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BACKGROUND: Unknown cardioembolic sources are frequent causes of cryptogenic stroke. We analyzed the risk of atrial fibrillation (AF) or high burden of ectopic atrial activity (HBEA) in patients with cryptogenic stroke, assessing atrial function and 1-year outcomes. METHODS AND RESULTS: The ARIES (Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke) study is an observational study including patients with cryptogenic stroke. We analyzed the frequency of AF and HBEA (>3000 atrial ectopic beats/day or >2 bursts or atrial tachycardia between 3 beats and ≤30 seconds) in two 30-day Holter-ECGs, comparing advanced echocardiography signs of left atrial (LA) dysfunction according to rhythm: AF, HBEA, and normal sinus rhythm. We also evaluated 1-year stroke recurrence and mortality. The study included 109 patients; 35 (32.1%) patients had AF, 27 (24.8%) HBEA, and 47 (43.1%) normal sinus rhythm. Compared with those with normal sinus rhythm, patients with AF presented higher 2-dimensional and 3-dimensional LA indexed volumes (38.8±11.2 versus 27.3±11.8 mL/m2, and 50.6±17.2 versus 34.0±15.4 mL/m2, respectively, P<0.001), lower 3-dimensional LA ejection fraction (50±14.6 versus 62.7±11.8, P=0.001), LA reservoir strain (22.0±8.6 versus 30.4±10.5, P<0.001), and LA contraction strain (10.5±8.18 versus 17.1±7.5, P<0.001), remaining significant in multivariate analysis. Patients with HBEA showed higher LA indexed volumes and lower LA reservoir strain than patients with normal sinus rhythm only in univariate analysis. There were no differences in ischemic recurrence or mortality among the groups. CONCLUSIONS: Patients with cryptogenic stroke showed a high incidence of AF and HBEA. AF is strongly related to LA volume, LA function, and LA reservoir and contraction strain, whereas HBEA showed milder structural changes. Advanced LA echocardiography could help patient selection for long-term ECG monitoring in suspected cardiac sources.
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Fibrilación Atrial , Función del Atrio Izquierdo , Electrocardiografía Ambulatoria , Accidente Cerebrovascular Embólico , Recurrencia , Humanos , Masculino , Femenino , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/diagnóstico , Anciano , Persona de Mediana Edad , Accidente Cerebrovascular Embólico/etiología , Accidente Cerebrovascular Embólico/fisiopatología , Función del Atrio Izquierdo/fisiología , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Frecuencia Cardíaca/fisiología , Factores de Riesgo , Complejos Atriales Prematuros/fisiopatología , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/complicaciones , Complejos Atriales Prematuros/epidemiología , Ecocardiografía/métodos , Factores de Tiempo , Medición de Riesgo/métodosRESUMEN
BACKGROUND AND AIMS: Baseline cardiovascular toxicity risk stratification is critical in cardio-oncology. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) score aims to assess this risk but lacks real-life validation. This study validates the HFA-ICOS score for anthracycline-induced cardiovascular toxicity. METHODS: Anthracycline-treated patients in the CARDIOTOX registry (NCT02039622) were stratified by the HFA-ICOS score. The primary endpoint was symptomatic or moderate to severe asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), with all-cause mortality and cardiovascular mortality as secondary endpoints. RESULTS: The analysis included 1066 patients (mean age 54 ± 14 years; 81.9% women; 24.5% ≥65 years). According to the HFA-ICOS criteria, 571 patients (53.6%) were classified as low risk, 333 (31.2%) as moderate risk, 152 (14.3%) as high risk, and 10 (0.9%) as very high risk. Median follow-up was 54.8 months (interquartile range 24.6-81.8). A total of 197 patients (18.4%) died, and 718 (67.3%) developed CTRCD (symptomatic: n = 45; moderate to severe asymptomatic: n = 24; and mild asymptomatic: n = 649). Incidence rates of symptomatic or moderate to severe symptomatic CTRCD and all-cause mortality significantly increased with HFA-ICOS score [hazard ratio 28.74, 95% confidence interval (CI) 9.33-88.5; P < .001, and hazard ratio 7.43, 95% CI 3.21-17.2; P < .001) for very high-risk patients. The predictive model demonstrated good calibration (Brier score 0.04, 95% CI 0.03-0.05) and discrimination (area under the curve 0.78, 95% CI 0.70-0.82; Uno's C-statistic 0.78, 95% CI 0.71-0.84) for predicting symptomatic or severe/moderate asymptomatic CTRCD at 12 months. CONCLUSIONS: The HFA-ICOS score effectively categorizes patients by cardiovascular toxicity risk and demonstrates strong predictive ability for high-risk anthracycline-related cardiovascular toxicity and all-cause mortality.
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A 69-year-old man who underwent a liver transplant in 2014 due to hepatitis C virus hepatopathy was evaluated for dyspnea on exertion and chest pain.
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Disnea , Neoplasias Cardíacas , Miocardio , Humanos , Masculino , Anciano , Disnea/etiología , Disnea/diagnóstico , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/complicaciones , Biopsia/métodos , Miocardio/patología , Huésped Inmunocomprometido , Trasplante de Hígado/métodos , Trasplante de Hígado/efectos adversos , Endocardio/patologíaAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Ecocardiografía , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Resultado del TratamientoAsunto(s)
Betacoronavirus , Anomalías de los Vasos Coronarios/etiología , Vasos Coronarios/diagnóstico por imagen , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Enfermedades Vasculares/congénito , Adulto , COVID-19 , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Infecciones por Coronavirus/epidemiología , Electrocardiografía , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2 , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/etiologíaRESUMEN
Introducción y objetivos: La evolución tras una primera hospitalización por insuficiencia cardiaca (IC), en particular la interacción entre supervivencia y rehospitalizaciones, no está bien establecida. Métodos: Se estudió a todos los pacientes con una primera hospitalización y diagnóstico principal de IC en el periodo 2009-2013, mediante el análisis del Conjunto Mínimo Básico de Datos en la Región de Murcia. Se diferenció entre pacientes nuevos o incidentes y recurrentes, y se calcularon tasas poblacionales y tendencias mediante regresión de joinpoint. Se realizó un seguimiento por tarjeta sanitaria individual hasta el fin de 2015, y se registraron la mortalidad y los reingresos, sus causas y la cronología de los reingresos respecto al fallecimiento. Resultados: Se identificó a 8.258 incidentes, con una tendencia creciente de la tasa anual (+2,3%; p <0,05) hasta 1,24/1.000 habitantes; esto supuso el 71% de los hospitalizados por IC y el 57% del total de altas por IC. En el primer año, el 22% reingresó por IC, el 31% por causa cardiovascular y el 54% por cualquier causa. La supervivencia a los 5 años fue del 40%, significativamente inferior a la de la población general ajustada por edad y sexo (76%) (p <0,001). Entre los fallecidos en el seguimiento, las rehospitalizaciones (1,5/paciente/año; 0,4 debidas a IC) mostraron un patrón en J, donde el 48% de reingresos se acumularon en los últimos 3 deciles de tiempo de supervivencia antes del fallecimiento. Conclusiones: La primera hospitalización por IC mantiene tasas en aumento, con elevada mortalidad y reingresos en el seguimiento, que se acumulan principalmente en el periodo previo al fallecimiento
Introduction and objectives: Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. Methods: We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. Results: A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. Conclusions: Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Insuficiencia Cardíaca/epidemiología , Tiempo de Internación/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Readmisión del Paciente/estadística & datos numéricos , Brote de los Síntomas , Análisis de Supervivencia , Progresión de la EnfermedadRESUMEN
INTRODUCTION AND OBJECTIVES: Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS: We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS: A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS: Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.
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Insuficiencia Cardíaca/epidemiología , Hospitalización/tendencias , Vigilancia de la Población/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/terapia , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Readmisión del Paciente/tendencias , Estudios Retrospectivos , España/epidemiología , Tasa de Supervivencia/tendencias , Adulto JovenRESUMEN
BACKGROUND: Reliable data are necessary if the burden of early readmissions following hospitalization for heart failure (HF) is to be addressed. We studied unplanned 30-day readmissions, their causes and timing over an 11-year period, using population-based linked data. METHODS: All hospitalizations from 2003 to 2013 were analyzed by using administrative linked data based on the Minimum Basic Set discharge registry of the Department of Health (Region of Murcia, Spain). Index hospitalizations with HF as principal diagnosis (n=27,581) were identified. Transfers between centers were merged into one discharge. Readmissions were defined as unplanned admissions to any hospital within 30-days after discharge. RESULTS: In the 2003-2013 period, 30-day readmission rates had a relative mean annual growth of +1.36%, increasing from 17.6% to 22.1%, with similar trends for cardiovascular and non-cardiovascular causes. The figure of 22.1% decreased to 19.8% when only same-hospital readmissions were considered. Most readmissions were due to cardiovascular causes (60%), HF being the most common single cause (34%). The timing of readmission shows an early peak on the fourth day post discharge (+13.29%) due to causes other than HF, followed by a gradual decline (-3.32%); readmission for HF decreased steadily from the first day (-2.22%). Readmission for HF (12.7%) or non-cardiovascular causes (13.3%) had higher in-hospital mortality rates than the index hospitalization (9.2%, p<0.001). Age and comorbidity burden were the main predictors of any readmission, but the performance of a predictive model was poor. CONCLUSION: These findings support the need for population-based strategies to reduce the burden of early-unplanned readmissions.