[Inconsistency between voltage of the electrocardiogram and the left ventricular wall thickness. diagnostic key in cardiac amyloidosis]

Restrictive cardiomyopathy is the least common form of cardiomyopathy, and the disease that most often cause it, is the system amyloidosis. We present a 62-year-old with a history of heart failure, which in its assessment highlights the discrepancy between the low voltage ventricular complexes in the electrocardiogram and the severity of left ventricular wall thickness on echocardiography. This discrepancy was the source of suspicion and subsequent confirmation of systemic amyloidosis with cardiac involvement.

[Stroke. are there any difference between patients with or without patent foramen ovale in left atrial appendage systolic function?]

INTRODUCTION

The aim of this study was to evaluate the systolic function of the left atrial appendage (LAA) in a group with and without patent foramen ovale (PFO) who suffered ischemic cerebrovascular events.

MATERIAL AND METHODS

Between September 2010 and October 2011, 17 patients were referred for transesophageal echocardiography (TEE) after suffering a stroke. PFO was defined as the passage of at least one bubble through atrial septum with bubble test. We compared systolic velocity in the appendage between patients with and without PFO and a control group.

RESULTS

Were 8 women and 9 men, mean age 54.1 ± 19.5 years and 8 patients were under 55 years of age. All patients had suffered a ischemic cerebrovascular events, 41.2% had stroke, 52.9% transient ischemic attack and amaurosis fugax 5.9%. In the assessment of TEE, 11.8% had atrial septal aneurysm and 35.3% PFO. Mean LAA systolic velocity was 66.3 ± 20.3 cm / sec. There was no difference in systolic velocity of the LAA between patients with and without PFO (67.5 ± 11.8 cm / sec vs 65.7 ± 24.3 cm / sec respectively, p = 0.87). The control group of 8 patients, 5 women and 3 men, mean age 39.5 ± 18 years, had a LAA systolic velocity of 77.6 ± 28.9 cm / sec, no significant differences with ischemic patients.

CONCLUSION

There were no differences in systolic function of the LAA between patients with and without PFO with ischemic cerebrovascular event.

[Temporary occlusion of atrial septal defect in the Lutembacher syndrome]

We report the case of an 82 year-old woman with symptoms of advanced heart failure and pulmonary arterial hypertension. An echocardiogram showed an ostium secundum type atrial septal defect and concomitant mitral valve stenosis (Lutembacher syndrome). Echocardiographic assessment of mitral pathology was hampered by the interatrial septal defect. Transient percutaneous occlusion test of the atrial septal defect was performed and severe mitral valve stenosis was detected. Atrial septal defect size modified the clinical manifestations and the transient occlusion test helped to decide the therapeutic strategy.

[Atrial fibrillation in postoperative cardiac surgery. Prevalence and hospitalized period]

Atrial fibrillation is the most common heart rhythm disorder after cardiac surgery. In previous studies it has been associated with prolonged hospitalization, increased costs and mortality. This study aimed to determine the prevalence of postoperative atrial fibrillation in cardiac surgery and its impact on the hospitalization period. Medical records of consecutive patients undergoing cardiac surgery (coronary artery bypass graft, valvular, or both) between January 2006 and November 2008 were included and retrospectively analyzed. Primary outcome was the presence of postoperative atrial fibrillation. The sample was divided into two groups, with and without atrial fibrillation in the postoperative. The clinical variables and length of hospital stay were compared between both groups. A total of 172 patients underwent surgery in this period. Seven patients were excluded from analysis due to lack of data. The mean age was 64.2 +/- 9.5 years, and they were predominantly male. Atrial fibrillation was the most common complication (23.6%). The average length hospital stay was 6.7 +/- 4.6 days. There were no significant differences between both groups, with atrial fibrillation (7.5 +/- 4.1 days), and without (6.5 +/- 4.7 days), p = 0.21. The presence of atrial fibrillation did not prolong hospitalization. Probably, such strategy of prevention would not be cost-effective.

[Euroscore system validation for cardiac surgery in Cordoba city]

BACKGROUND

We recommend the use of models to estimate mortality hospital risk in cardiac surgery (CC). The aim of this study was to validate a risk stratification system, widely used as the EuroSCORE (ES), in our institution.

MATERIAL AND METHODS

We retrospectively analyzed the records of patients undergoing CC consecutively between January 2006 and November 2008. The ES was calculated retrospectively based on data from medical records. Mortality was considered until the time of discharge. In all patients, the ES was calculated by logistic and additive. To study the validity of the model, we analyzed their ability to calibration and discrimination through the goodness of fit test of Hosmer and Lemeshow and area under the ROC curve, respectively.

RESULTS

153 patients were included, mean age 64.1 ± 9.5 years, 77.8% men. The CRM was 60.8%, 24.8% and 14.4% valvular surgery combined (bypass + valve). Overall mortality was 3.9%. The area under the curve of the logistic model was 0.87 and the Hosmer Lemeshow test was 0.84. The area under the curve of the additive model was 0.86 and the Hosmer Lemeshow test was p = 0.89. A score greater than 7 points is additive had a sensitivity of 66% and 91,5% specificity for predicting hospital mortality.

CONCLUSION

The ES is a useful model and can be used to estimate the risk of hospital mortality in CC in the city of Cordoba.

[Clinical characteristics and tilt test of patients with vasovagal syncope suspicion]

BACKGROUND

Vasovagal syncope is the most common cause of syncope and is an amount medical, social and economic problem.

MATERIAL AND METHODS

We study a population of patients with history of syncope of presumed vasovagal origin submitted to head-up tilt test (TT) with intention to describe and to compare symptoms, signs and trigger situations between positive and negative TT. Twenty four variables were investigated (chosen according to the clinical experience).

RESULTS

One hundred thirteen patients were included. The age mean was 33,3 ± 19,4 years and 67.3% corresponded to women. 81 patients (71,7%) experienced syncope during test. The more frequent response was mixed subtype (58 %), followed by vasodepressor response (30,9%) and cardioinhibitory response (11,1%). There were not significant differences between both groups in symptoms, signs and trigger situations. In patients with negative TT was more frequent syncopes triggered by extreme exercise (p = 0,012).

CONCLUSION

In patients with vasovagal syncope suspicion, a clinic history does not predict TT results.