02 12;16(1):14. Epub 2021 Feb 12.

Servicios y Tecnología Cardiovascular de Guatemala S.A, GT.

Background: Infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) exhibits a strong infectivity but less virulence compared to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). In terms of cardiovascular morbidity, susceptible population include elderly and patients with certain cardiovascular conditions. This infection has been associated with cardiac injury, cardiovascular complications and higher mortality.

Objectives: The main objective of the CARDIO COVID 19-20 Registry is to determine the presence of cardiovascular comorbidities and cardiovascular complications in COVID-19 infected patients that required in-hospital treatment in different Latin American institutions.

Methods: The CARDIO COVID 19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection who required in-hospital treatment in Latin America. Enrollment of patients started on May 01, 2020 and was initially planned to last three months; based on the progression of pandemic in Latin America, enrollment was extended until December 2020, and could be extended once again based on the pandemic course in our continent at that moment.

Conclusions: The CARDIO COVID 19-20 Registry will characterize the in-hospital population diagnosed with COVID-19 in Latin America in order to identify risk factors for worsening of cardiovascular comorbidities or for the appearance of cardiovascular complications during hospitalization and during the 30-day follow up period.
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http://dx.doi.org/10.5334/gh.925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894365PMC
February 2021

Lung ultrasound in acute myocardial infarction. Updating Killip & Kimball.

Indian Heart J 2021 Jan-Feb;73(1):104-108. Epub 2020 Nov 24.

Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina.

Background: Heart failure complicating acute myocardial infarction marks an ominous prognosis. Killip and Kimball's classification of heart failure remains a useful tool in these patients. Lung ultrasound can detect pulmonary congestion but its usefulness in this scenario is unknown.

Objective: To investigate the diagnostic accuracy of lung ultrasound to predict heart failure in patients with acute myocardial infarction.

Methods: Patients admitted with acute myocardial infarction and without heart failure were evaluated with a lung ultrasound. The presence of B-lines was recorded and counted. The presence of new heart failure (Killip Class B, C, or D) during hospitalization was evaluated by a cardiologist blinded to the results of lung ultrasound. A ROC curve analysis was done to evaluate the diagnostic accuracy of B-lines to predict heart failure.

Results: 200 patients were included. Three patients were diagnosed with cardiogenic shock, 5 with acute pulmonary edema, and 17 with mild heart failure. Patients who develop heart failure had a median of 14 B-lines, however, patients who remained in Killip class A had a median of 2 (p = 0,0001). The area under the ROC curve of the sum of B-lines to predict any form of heart failure was 0,91 (CI95% 86-97). The best cut-off value was 5 B-lines, with a sensitivity of 88% (IC95% 68,8-97,5) and specificity of 81% (IC95% 73,9-86,2).

Conclusion: Lung ultrasound done at admission can help to predict heart failure In patients with acute myocardial infarction.
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http://dx.doi.org/10.1016/j.ihj.2020.11.148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961256PMC
July 2021

The predictive value of plasma biomarkers in discharged heart failure patients: role of troponin I/T.

Minerva Cardioangiol 2016 Apr 23;64(2):165-80. Epub 2015 Nov 23.

Heart Failure Division, "J. F. Cabral" Cardiology Institute, Corrientes, Argentina -

Hospitalization for heart failure (HHF) is a frequent manifestation of chronic heart failure (CHF), and represents the moment of greatest impact on costs and on risk for the patient, in particular after discharge. Contributing factors to this disappointingly high postdischarge event rate include the incomplete relief of fluid overload, insufficient patient education, the lack of implementation of evidence-based therapies, poor follow-up and inadequate risk stratification before leaving hospital. Among available tools, different biomarkers have been tested, including cardiac troponin (cTn). The value of cTn to monitoring and to stratifying risk before discharge has been evaluated by mean of three strategies: a single measurement before discharge, monitoring with serial sampling during hospitalization, and comparing admission and predischarge values to establishing the cTn "delta". Acute heart failure syndrome (AHFS) is an active and continuing process, which starts at admission, but its evolution might be unpredictable, and the prevention of ongoing myocardial damage (OMD) might be one of the important targets to improve prognosis. OMD is also a dynamic process and can be detected in CHF and HHF, at different moments and in diverse magnitudes, justifying the cTn monitoring. The favorable effect of drugs on cTn release and its association with better prognosis have increased our expectation for the role of serial determination in HHF patients.
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April 2016

Minor myocardial damage is a prevalent condition in patients with acute heart failure syndromes and preserved systolic function with long-term prognostic implications: a report from the CIAST-HF (Collaborative Italo-Argentinean Study on cardiac Troponin T in Heart Failure) study.

J Card Fail 2012 Nov;18(11):822-30

Heart Failure Clinic, Coronary Intensive Care Unit, Instituto de Cardiologia "Juana F. Cabral", Corrientes, Argentina.

Background: Half of patients with acute heart failure syndromes (AHFS) have preserved left ventricular ejection fraction (PLVEF). In this setting, the role of minor myocardial damage (MMD), as identified by cardiac troponin T (cTnT), remains to be established.

Aim: To evaluate the prevalence and long-term prognostic significance of cTnT elevations in patients with AHFS and PLVEF.

Patients And Methods: This retrospective, multicenter, collaborative study included 500 patients hospitalized for AHFS with PLVEF (ejection fraction ≥40%) between October 2000 and December 2006. Blood samples were collected within 12 hours after admission and were assayed for cTnT. MMD was defined as a cTnT value of ≥0.020 ng/mL.

Results: Mean age was 73 ± 12 years, 47% were female, 38% had an ischemic etiology, and New York Heart Association (NYHA) class was 2.2 ± 0.7. Mean cTnT value was 0.149 ± 0.484 ng/mL, and cTnT was directly correlated with serum creatinine (Spearman's Rho = 0.35, P < .001) and NYHA class (0.25, P < .001). MMD was diagnosed in 220 patients (44%). Patients with MMD showed lower left ventricular ejection fraction (P < .05), higher serum creatinine (P < .001), higher prevalence of ischemic etiology and diabetes mellitus, a worse NYHA class (P < .001), and higher natriuretic peptide levels (P < .001) as compared with patients without MMD. At 6-month follow-up, overall event-free survival was 55% and 75% in patients with and without MMD (P < .001), respectively. On multivariate Cox regression analysis, only NYHA class (HR = 1.50; P = .002) and MMD (HR = 1.81; P = .001) were identified as predictors of events.

Conclusions: Increased cTnT levels were detected in approximately 50% of patients with AHFS with preserved systolic function, and were found to correlate with clinical measures of disease severity. The presence of MMD was associated with a worse long-term outcome, lending support to cTnT-based risk stratification in the setting of AHFS.
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http://dx.doi.org/10.1016/j.cardfail.2012.10.008DOI Listing
November 2012

Time to reperfusion in acute myocardial infarction. It is time to reduce it!

J Electrocardiol 2007 Jul;40(3):257-64

University of Texas Medical Branch, Galveston, TX 77555-0553, USA.

Background And Objectives: Mortality from ST-segment elevation myocardial infarction remains high, with most deaths occurring before hospital admission. Despite effective pre- and in-hospital reperfusion strategies becoming standard over the past 2 decades, time-to-admission and time-to-treatment remain prolonged. We reviewed temporal trends in these times in published clinical trials.

Methods: All major randomized clinical trials reporting on reperfusion strategies for acute myocardial infarction published between 1993 and 2003 were evaluated. Strategies included pre- and in-hospital thrombolysis, primary percutaneous coronary intervention (pPCI) with or without transfer, and "facilitated" PCI. We generated overall estimates of time-to-admission, time-to-treatment, door-to-balloon (DTB), and door-to-needle (DTN) times and evaluated temporal trends in the length of time-to-admission and time-to-treatment.

Results: In studies that evaluated only in-hospital thrombolysis, the time-to-admission was 149 +/- 45 minutes; the mean time-to-treatment was 181 +/- 29 minutes. In studies that considered only in-hospital pPCI (without transfer), the mean time-to-admission was 153 +/- 41 minutes; the mean time-to-treatment was 234 +/- 43 minutes. In studies that compared in-hospital pPCI with in-hospital thrombolytic therapy, the mean time-to-admission was 155 +/- 47 and 150 +/- 48 minutes, respectively. The DTN time was 65 +/- 10 minutes, whereas DTB time was 81 +/- 39 minutes. In other trials evaluating in-hospital thrombolysis and pPCI with transfer to a referral center, the time-to-admission in subjects treated with thrombolysis (n = 1345) was 127 +/- 32 minutes vs 131 +/- 36 minutes for pPCI (n = 1528). For in-hospital thrombolysis, time-to-treatment was 151 +/- 23 minutes vs 203 +/- 15 minutes for pPCI patients with transfer. The DTN time in the thrombolysis group was 44 +/- 28 minutes as compared with DTB time of 78 +/- 38 minutes in the pPCI group. Throughout the last decade, time-to-admission decreased significantly (P = .02) but time-to-treatment remained unchanged (P = .38) for patients undergoing thrombolysis. In the pPCI arm, time-to-admission remained unchanged (P = .11) but a insignificant trend toward reduction was demonstrated in time-to-treatment (P = .11).

Conclusion: Time-to-admission and time-to-treatment for ST-segment elevation myocardial infarction are still prolonged. Resources should be directed to early recognition of the acute myocardial infarction, improved utilization of emergency services for transportation, and prehospital diagnosis and triaging. Ambulances equipped with wireless capability to transmit electrocardiograms to the on-call cardiologist seem to be promising tools to achieve earlier diagnosis and triaging with high diagnostic sensitivity and specificity.
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http://dx.doi.org/10.1016/j.jelectrocard.2007.01.007DOI Listing
July 2007

[Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome].

Rev Esp Cardiol 2006 Dec;59(12):1268-75

Unidad de Cuidados Intensivos Coronarios, Instituto de Cardiología Juana F. Cabral, Corrientes, Argentina.

Introduction And Objectives: Hyperglycemia can increase the risk of death or a poor outcome following myocardial infarction. Our objective was to investigate the value of the admission glucose level in predicting long-term outcome in patients with acute coronary syndrome.

Methods: The study population comprised 565 patients admitted with acute coronary syndrome within 24 hours of the start of symptoms. The final diagnosis was myocardial infarction in 56% and unstable angina in 44%.

Results: The patients' mean glucose level was 143 (77) mg/dL. During follow-up (42 [6] months), 55 (9.7%) patients died. The area under the receiver operating characteristic curve for the optimum cut point for predicting death from the glucose level was 0.67; the cut point was 128 mg/dL, with a sensitivity of 85% and a specificity of 62%. Patients were divided into 2 groups according to blood glucose level: in group 1 (36.8%), it was > or = 128 mg/dL; in group 2, <128 mg/dL. There were differences between the groups in the incidence of diabetes (47.2% vs 12.6%; P< .001), systolic blood pressure (138 [33] mm Hg vs 133 [33] mm Hg; P< .001), and ejection fraction (48.3 [0.9]% vs 55.2 [12.4]%; P=.004). At 4 years, the survival rates were 40% and 77% in groups 1 and 2, respectively (log rank test P< .001). The following were independent predictors of mortality: admission glucose level > or =128 mg/dL (hazard ratio [HR= 2.41; P=.021), admission systolic blood pressure (HR= 0.97; P< .001), admission troponin-T level (HR=4.88; P< .001), and the development of heart failure (HR=1.04; P=.001). A rise of 10 mg/dL in glucose level was associated with a 2.56-fold increase in the risk of death (P=.012).

Conclusions: In patients with acute coronary syndrome, hyperglycemia at admission (cut point > or =128 mg/dL) was associated with increased long-term risk and, in addition, was a strong independent predictor of mortality.
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December 2006

Increased levels of cardiac troponin-T in outpatients with heart failure and preserved systolic function are related to adverse clinical findings and outcome.

Coron Artery Dis 2006 Dec;17(8):685-91

Heart Failure Clinic, Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina.

Background: The implications of increased levels of cardiac troponin T in congestive heart failure with preserved systolic function have been poorly evaluated. We hypothesized that its presence might be related to disease severity and prognosis in this setting.

Methods: Clinical, echocardiographic, 6-min walking test and laboratory data were prospectively obtained in 69 congestive heart failure outpatients with ejection fraction > or = 40%. Serial blood samples were assayed for cardiac troponin T with a third-generation immunoassay and values > or = 0.02 ng/ml were considered abnormal.

Results: Abnormal cardiac troponin T levels in at least one sample were found in 27 patients (39%, group 1). These patients were older (71.7 +/- 11 vs. 63 +/- 12.4 years, P = 0.002); more frequently hospitalized during the previous year (63 vs. 26.2%, P = 0.003), had lower systolic blood pressure (129.3 +/- 19.6 vs. 140.4 +/- 23.5 mmHg, P = 0.04), but had similar proportion of ischemic etiology (55.6 vs. 42.9%, P = 0.21) than those with normal cardiac troponin T (group 2). In groups 1 and 2, the functional class was 2.8 +/- 0.8 and 2.1 +/- 0.9 (P = 0.03), and the distance covered in 6 min was 339 +/- 100 and 386 +/- 103 m (P = 0.05), respectively. In groups 1 and 2, the 18-month congestive heart failure hospitalization-free survival was 22 and 87%, respectively (log-rank test P = 0.0003). In a Cox-proportional hazard model, functional class III-IV (hazard ratio = 5.21, 95% confidence interval: 1.43-18.96) and myocardial injury (hazard ratio = 5.51, confidence interval: 1.58-19.24) were independently associated with prognosis.

Conclusion: Increased levels of cardiac troponin T were detected in one out of three congestive heart failure outpatients with preserved systolic function and correlated with clinical measures of disease severity and poor outcome. These findings suggest a link between ongoing myocardial injury and progressive impairment in congestive heart failure despite preserved systolic function.
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http://dx.doi.org/10.1097/01.mca.0000236287.56435.14DOI Listing
December 2006

Importance of early combined N-terminal pro-brain natriuretic peptide and cardiac troponin T measurements for long-term risk stratification of patients with decompensated heart failure.

J Heart Lung Transplant 2006 Oct;25(10):1230-40

Heart Failure Clinic, Instituto de Cardiologia J. F. Cabral, Corrientes, Argentina.

Background: Markers of myocardial necrosis and natriuretic peptides are risk predictors in decompensated heart failure (DHF). We prospectively studied the optimal timing of combined cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements for long-term risk stratification.

Methods: cTnT and NT-proBNP were measured upon admission, and before discharge in 76 patients hospitalized for DHF (mean age 62.3 +/- 15 years; 71% men).

Results: During a mean follow-up of 252 +/- 120 days, 39.5% of patients died or were re-hospitalized for DHF. From receiver-operator-characteristic (ROC) curves, the selected cut-off values for cTnT and NT-proBNP were 0.026 ng/ml and 3,700 pg/ml on admission, and 0.030 ng/ml and 3,200 pg/ml, respectively, at discharge. Depending upon measurements above vs below cut-off, the population was distributed on admission and before discharge for three groups: both negative (24% and 30% of patients); one positive (43% and 42%); and both positive (33% and 28%). For the admission groups, the 1-year DHF-free re-hospitalization survival rates were 85%, 60% and 34%, respectively (p = 0.0047). One-year survival rates for DHF-free re-hospitalization were 63%, 71% and 26% (p = 0.0029), respectively, for the discharge groups. In the Cox proportional hazards model, systolic blood pressure (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96 to 0.99), heart rate (HR: 0.97; 95% CI: 0.94 to 0.98), one positive biomarker on admission (HR: 10.5; 95% CI: 1.3 to 83.7) and two positive biomarkers on admission (HR: 13.9; 95% CI: 1.8 to 98.5) were independent predictors of long-term outcomes. However, NT-proBNP on admission was the most important predictor of long-term prognosis (HR: 5.1; 95% CI: 2.3 to 12.2).

Conclusions: The combined measurements of cTnT and NT-proBNP on hospital admission were more reliable than their measurements before discharge in the long-term risk stratification of DHF. A single positive measurement on admission predicted a poor long-term outcome.
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http://dx.doi.org/10.1016/j.healun.2006.08.004DOI Listing
October 2006

Overview of acute decompensated heart failure in Argentina: lessons learned from 5 registries during the last decade.

Am Heart J 2006 Jan;151(1):84-91

Instituto de Cardiologia Juana F. Cabral, Corrientes, Argentina.

Background: The acute decompensated heart failure (ADHF) is not as well characterized as the chronic phase, particularly in Latin American countries. Thus, the aim of this overview was to describe the clinical profile, treatment, and inhospital course of ADHF during the last decade in Argentina.

Methods: Results obtained from 5 Argentinean prospective and multicenter registries, involving 2974 patients admitted for ADHF, were assessed. These registries were performed and published between 1992 and 2004.

Results: The mean age was 65 to 70 years, and nearly 40% were female. Coronary artery disease was the main etiology in nearly 30% of the patients. Between 1992 and 2004, the use of angiotensin-converting enzyme inhibitors increased from 29.9% to 53.4% before admission and from 48.5% to 69.3% before discharge; the use of beta-blockers rose from 4.2% to 33.2% at admission and from 2.5% to 42.4% at predischarge (all P < .0001). Inhospital mortality rates in the first to the fifth registries were 12.1%, 4.6%, 10.5%, 8.9%, and 4.7% (P [trend] = .006). However, there were 98 (7.7%) deaths among 1272 patients before 2002, compared with 129 (7.6%) among 1702 since 2002 (P = .9).

Conclusions: The clinical profile of this largest sample of ADHF reported from a Latin American country is different from that observed in clinical trials and comparable to registries worldwide. Although an improvement in the use of recommended drugs was observed in the last decade, the average mortality has not changed. These findings might have implications in the design of multinational clinical trials.
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http://dx.doi.org/10.1016/j.ahj.2005.03.010DOI Listing
January 2006

Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: new insights in chronic heart failure.

Int J Cardiol 2006 Apr;108(2):181-8

Echocardiography Laboratory, Instituto de Cardiología Juana F. Cabral, Bolívar 1334, Corrientes 3400, Argentina.

Background: Tissue Doppler imaging (TDI) is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis. We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure (CHF) with normal and reduced ejection fraction.

Methods And Results: One hundred ten outpatients with CHF and 68 controls were included. Ejection fraction (EF) was obtained and longitudinal systolic (S) and diastolic (E' and A') wall velocities were recorded from basal septum. Group A (controls) were normal and CHF patients were classified by EF in Group B1: > 45% and B2: < or = 45%. In A, B1 and B2 the mean S peak was 7.74; 5.45 and 4.89 cm/s (p<0.001); the mean E' peak was 8.56; 5.72 and 6.1 cm/s (p<0.001); and the mean A' peak was 10.2; 7.3 and 5.3 cm/s (p<0.001). Also, isovolumic contraction and relaxation time were different among control and CHF groups, (both p<0.001). The most useful parameters for identifying diastolic CHF were IVRT and S peak, with area under ROC curves of 0.93 and 0.89. The cut-off of 115 ms for IVRT and 5.8 cm/s for S peak showed a sensitivity of 94 and 97%, with a specificity of 82 and 73%, respectively.

Conclusion: These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition.
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http://dx.doi.org/10.1016/j.ijcard.2005.04.026DOI Listing
April 2006

Atorvastatin has an important acute anti-inflammatory effect in patients with acute coronary syndrome: results of a randomized, double-blind, placebo-controlled study.

Am Heart J 2005 Mar;149(3):451-7

Coronary Intensive Care Unit, Instituto de Cardiología Juana F. Cabral, Corrientes, Argentina.

Background: C-reactive protein (CRP) levels are associated with cardiovascular risk. We assessed the hypothesis that atorvastatin might have anti-inflammatory effects in acute coronary syndromes (ACS) as shown by CRP reduction.

Methods: This study was a prospective, randomized, double-blind, placebo-controlled study of 90 consecutive patients admitted within 48 hours of onset of ACS with CRP levels > or =1.4 mg/dL. Patients were assigned to atorvastatin 40 mg daily or placebo over 30 days. C-reactive protein levels, lipid profiles, serum fibrinogen, white cell count, and erythrocyte sedimentation rate were measured at entry, hospital discharge, and 1 month later.

Results: Baseline clinical characteristics did not differ between atorvastatin and placebo groups (mean age 59.3 +/- 13.4 vs 61.1 +/- 11.5, P = ns); myocardial infarction 52.3% versus 67.4% ( P = ns). In both groups, median baseline CRP levels were comparable (5.97 +/- 6.2 vs 4.64 +/- 4.2 mg/dL, P = ns). C-reactive protein levels were lower in the atorvastatin group versus control group at discharge (1.68 +/- 1.65 vs 4.12 +/- 4.18 mg/dL) and at 30 days (0.50 +/- 0.71 vs 2.91 +/- 2.68 mg/dL, both P < .0001). C-reactive protein levels significantly decreased from baseline to discharge and 1 month later in placebo and atorvastatin groups (both P < .0001); however, the reduction was greater in the atorvastatin group (62% vs 11% at discharge [P < .0001]; 84% vs 30% at 1 month [P < .0001]). In addition, atorvastatin was associated with a reduction in total and low-density lipoprotein cholesterol and erythrocyte sedimentation rate at discharge and at 30 days (P < .0001 for all comparisons). No correlation was found between changes in CRP and cholesterol levels.

Conclusions: C-reactive protein levels in ACS were rapidly reduced with atorvastatin. These data provide evidence that statins have fast and early anti-inflammatory effects in addition to lipid-lowering effects in ACS.
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http://dx.doi.org/10.1016/j.ahj.2004.07.041DOI Listing
March 2005

Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with acute decompensated heart failure.

Int J Cardiol 2005 Mar;99(2):253-61

Heart Failure Clinic, Coronary Intensive Care Unit, Instituto de Cardiología "Juana F. Cabral", Bolivar 1334, Corrientes 3400, Argentina.

Background: The progression of chronic heart failure (CHF) is characterized by frequent exacerbation requiring hospitalization and high mortality. Clinical deterioration is triggered by many factors that could promote ongoing myocytes injury. We sought to determine whether a specific marker of cardiac injury, troponin T (cTnT), is associated with prognosis in acute decompensated heart failure (ADHF).

Methods: One hundred and eighty-four consecutive patients with ADHF were enrolled in the absence of an acute coronary syndrome. A cTnT value> or =0.1 ng/ml in samples drawn at 6, 12 or 24 h after hospital admission was considered abnormal.

Results: Increased levels of cTnT were found in 58 patients (31.5%, group 1). There were no significant differences between group 1 and patients with cTnT<0.1 ng/ml (group 2) in terms of demographic and clinical characteristics, although ischemic etiology was more prevalent in group 1 (51.7% vs. 31.7%, p=0.009). During follow-up, the mortality in groups 1 and 2 was 31% and 17.5% (p=0.038, OR=2.13, 95% CI: 1.03-4.69), respectively. The 3-year free-CHF readmission survival in group 1 and 2 was 25% and 53% (log rank test p=0.015). In a Cox proportional hazard model, poor tissue perfusion (HR=2.46, 95% CI=1.31-4.6), previous infarction (HR=1.99, 95% CI=1.02-3.9) and cTnT> or =0.1 ng/ml (HR=1.74, 95% CI=1.05-2.9) emerged as the independent predictors of long-term outcome.

Conclusions: One third of patients with decompensated CHF had elevated levels of cTnT. Troponin T was an independent long-term prognostic marker of morbidity and mortality and it suggests a role of biochemical risk stratification in this setting.
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http://dx.doi.org/10.1016/j.ijcard.2004.01.017DOI Listing
March 2005

Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification.

Circulation 2004 Oct 11;110(16):2376-82. Epub 2004 Oct 11.

Heart Failure Clinic, Instituto de Cardiología Juana F. Cabral, Bolívar 1334, Corrientes, 3400, Argentina.

Background: The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF.

Methods And Results: Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61+/-11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction <40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations > or =0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently <0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had > or =2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (P=0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HR=2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HR=2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HR=1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point.

Conclusions: Abnormal cTnT concentrations were detected in >50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.
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http://dx.doi.org/10.1161/01.CIR.0000145158.33801.F3DOI Listing
October 2004

[Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function].

Rev Esp Cardiol 2004 Jan;57(1):45-52

Instituto de Cardiología Juana Francisca Cabral. Corrientes. Argentina.

Objectives: To compare the clinical characteristics and short- and long-term prognosis for chronic heart failure with left ventricular systolic dysfunction or preserved systolic function.

Patients And Method: Three-hundred twenty-eight consecutive patients with decompensated chronic heart failure were studied prospectively. Depending on ejection fraction, participants were classified as having systolic dysfunction (group 1, ejection fraction < or = 40%,) or preserved systolic function (group 2, ejection fraction >40%).

Results: Systolic dysfunction was detected in 192 patients (58.5%) and preserved systolic function in 41.5%. Mean age was 62.7 (12.5 years) in group 1 and 65.2 (16.2 years) in group 2 (P=.03), with a male prevalence of 73.3% and 49.3%, respectively (P<.001). Ischemic cardiomyopathy was more frequent in group 1 (44.8% vs 25%; P<.001). Physical examination and electrocardiogram findings were similar in both groups, except for a higher proportion of patients in group 1 with a heart third sound (43.2% vs 25%; P=.001) and left bundle branch block (40.6% vs 15.4%; P<.001) and abnomal Q waves (31.3% vs 20.6%; P=.04). In-hospital mortality was similar in patients with systolic dysfunction and preserved systolic function (2.9% vs 1%; P=NS). Twenty-four-month cumulative survival was 61% for patients with systolic dysfunction and 76% for patients with preserved systolic function (log rank test P=NS). In the Cox proportional hazards model, which included age, sex, functional class, hepatomegaly, peripheral hypoperfusion, BUN, sodium level, ejection fraction > 40%, and biventricular heart failure, preserved systolic function was not associated with late mortality. The variables that were independent predictors of late mortality were peripheral hypoperfusion (OR = 3.7; P<.0001), low sodium level (OR=0.9; P=.009) and male sex (OR=1.9; P=.041).

Conclusions: Decompensated chronic heart failure with preserved systolic function was more frequent in women and older patients. Patients with preserved systolic function had a lower prevalence of coronary heart disease. However, these differences had no impact on the short- and long-term prognosis.
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January 2004
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