RESUMEN
OBJECTIVE: Qiliqiangxin Capsule (QL) was investigated for its possible role in cardiac hypertrophy in this study. METHODS: QL (0.5 mg/mL) was pre-treated in Neonatal Mouse Ventricular Cardiomyocytes (NMVCs) before induction of cardiomyocyte hypertrophy by Angiotensin II (Ang-II). Immunofluorescence staining for α-actinin was conducted to determine cell surface area. Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP) of hypertrophy markers were examined. Ang-II infusion was given to stimulate cardiac hypertrophy in mice. The cardiac function of mice was detected by echocardiography, and the pathological status of myocardial tissue was observed. RESULTS: The surface of cardiomyocytes was enlarged by Ang-II, and ANP and BNP levels were increased. QL processing could save these changes. miR-382-5p was upregulated in Ang-II-treated NMVCs, and reducing miR-382-5p could further enhance the therapeutic effect of QL while elevating miR-382-5p weakened the protective effect of QL. QL could inhibit miR-382-5p expression to negatively regulate Activated Transcription Factor 3 (ATF3) expression. Enhancing ATF3 expression rescued miR-382-5p upregulation-mediated role in NMVCs. In addition, QL alleviated Ang-II-stimulated cardiac hypertrophy and cardiac dysfunction in mice. CONCLUSION: QL may alleviate cardiac hypertrophy and cardiac dysfunction via the miR-382-5p/ATF3 axis.
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Factor de Transcripción Activador 3 , Angiotensina II , Cardiomegalia , Medicamentos Herbarios Chinos , MicroARNs , Miocitos Cardíacos , Animales , Medicamentos Herbarios Chinos/farmacología , Medicamentos Herbarios Chinos/uso terapéutico , MicroARNs/metabolismo , Cardiomegalia/tratamiento farmacológico , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/metabolismo , Factor de Transcripción Activador 3/metabolismo , Angiotensina II/farmacología , Factor Natriurético Atrial , Masculino , Péptido Natriurético Encefálico/metabolismo , Ratones , Ratones Endogámicos C57BL , Ecocardiografía , Regulación hacia Arriba/efectos de los fármacos , Modelos Animales de EnfermedadRESUMEN
OBJECTIVE: This study aimed to investigate umbilical artery N-terminal proBrain natriuretic peptide (NT-proBNP) in fetuses delivered by cesarean section due to fetal distress in term pregnancies. METHODS: This prospective case-control study was conducted at the Antalya Training and Research Hospital Obstetric Department, Turkiye. A total of 140 pregnant women, 70 underwent elective cesarean sections between weeks 37 and 40 of gestation (Group 1, the control group) and 70 underwent cesarean sections due to fetal distress (Group 2, the study group), were included. The participants' sociodemographic and obstetric data and fetal umbilical blood NT-proBNP levels were recorded in a database. RESULTS: Age, body mass index, gestational age, prenatal diagnostic tests, fetal anatomical scanning, and baby gender ratios were comparable between the groups (p>0.05), while statistically significant differences were observed in terms of gravidity (3.0 vs. 1.0, p≤0.001) and parity numbers (2 vs. 0, p≤0.001), baby height (50.36±0.88 vs. 49.80±0.86, p≤0.001) and weight (3422.43±409.16 vs. 3239.86±293.74, p=0.003), 1-min Apgar (9.0±0.1 vs. 8.5±1.3, p≤0.001) and 5-min Apgar (10.0±0.1 vs. 9.8±0.4, p=0.026) scores, umbilical artery pH (7.32±0.05 vs. 7.25±0.07, p≤0.001), umbilical artery base deficit (-2.48±1.23 vs. -4.36±1.09. p≤0.001), and NT-proBNP levels [8.77 (7.72-9.39) vs. 12.35 (9.69-12.92), p<0.001]. CONCLUSION: This study showed that NT-proBNP can be used as an important marker in the diagnosis of fetal distress. Prospective studies with more participants are now needed to confirm the accuracy of our results.
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Biomarcadores , Sufrimiento Fetal , Péptido Natriurético Encefálico , Fragmentos de Péptidos , Arterias Umbilicales , Humanos , Femenino , Embarazo , Péptido Natriurético Encefálico/sangre , Arterias Umbilicales/diagnóstico por imagen , Sufrimiento Fetal/sangre , Sufrimiento Fetal/diagnóstico , Estudios de Casos y Controles , Estudios Prospectivos , Fragmentos de Péptidos/sangre , Adulto , Biomarcadores/sangre , Cesárea/estadística & datos numéricos , Edad Gestacional , Sangre Fetal/química , Adulto Joven , Recién NacidoRESUMEN
Chronic Chagas cardiomyopathy (CCC) has unique pathogenic and clinical features with worse prognosis than other causes of heart failure (HF), despite the fact that patients with CCC are often younger and have fewer comorbidities. Patients with CCC were not adequately represented in any of the landmark HF studies that support current treatment guidelines. PARACHUTE-HF (Prevention And Reduction of Adverse outcomes in Chagasic Heart failUre Trial Evaluation) is an active-controlled, randomized, phase IV trial designed to evaluate the effect of sacubitril/valsartan 200 mg twice daily vs enalapril 10 mg twice daily added to standard of care treatment for HF. The study aims to enroll approximately 900 patients with CCC and reduced ejection fraction at around 100 sites in Latin America. The primary outcome is a hierarchical composite of time from randomization to cardiovascular death, first HF hospitalization, or relative change from baseline to week 12 in NT-proBNP levels. PARACHUTE-HF will provide new data on the treatment of this high-risk population. (Efficacy and Safety of Sacubitril/Valsartan Compared With Enalapril on Morbidity, Mortality, and NT-proBNP Change in Patients With CCC [PARACHUTE-HF]; NCT04023227).
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Aminobutiratos , Antagonistas de Receptores de Angiotensina , Compuestos de Bifenilo , Cardiomiopatía Chagásica , Combinación de Medicamentos , Enalapril , Insuficiencia Cardíaca , Tetrazoles , Valsartán , Humanos , Compuestos de Bifenilo/uso terapéutico , Aminobutiratos/uso terapéutico , Enalapril/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Cardiomiopatía Chagásica/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Tetrazoles/uso terapéutico , Volumen Sistólico/fisiología , Fragmentos de Péptidos/sangre , Enfermedad Crónica , Péptido Natriurético Encefálico/sangre , Masculino , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Femenino , Resultado del TratamientoRESUMEN
BACKGROUND: Heart failure (HF) is a leading cause of hospitalization and mortality worldwide and places a great economic burden on healthcare systems. Identification of prognostic factors in HF patients is of great importance to establish optimal management strategies and to avoid unnecessary invasive and costly procedures in end-stage patients. OBJECTIVES: In the current study, we aimed to investigate the association between diastolic strain parameters including E/e' SR, and short-term outcomes in advanced HF patients. METHODS: The population study included 116 advanced HF with reduced ejection fraction (HFrEF) patients. Clinical, laboratory, and echocardiographic evaluations of the patients were performed within the first 24 hours of hospital admission. Patients were followed for one month and any re-hospitalization due to worsening of HF symptoms and any mortality was recorded. The level of significance adopted in the statistical analysis was 5%. RESULTS: E/e' SR was significantly higher in the patient group compared to the control group (p=0.001). During one-month follow-up, 13.8% of patients died and 37.1% of patients were rehospitalized. Serum NT-ProBNP (p=0.034) and E/e' SR (p=0.033) were found to be independent predictors of mortality and ACEI use (p=0.027) and apical 3C strain (p=0.011) were found to be independent predictors of rehospitalization in the patient group. CONCLUSION: Findings of the current prospective study demonstrate that E/e' SR measured by speckle tracking echocardiography is an independent and sensitive predictor of short-term mortality in advanced HFrEF patients and may have a role in the identification of end-stage HFrEF patients.
FUNDAMENTO: A insuficiência cardíaca é uma das principais causas de hospitalização e mortalidade em todo o mundo e representa um grande fardo económico para os sistemas de saúde. A identificação de fatores prognósticos em pacientes com IC é de grande importância para estabelecer estratégias de manejo ideais e evitar procedimentos invasivos e dispendiosos desnecessários em pacientes em estágio terminal. OBJETIVOS: No presente estudo, nosso objetivo foi investigar a associação entre parâmetros de strain diastólico, incluindo E/e' SR, e resultados de curto prazo em pacientes com IC avançada. MÉTODOS: O estudo populacional incluiu 116 pacientes com insuficiência cardíaca avançada com fração de ejeção reduzida (ICFEr) avançada. Avaliações clínicas, laboratoriais e ecocardiográficas dos pacientes foram realizadas nas primeiras 24 horas de internação. Os pacientes foram acompanhados por um mês e qualquer reinternação por piora dos sintomas de IC e qualquer mortalidade foi registrada. O nível de significância adotado na análise estatística foi de 5%. RESULTADOS: A E/e' SR foi significativamente maior no grupo de pacientes em comparação ao grupo controle (p=0,001). Durante o acompanhamento de um mês, 13,8% dos pacientes morreram e 37,1% dos pacientes foram reinternados. NT-ProBNP sérico (p=0,034) e E/e' SR (p=0,033) foram considerados preditores independentes de mortalidade e o uso de IECA (p=0,027) e strain 3C apical (p=0,011) foram considerados independentes preditores de reinternação no grupo de pacientes. CONCLUSÃO: Os resultados do presente estudo prospectivo demonstram que a E/e' SR medida pela ecocardiografia com speckle tracking é um preditor independente e sensível de mortalidade em curto prazo em pacientes com ICFEr avançada e pode ter um papel na identificação de pacientes com ICFEr em estágio terminal.
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Insuficiencia Cardíaca , Readmisión del Paciente , Volumen Sistólico , Humanos , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Masculino , Femenino , Readmisión del Paciente/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Volumen Sistólico/fisiología , Pronóstico , Diástole/fisiología , Factores de Tiempo , Péptido Natriurético Encefálico/sangre , Factores de Riesgo , Ecocardiografía , Estudios Prospectivos , Fragmentos de Péptidos/sangre , Estadísticas no Paramétricas , Valores de ReferenciaRESUMEN
BACKGROUND: Chemotherapy with doxorubicin may lead to left ventricular dysfunction. There is a controversial recommendation that biomarkers can predict ventricular dysfunction, which is one of the most feared manifestations of anthracycline cardiotoxicity. OBJECTIVE: The aim of this study was to evaluate the behavior of biomarkers such as Troponin I, type B natriuretic peptide, creatine phosphokinase fraction MB, and myoglobin in predicting cardiotoxicity in a cohort of women with breast cancer undergoing chemotherapy with anthracycline. METHODS: This is an observational, prospective, longitudinal, unicentric study, which included 40 women with breast cancer, whose therapeutic proposal included treatment with doxorubicin. The protocol had a clinical follow-up of 12 months. Biomarkers such as Troponin I, type B natriuretic peptide, creatine phosphokinase fraction MB, and myoglobin were measured pre-chemotherapy and after the first, third, fourth, and sixth cycles of chemotherapy. RESULTS: There was a progressive increase in type B natriuretic peptide and myoglobin values in all chemotherapy cycles. Although creatine phosphokinase fraction MB showed a sustained increase, this increase was not statistically significant. Troponin, type B natriuretic peptide, myoglobin, and creatine phosphokinase fraction MB were the cardiotoxicity markers with the earliest changes, with a significant increase after the first chemotherapy session. However, they were not able to predict cardiotoxicity. CONCLUSION: Troponin I, type B natriuretic peptide, myoglobin, and creatine phosphokinase fraction MB are elevated during chemotherapy with doxorubicin, but they were not able to predict cardiotoxicity according to established clinical and echocardiographic criteria. The incidence of subclinical cardiotoxicity resulting from the administration of doxorubicin was 12.5%.
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Biomarcadores , Neoplasias de la Mama , Cardiotoxicidad , Doxorrubicina , Mioglobina , Troponina I , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Estudios Prospectivos , Troponina I/sangre , Doxorrubicina/efectos adversos , Cardiotoxicidad/etiología , Persona de Mediana Edad , Biomarcadores/sangre , Mioglobina/sangre , Adulto , Antibióticos Antineoplásicos/efectos adversos , Péptido Natriurético Encefálico/sangre , Anciano , Forma MB de la Creatina-Quinasa/sangre , Estudios Longitudinales , Antraciclinas/efectos adversos , Disfunción Ventricular Izquierda/inducido químicamente , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. OBJECTIVES: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. METHODS: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. RESULTS: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 µUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). CONCLUSIONS: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.
FUNDAMENTO: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. OBJETIVOS: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. MÉTODOS: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p <0,05 foram aceitos como estatisticamente significativos. RESULTADOS: Um total de 593 pacientes foram incluídos 412 com FA paroxística e 181 com FA persistente. Durante o seguimento médio de 24±6 meses, 76,4% não apresentaram recidiva após ablação. Individualmente, os biomarcadores demonstraram um valor preditivo baixo ou nulo para recorrência. No entanto, TSH >1,8 µUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor "anormal" foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p<0,001). Doentes com três biomarcadores "anormais" apresentaram três vezes maior probabilidade de recorrência de FA, comparativamente aos que não apresentaram nenhum biomarcador "anormal" (HR=2,88 [IC95%, 1,39-5,17], p=0,003). CONCLUSÕES: Quando combinados, valores anormais de TSH, FT4 e BNP podem ser uma ferramenta útil para prever a recorrência de FA pós ablação guiada pelo AI.
Asunto(s)
Fibrilación Atrial , Biomarcadores , Ablación por Catéter , Recurrencia , Tirotropina , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/sangre , Biomarcadores/sangre , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Ablación por Catéter/métodos , Anciano , Tirotropina/sangre , Péptido Natriurético Encefálico/sangre , Valor Predictivo de las Pruebas , Proteína C-Reactiva/análisis , Resultado del Tratamiento , Tiroxina/sangre , Factores de Riesgo , Troponina I/sangreRESUMEN
OBJECTIVE: To assess the effect of treating pulmonary hypertension (PH) in infants younger than 1 year of age with systemic glucocorticoids while using echocardiographic and diagnostic biomarkers as measures of efficacy. STUDY DESIGN: A retrospective chart review was performed on 17 hospitalized infants younger than 1 year of age at St Louis Children's Hospital who received a 5- to 7-day course of systemic glucocorticoid treatment followed by a 3-week taper with no significant intracardiac shunts from January 1, 2017, to December 31, 2021. Quantitative echocardiographic indices for PH, N-terminal pro b-type natriuretic peptide, and/or b-type natriuretic peptide levels were collected before glucocorticoid treatment, after the glucocorticoid burst, and after the 21-day taper. RESULTS: Mean (±SD) gestational age was 32.1 (±5.8) weeks, 5 infants were (29%) concomitantly treated with sildenafil, and 8 were male. Twelve were classified as World Health Organization group 3 PH (71%) and 5 as World Health Organization group 1 PH. There were significant improvements 30 days after glucocorticoid initiation in b-type natriuretic peptide levels (P = .008), PCO2 (P = .03), eccentricity index (P = .005), right ventricular ejection time (P = .04), pulmonary artery acceleration time (P = .002), and pulmonary artery acceleration time-to-right ventricular ejection time ratio (P = .02). Tricuspid regurgitation velocity was not able to be assessed. There were no mortalities during the study timeline. CONCLUSIONS: In our retrospective study, systemic glucocorticoid therapy was well tolerated and appeared to be associated with significant improvement in cardiopulmonary function in infants with PH. Further prospective study in a larger sample is warranted.
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Biomarcadores , Ecocardiografía , Glucocorticoides , Hipertensión Pulmonar , Péptido Natriurético Encefálico , Humanos , Masculino , Estudios Retrospectivos , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificación , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/diagnóstico por imagen , Femenino , Biomarcadores/sangre , Lactante , Recién Nacido , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Resultado del TratamientoRESUMEN
OBJECTIVE: Heart failure is a disease with cardiac dysfunction, and its morbidity and mortality are associated with the degree of dysfunction. The New York Heart Association classifies the heart failure stages based on the severity of symptoms and physical activity. End-tidal carbon dioxide refers to the level of carbon dioxide that a person exhales with each breath. End-tidal carbon dioxide levels can be used in many clinical conditions such as heart failure, asthma, and chronic obstructive pulmonary disease. The aim of the study was to reveal the relationship between end-tidal carbon dioxide levels and the New York Heart Association classification of heart failure stages. METHODS: This study was conducted at Kahramanmaras Sütçü Imam University Faculty of Medicine Adult Emergency Department between 01/03/2019 and 01/09/2019. A total of 80 patients who presented to the emergency department with a history of heart failure or were diagnosed with heart failure during admission were grouped according to the New York Heart Association classification of heart failure stages. The laboratory parameters, ejection fraction values, and end-tidal carbon dioxide levels of the patients were measured and recorded in the study forms. RESULTS: End-tidal carbon dioxide levels and ejection fraction values were found to be significantly lower in the stage 4 group compared to the other groups. Furthermore, pro-B-type natriuretic peptide (BNP) values were found to be significantly higher in stage 4 group compared to the other groups. CONCLUSION: It was concluded that end-tidal carbon dioxide levels could be used together with pro-BNP and ejection fraction values in determining the severity of heart failure.
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Dióxido de Carbono , Insuficiencia Cardíaca , Índice de Severidad de la Enfermedad , Volumen Sistólico , Humanos , Insuficiencia Cardíaca/clasificación , Insuficiencia Cardíaca/metabolismo , Dióxido de Carbono/análisis , Dióxido de Carbono/metabolismo , Femenino , Masculino , Persona de Mediana Edad , Anciano , Volumen Sistólico/fisiología , Adulto , Volumen de Ventilación Pulmonar/fisiología , Péptido Natriurético Encefálico/sangre , Péptido Natriurético Encefálico/análisis , Pruebas Respiratorias/métodos , Servicio de Urgencia en HospitalRESUMEN
Introducción: La insuficiencia cardíaca (IC) tiene alta morbilidad y mortalidad. Su diagnóstico temprano en atención primaria de salud (APS) es un reto dada la baja especificidad de sus criterios clínicos y las limitaciones en acceso a técnicas diagnósticas. Objetivo: Analizar la prevalencia de IC, subtipos y pronóstico de pacientes con disnea y/o edema de extremidades inferiores que consultan en APS. Metodología: Se trata de un estudio prospectivo de 340 pacientes en APS, sin diagnóstico previo de IC. Se realizó una evaluación clínica, electrocardiograma, NT-proBNP "point-of-care", ecocardiografía con interpretación telemática por cardiólogos. Utilizando los algoritmos HFA-PEFF y H2FPEF se clasificaron los pacientes como :1) IC con fracción de eyección (FE) reducida (ICFER); 2) IC con FE preservada (ICFEP) y 3) pacientes sin diagnóstico de IC. Se efectuó un análisis de sobrevida de los diferentes grupos. Resultados: La prevalencia de ICFER fue 8%, ICFEP por HFA-PEFF 42% y por H2FPEF 8%. Los algoritmos sugieren efectuar un estudio complementario en el 47% con HFA-PEFF y 76% con H2FPEF (p<0.05). La sobrevida global a 36 meses fue 90±2% y cardiovascular 95±1%. Usando HFA-PEFF, los pacientes con IC tuvieron menor sobrevida que aquellos sin IC (HR 2.3, IC95% 1.14.9; p=0.029). No hubo diferencias de mortalidad con H2FPEF. Conclusiones: En pacientes de APS que consultan por disnea y/o edema de extremidades inferiores sometidos a evaluación con NT-proBNP y ecocardiografía, se observó una prevalencia de IC de hasta 50%, 8% de ICFER y 42% de ICFEP. La caracterización de IC utilizando HFA-PEFF está asociada al pronóstico vital.
Background: Heart failure (HF) is a condition associated with high morbidity and mortality. Its early diagnosis in primary health care (PHC) represents a substantial challenge, considering its non-specific clinical manifestations and the limitations on timely access to diagnostic techniques. Objective: To evaluate the prevalence of HF, characterize subtypes and determine the prognosis of patients consulting in PHC for dyspnea Edema of the lower extremities. Methods: Prospective study in 340 patients who consulted in PHC, without previous diagnosis of HF. Clinical evaluation, electrocardiogram, NT-proBNP point-ofcare and echocardiography with telematic interpretation by cardiologists were performed. Using the HFA-PEFF and H2FPEF algorithms patients were classified as: 1) HF with reduced ejection fraction (HFREF); 2) HF with preserved ejection fraction (HFPEF) and 3) No HF. Actuarial survival analyses were performed. Results: We observed a prevalence of HFREF of 8%, high probability of HFPEF by HFA-PEFF in 42% and by H2FPEF in 8%. Intermediate probability of HFPEF, requiring complementary study, was observed in 47% of patients with HFA-PEFF and 76% of patients with H2FPEF (p<0.05). Overall survival at 36 months was 90±2% and cardiovascular survival at 36 months was 95±1%. Using HFA-PEFF, patients with HF presented lower overall survival compared to patients with no HF (HR 2.3, 95%CI 1.1-4.9; p=0.029). We did not observe mortality differences with H2FPEF. Conclusions: In patients consulting for dyspnea and/or lower extremity edema at PHC and undergoing evaluation with NT-proBNP and echocardiography, we observed a HF prevalence of 50%. HF classification through HFA-PEFF was associated with lower survival rates.
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Humanos , Masculino , Femenino , Anciano , Atención Primaria de Salud , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Pronóstico , Volumen Sistólico , Análisis de Supervivencia , Chile , Prevalencia , Péptido Natriurético Encefálico/análisis , Insuficiencia Cardíaca/clasificaciónRESUMEN
Introducción: El término MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) ha cobrado relevancia como diagnóstico de trabajo en el contexto de pacientes con sospecha de isquemia miocárdica y estudio coronario sin lesiones obstructivas. Objetivos: Describir las distintas etiologías y variables clínicas de pacientes con MINOCA hospitalizados en la unidad coronaria de nuestro centro (Hospital de la P Universalidad de Chile) Métodos: Estudio observacional retrospectivo en el que se realizó un análisis descriptivo de las variables estudiadas. Además, se analizó el uso de los métodos de imágenes complementarios y otras variables pronósticas. El seguimiento se realizó dentro del primer año posterior al evento. Resultados: El diagnóstico etiológico más frecuente de los pacientes con MINOCA fue el de miocardiopatía por estrés (MCE). Se incluyeron 55 pacientes, 55% de ellos mujeres. La edad promedio fue 57 años y la frecuencia de factores de riesgo cardiovascular clásicos (FRCV) fue baja. En los pacientes con MCE se observó menores niveles de troponina ultrasensible; mayores niveles de NT-proBNP y mayor mortalidad en comparación a otras etiologías. Conclusiones: El perfil de pacientes con MINOCA hospitalizados en nuestro centro correspondió predominantemente a mujeres postmenopáusicas con baja frecuencia de FRCV. La mortalidad de los pacientes con MINOCA se concentró en el grupo con MCE.
Background: MINOCA (acronym for "Myocardial Infarction with Non-Obstructive Coronary Arteries") is relevant as a working guide in the diagnosis of patients with suspicion of ischemia and absence of obstructive coronary artery disease. Aim: to describe the different causes and clinical variables in patients with MINOCA admitted to a coronary care unit of a University hospital in Santiago, Chile. Methods: this is an observational retrospective analysis of relevant clinical variables in 55 patients finally diagnosed as having MINOCA. Use of image based studies and characteristics related to prognosis were also analyzed. Follow up extended for one year after the event. Results: 55 patients were included, 55% of them women. Mean age was 57 years; presence of traditional risk factors for myocardial infarction was low. The most common eventual etiologic diagnosis was Stress Cardiomyopathy (SCM) in which lower levels of ultrasensitive troponin and higher levels of NT-proBNP were observed. Mortality in SCM was higher than that observed in other etiologies. Conclusion: MINOCA was more frequent in post menopausal women. Mortality was greater in patients with SMC.
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Humanos , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Pronóstico , Troponina/análisis , Estudios Retrospectivos , Análisis de Varianza , Péptido Natriurético Encefálico/análisis , Tomografía de Coherencia Óptica , Infarto del Miocardio/etiologíaRESUMEN
ABSTRACT: Angiotensin (Ang)-(1-7) is a cardioprotective peptide of the renin-angiotensin system. Prepuberty has been considered as a later susceptible window of development, and stressful factors in this life phase can induce chronic diseases in adulthood. We aimed to investigate whether the treatment with Ang-(1-7) during the prepuberty could attenuate the development of hypertension and cardiac injury in adult spontaneously hypertensive rats (SHRs). SHRs were treated with Ang-(1-7) (24 µg/kg/h) from age 4 to 7 weeks. Systolic blood pressure was measured by tail-cuff plethysmography up to 17th week. Thereafter, echocardiography was performed, and the rats were euthanized for the collection of tissues and blood. Ang-(1-7) did not change the systolic blood pressure but reduced the septal and posterior wall thickness, and cardiomyocyte hypertrophy and fibrosis in SHR. In addition, Ang-(1-7) reduced the gene expression of atrial natriuretic peptide and brain natriuretic peptide, increased the metalloproteinase 9 expression, and reduced the extracellular signal-regulated kinases 1/2 phosphorylation. Ang-(1-7) also prevented the reduction of Mas receptor but did not change the protein expression of angiotensin-converting enzyme, angiotensin-converting enzyme 2, AT1, and AT2. The treatment with Ang-(1-7) decreased the malondialdehyde (MDA) levels and increased superoxide dismutase-1 and catalase activities and protein expression of catalase. Our findings demonstrate that the treatment of SHR with Ang-(1-7) for 3 weeks early in life promotes beneficial effects in the heart later in life, even without altering blood pressure, through mechanisms involving the reduction of oxidative stress and ERK1/2 phosphorylation. In addition, this study supports the prepuberty as an important programming window.
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Angiotensina I , Presión Sanguínea , Cardiomegalia , Hipertensión , Estrés Oxidativo , Fragmentos de Péptidos , Ratas Endogámicas SHR , Animales , Angiotensina I/farmacología , Fragmentos de Péptidos/farmacología , Masculino , Hipertensión/fisiopatología , Hipertensión/tratamiento farmacológico , Hipertensión/prevención & control , Cardiomegalia/prevención & control , Cardiomegalia/fisiopatología , Cardiomegalia/metabolismo , Cardiomegalia/tratamiento farmacológico , Cardiomegalia/patología , Estrés Oxidativo/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Fibrosis , Modelos Animales de Enfermedad , Ratas , Fosforilación , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/patología , Miocitos Cardíacos/metabolismo , Péptido Natriurético Encefálico/metabolismo , Factores de Edad , Metaloproteinasa 9 de la Matriz/metabolismo , Factor Natriurético Atrial/metabolismo , Antihipertensivos/farmacología , Remodelación Ventricular/efectos de los fármacosRESUMEN
Background: Pan-immuno-inflammation value (PIV) is a new and comprehensive index that reflects both the immune response and systemic inflammation in the body. Objective: The aim of this study was to investigate the prognostic relevance of PIV in predicting in-hospital mortality in acute pulmonary embolism (PE) patients and to compare it with the well-known risk scoring system, PE severity index (PESI), which is commonly used for a short-term mortality prediction in such patients. Methods: In total, 373 acute PE patients diagnosed with contrast-enhanced computed tomography were included in the study. Detailed cardiac evaluation of each patient was performed and PESI and PIV were calculated. Results: In total, 60 patients died during their hospital stay. The multivariable logistic regression analysis revealed that baseline heart rate, N-terminal pro-B-type natriuretic peptide, lactate dehydrogenase, PIV, and PESI were independent risk factors for in-hospital mortality in acute PE patients. When comparing with PESI, PIV was non-inferior in terms of predicting the survival status in patients with acute PE. Conclusion: In our study, we found that the PIV was statistically significant in predicting in-hospital mortality in acute PE patients and was non-inferior to the PESI.
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Mortalidad Hospitalaria , Inflamación , Embolia Pulmonar , Índice de Severidad de la Enfermedad , Humanos , Embolia Pulmonar/mortalidad , Masculino , Femenino , Anciano , Persona de Mediana Edad , Enfermedad Aguda , Pronóstico , Factores de Riesgo , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , L-Lactato Deshidrogenasa/sangre , Biomarcadores , Valor Predictivo de las Pruebas , Modelos LogísticosRESUMEN
INTRODUCTION: In cardiorenal syndrome type 1 (CRS1), vascular congestion is central to the pathophysiology of heart failure and thus a key target for management. The venous evaluation by ultrasound (VExUS) system could guide decongestion effectively and thereby improve outcomes. METHODS: In this randomized clinical trial, patients with CRS1 (i.e., increase in creatinine ≥0.3 mg/dL) were randomized to guide decongestion with VExUS compared to usual clinical evaluation. The primary endpoint was to assess kidney function recovery (KFR), and the key secondary endpoint was decongestion evaluated by physical examination and changes in brain natriuretic peptide (BNP) and CA-125. Exploratory endpoints included days of hospitalization and mortality. RESULTS: From March 2022 to February 2023, a total of 140 patients were randomized 1:1 (70 in the VExUS and 70 in the control group). KFR was not statistically different between groups. However, VExUS improved more than twice the odds to achieve decongestion (odds ratio [OR]: 2.6, 95% CI: 1.9-3.0, p = 0.01) and the odds to reach a decrease of BNP >30% (OR: 2.4, 95% CI: 1.3-4.1, p = 0.01). The survival at 90 days, recongestion, and CA-125 were similar between groups. CONCLUSION: In patients with CRS1, we observed that VExUS-guided decongestion did not improve the probability of KFR but improved the odds to achieve decongestion.
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Síndrome Cardiorrenal , Insuficiencia Cardíaca , Humanos , Diuréticos , Recuperación de la Función , Riñón/diagnóstico por imagen , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/diagnóstico , Péptido Natriurético EncefálicoRESUMEN
BACKGROUND: Chagas disease, endemic in Latin America and spreading globally due to emigration, has a significant health burden, particularly in relation to chagasic heart failure (HF). Chagasic cardiomyopathy (CCM) is characterized by chronic inflammatory myocardial disease. This study aimed to identify inflammatory parameters and biomarkers that could aid in the management of patients with chagasic HF. METHODS AND FINDINGS: A cohort study was conducted at a tertiary cardiology single-center over a mean follow-up period of 2.4 years. The study included patients with HF secondary to CCM enrolled between October 2013 and July 2017. Various clinical parameters, echocardiography findings, parasitemia status, brain natriuretic peptide (BNP) and troponin T (TnT) levels, and inflammatory biomarkers (IL-6, IL-10, IL-12p70, IL-17A, adiponectin, and IFN-γ) were assessed. The study encompassed a cohort of 103 patients, with a median age of 53 years and 70% being male. The left ventricular ejection fraction (LVEF) was 28%, with 40% of patients classified as NYHA II functional class. The median BNP level was 291 pg/ml. The observed mortality rate during the study period was 38.8%. Predictors of lower survival were identified as elevated levels of BNP, TnT, reduced LVEF, and increased adiponectin (thresholds: BNP > 309 pg/ml, TnT > 27.5 ng/ml, LVEF < 25.5%, adiponectin > 38 µg/mL). Notably, there was no evidence indicating a relationship between parasitemia and the inflammatory parameters with lower survival in these patients, including INF-γ, IL-6, IL-10, IL12-(p70), and IL17a. CONCLUSION: Despite the presence of a chronic inflammatory process, the evaluated inflammatory biomarkers in this cohort were not predictive of survival in patients with chagasic HF with reduced ejection fraction (HFrEF). However, reduced LVEF, elevated BNP, adiponectin levels, and troponin T were identified as predictors of lower survival in these patients.
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Cardiomiopatía Chagásica , Insuficiencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Femenino , Insuficiencia Cardíaca/epidemiología , Volumen Sistólico , Interleucina-10 , Función Ventricular Izquierda , Estudios de Cohortes , Troponina T , Adiponectina , Interleucina-6 , Parasitemia , Biomarcadores , Péptido Natriurético Encefálico , PronósticoRESUMEN
The complex, heterogeneous, and dynamic interaction between the interstitial and intravascular fluid compartments is one of the main reasons for the wide variability in the distribution and severity of congestion among patients with acute heart failure. The "hemodynamic congestion" often goes undetected clinically; as opposed to "clinical congestion", which occurs later and is evidenced by dyspnea and orthopnea, rales, peripheral edema, and jugular venous distension. Clinical signs, chest X-ray, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), central venous pressure (CVP), echocardiogram, inferior vena cava (IVC) diameter, and pulmonary wedge pressure are the most commonly used elements to assess congestion. Other alternatives are pulmonary and visceral ultrasound (VEXUS), CA 125 and other markers, and recently, the CardioMems system.
La interacción compleja, heterogénea y dinámica entre los compartimentos de líquido intersticial e intravascular es una de las principales razones que explican la amplia variabilidad en la distribución y gravedad de la congestión entre los pacientes con insuficiencia cardíaca descompensada. La "congestión hemodinámica" suele pasar desapercibida clínicamente; en oposición a la "congestión clínica", que ocurre más tarde y se evidencia por disnea y ortopnea, estertores pulmonares, edema periférico y distensión venosa yugular. Los signos clínicos, la radiografía de tórax, el péptido natriurético cerebral (brain natriuretic peptide o BNP) o la porción terminal N del pro BNP (NT-proBNP), la presión venosa central (PVC), el ecocardiograma, el diámetro de la vena cava inferior (VCI) y la presión de enclavamiento pulmonar son los elementos más utilizados para evaluar la congestión. Otras alternativas son el ultrasonido pulmonar y visceral (VEXUS), el CA 125 y otros marcadores y, recientemente, el sistema CardioMems.
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Insuficiencia Cardíaca , Humanos , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Péptido Natriurético Encefálico , Edema , Ultrasonografía , Ecocardiografía , Disnea/etiología , Fragmentos de PéptidosRESUMEN
This research investigated the predictive value of combined detection of brain natriuretic peptide (BNP) and cystatin C (Cys C) in heart failure after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Sixty-five AMI patients complicated by heart failure (HF) after PCI and 79 non-heart failure (non-HF) patients were involved in this research. The levels of Cys C and BNP were measured. Risk factors for heart failure in AMI patients after PCI were analyzed by multivariate logistic regression analysis. Efficacy of BNP and Cys C on predicting heart failure were analyzed by receiver operating characteristic (ROC) curve. Cys C and BNP levels were significantly higher in the HF group than in the non-HF group. BNP and Cys C levels were the independent influencing factors causing heart failure within one year after PCI. The area under the predicted curve (AUC) of Cys C, BNP, and combined Cys C and BNP were 0.763, 0.829, and 0.893, respectively. The combined detection of Cys C and BNP was highly valuable in predicting heart failure in AMI patients after PCI, which can be regarded as the serum markers for diagnosis and treatment of heart failure.
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Insuficiencia Cardíaca , Infarto del Miocardio , Intervención Coronaria Percutánea , Humanos , Péptido Natriurético Encefálico , Intervención Coronaria Percutánea/efectos adversos , Cistatina C , Valor Predictivo de las Pruebas , Infarto del Miocardio/diagnóstico , BiomarcadoresRESUMEN
OBJECTIVE: To describe our experience with treprostinil, evaluate correlations with cardiac function, and assess for adverse effects in neonates with congenital diaphragmatic hernia-related pulmonary hypertension (CDH-PH). STUDY DESIGN: A retrospective review of a single-center prospective registry at a quaternary care children's hospital. Patients included in the study had CDH-PH treated with treprostinil between April 2013 and September 2021. Assessed outcomes were brain-type natriuretic peptide levels and quantitative echocardiographic parameters collected at baseline, 1 week, 2 weeks, and 1 month after treprostinil initiation. Right ventricular (RV) function was assessed by tricuspid annular plane systolic excursion Z-score and speckle tracking echocardiography (global longitudinal and free wall strain). Septal position and left ventricular (LV) compression were assessed by eccentricity index and M-mode Z-scores. RESULTS: Fifty-one patients were included, with an average expected/observed lung-to-head ratio of 28.4 ± 9.0%. Most patients required extra-corporeal membrane oxygenation (n = 45, 88%). Survival to hospital discharge was 31/49 (63%). Treprostinil was initiated at a median age of 19 days with a median effective dose of 34 ng/kg/minute. Median baseline brain-type natriuretic peptide level decreased from 416.9 pg/mL to 120.5 pg/mL after 1 month. Treprostinil was associated with improved tricuspid annular plane systolic excursion Z-score, RV global longitudinal strain, RV free wall strain, LV eccentricity index, and LV diastolic and systolic dimensions, reflecting less compression by the RV, regardless of ultimate patient survival. No serious adverse effects were recorded. CONCLUSIONS: In neonates with CDH-PH, treprostinil administration is well tolerated and is associated with improved RV size and function.
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Antihipertensivos , Epoprostenol , Hernias Diafragmáticas Congénitas , Hipertensión Pulmonar , Humanos , Antihipertensivos/uso terapéutico , Epoprostenol/uso terapéutico , Masculino , Femenino , Hernias Diafragmáticas Congénitas/tratamiento farmacológico , Hipertensión Pulmonar/tratamiento farmacológico , Estudios Retrospectivos , Recién Nacido , Péptido Natriurético Encefálico/sangre , Resultado del TratamientoRESUMEN
BACKGROUND: Sodium restriction is recommended for patients with heart failure (HF) despite the lack of solid clinical evidence from randomized controlled trials. Whether or not sodium restrictions provide beneficial cardiac effects is not known. METHODS: The present study is a randomized, double-blind, controlled trial of stable HF patients with ejection fraction ≤ 40%. Patients were allocated to sodium restriction (2 g of sodium/day) vs. control (3 g of sodium/day). The primary outcome was change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 20 weeks. Secondary outcomes included quality of life and adverse safety events (HF readmission, blood pressure or electrolyte abnormalities). RESULTS: Seventy patients were enrolled. Median baseline sodium consumption was 3268 (2225-4537) mg/day. Adherence to the intervention based on 24-hour urinary sodium was 32%. NT-proBNP and quality of life did not significantly change between groups (p > 0.05 for both). Adverse safety events were not significantly different between the arms (p > 0.6 for all). In the per protocol analysis, patients who achieved a sodium intake < 2500 mg/day at the intervention conclusion showed improvements in NT-proBNP levels (between-group difference: -55%, 95% confidence interval -27 to -73%; p = 0.002) and quality of life (between-group difference: -11 ± 5 points; p = 0.04). Blood pressure decreased in patients with lower sodium intake (between-group difference: -9 ± 5 mmHg; p = 0.05) without significant differences in symptomatic hypotension or other safety events (p > 0.3 for all). CONCLUSIONS: Adherence assessed by 24-hour natriuresis and by the nutritionist was poor. The group allocated to sodium restriction did not show improvement in NT-proBNP. However, patients who achieved a sodium intake < 2500 mg/day appeared to have improvements in NT-proBNP and quality of life without any adverse safety signals. CLINICALTRIALS: gov Identifier: NCT03351283.
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Insuficiencia Cardíaca , Sodio en la Dieta , Humanos , Biomarcadores , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Péptido Natriurético Encefálico , Fragmentos de Péptidos , Calidad de Vida , Sodio , Volumen Sistólico/fisiologíaRESUMEN
CONTEXTO: La insuficiencia cardiaca aguda (ICA), se define como la aparición rápida o gradual de signos o síntomas de insuficiencia cardiaca (IC), lo bastante graves para que la persona necesite atención médica urgente que lleva al ingreso hospitalario no planificado o a la atención en el servicio de urgencias. Las personas con ICA, requieren evaluación urgente y el inicio o la intensificación del tratamiento, incluidos fármacos intravenosos y procedimientos. La ICA es la mayor causa de hospitalizaciones de personas de más de 65 años y se asocia con tasas elevadas de muerte y reingreso. La mortalidad hospitalaria varía entre el 4 y el 10%1 2 3 4. La mortalidad al año, después del alta, puede ser del 25 al 30%, con tasa de reingreso superior a 45%1 2 3 31. La ICA se puede presentar como una primera manifestación de la IC (de novo) o, más frecuentemente, como consecuencia de una descompensación aguda de la IC crónica. Comparados con pacientes con descompensación aguda de la IC crónica, pacientes con IC de nueva aparición pueden tener una tasa más alta de mortalidad hospitalaria1 , pero las tasas de mortalidad y reingresos después del alta son más bajas1 4 6 7. Factores extrínsecos pueden precipitar, pero no causar, la ICA en pacientes con disfunción cardiaca preexistente. La gravedad clínica y la evolución en el hospital están determinadas por la compleja interacción entre los factores precipitantes, el sustrato cardiaco y las comorbilidades de pacientes. El proceso diagnóstico de la ICA comienza en el momento del primer contacto médico y continúa durante las fases iniciales, a efectos de identificar la presentación clínica, diagnosticar y tratar en el momento oportuno las posibles causas, los factores desencadenantes y las comorbilidades que pudieran suponer riesgo para la vida. Además de los signos clínicos, el proceso diagnóstico incluye ECG y la ecocardiografía, siempre que sea posible. Pueden hacerse pruebas adicionales como radiografía de tórax y ecografía pulmonar para confirmar el diagnóstico de ICA. Se deben medir las concentraciones plasmáticas de péptido natriurético (BNP, NT-proBNP o MR-proANP) cuando el diagnóstico sea incierto. Se pueden describir cuatro presentaciones clínicas con algunos solapamientos entre ellas 1 13 14: 1. Insuficiencia cardiaca en descompensación aguda 2. Edema pulmonar agudo 3. Insuficiencia ventricular derecha aislada 4. Choque cardiogênico. El tratamiento se puede subdividir en 3 etapas diferentes (prehospitalaria, hospitalaria y antes del alta), que tienen distintos objetivos y requieren distintas estrategias terapéuticas. MÉTODOS: Para dar respuesta a la pregunta propuesta, se realizó una búsqueda sistemática en las bases de datos de Pubmed, CENTRAL (Cochrane), y de la Biblioteca Médica de Salud (BVS), utilizando tesauros (MeSH), así como términos libres sin limitaciones por edad, sexo, año de publicación, tipo de estudio, ni idioma. De manera adicional, se empleó Google Académico para la búsqueda de información económica. Se usaron las siguientes palabras clave: acute heart failure, acute descompensated heart failure, insuficiencia cardiaca aguda, insuficiencia cardiaca crónica descompensada, nesiritida, natriuretic peptide, nesiritida, análogo de péptido natriurético humano. Para los aspectos económicos se utilizaron los siguientes términos: acute heart failure, nesiritida, cost analysis, cost effectiveness, cost utility, cost benefit, economic evaluation, budget impact, health technology assessment. RESULTADOS: Cuatro ensayos clínicos mostraron en sus resultados que no existe diferencia estadísticamente significativa de uso de nesiritida en la mortalidad en los distintos puntos de corte de los diferentes ensayos (9, 30, 60 y 180 días), siendo estas comparaciones contra terapia convencional o placebo, en pacientes mayores de 18 años con ICA. El ranking de medicamentos de la revisión sistemática con metaanálisis en red, mostró la inferioridad de nesiritida, respecto a la mortalidad por todas las causas a los 30 días, frente a omecamtiv, mecarbil, conivaptan, clorotiazida, KW-3902. Nesiritida no mostró superioridad ante placebo. Un ensayo clínico realizó el análisis de la mortalidad en un desenlace compuesto con rehospitalización, no encontrando diferencias estadísticamente significativas a favor de la intervención frente a placebo. Al analizarse, en otro ensayo clínico, la readmisión a los 3 meses, tanto solo como en combinación con levosimendan, no hubo diferencias estadísticamente significativas al comprarse contra placebo. Por último, de acuerdo a la revisión sistemática con metaanálisis en red, la comparación de nesiritida contra placebo, ularitida, tolvaptan, omecamtiv mecarbil, y TRV027, no demuestra diferencias estadísticamente significativas entre ellos. Un ensayo clínico evaluó la mejoría clínica como desenlace compuesto a los 9 días (decremento de uno a más clases desde las líneas basales [disnea, congestión pulmonar, edema o clase funcional de la NYHA], el tratamiento fue considerado como efectivo si ocurría mejoría en uno o más parámetros, mientras los demás parámetros se mantenían sin cambios y la terapia no fuese modificada por adición de diuréticos o apoyos hemodinámicos farmacológicos de otro tipo), no encontrando diferencias estadísticamente significativas al compararse contra placebo. El uso de nesiritida estuvo relacionado a una tasa mayor de hipotensión sintomática y asintomática, contra placebo, pero no en episodios de hipotensión grave. Se presentó un aumento de falla al tratamiento contra placebo en pacientes con ICA y disfunción renal con FEp. CONCLUSIONES: Nuestro análisis demuestra la poca eficacia de nesiritida en los desenlaces evaluados, agregado a un aumento de reacciones adversas, especialmente hipotensión, tanto sintomática como asintomática, aunque, al parecer, no en hipotensión grave. Aunque se observó mejoría clínica de acuerdo a la escala MRC, esta escala fue realizada por el grupo investigador, sin verificación por pares, por lo que la escala podría no tener validez, además de que los parámetros usados para determinar cada categoría son confusos y traslapables. Al observar la nula superioridad del medicamento frente a placebo en desenlaces tan relevantes como mortalidad o mejoría en el deterioro renal, se recomienda considerar a nesiritida como una terapia poco eficaz, clínicamente hablando. Por último, a pesar que no se demostró hipotensión grave, las y los pacientes, incluidos en los estudios, siempre se mantuvieron con PAS superior a 100, por lo que el uso en pacientes hipotensos podría ser peligroso.