Publication: Situación actual de la insuficiencia cardiaca con fracción de eyección del ventrículo izquierdo preservada en un hospital general nivel 2
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2015-05-28
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Universidad Complutense de Madrid
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Abstract
"Introducción": La fracción de eyección del ventrículo izquierdo (FEVI) se ha propuesto como elemento diferenciador del síndrome de la IC en dos entidades distintas, entendiendo que los pacientes en IC con FEVI preservada (IC FEP) presentan unas características clínicas y pronósticas específicas. "Objetivo": El objetivo de este estudio fue describir las características clínico-epidemiológicas e identificar los principales factores pronósticos relacionados con la rehospitalización por IC y mortalidad al año de pacientes hospitalizados por IC FEP en un hospital general nivel 2." Metodología y resultados": Estudio observacional y prospectivo en el que se incluyeron de forma consecutiva 154 pacientes hospitalizados con diagnóstico de IC FEP, según las clasificaciones vigentes, entre mayo de 2011 y mayo de 2012 en el Hospital Universitario Fundación Alcorcón. Durante un periodo de seguimiento de un año, se recogieron los datos relacionados con la mortalidad por cualquier causa y/o la rehospitalización por IC de estos pacientes. La edad media (DE) fue 81 (9) años, con un mayor porcentaje de ingresos en Medicina Interna. El 63% de los pacientes fueron mujeres. El 87% eran hipertensos, el 53,8% tenían antecedentes de fibrilación auricular y el 53,2% anemia. La mortalidad al año fue del 24%. En el análisis de regresión logística se identificaron tres predictores independientes de mortalidad: la edad superior a 80 años (OR 5,59; 1,60-22,48 IC 95%, p = 0,008), niveles de NT proBNP superiores a la mediana (OR 5,36; 1,84-15,65 IC 95%, p = 0,002) y la necesidad de soporte crónico con oxigenoterapia domiciliaria (OR 4,19; 1,51-11,59 IC 95%, p = 0,006). En el modelo predictivo de regresión de Cox, entre los pacientes sin historia de ingresos previos por IC, sólo se asoció a un mayor riesgo de rehospitalización por IC la determinación plasmática de NT proBNP superior a 1822,5 ng/l (HR 3,67; 1,22 – 11,05 IC 95%, p = 0,021)." Conclusiones": La IC FEP es frecuente entre pacientes octogenarios, en los que la edad, la elevación plasmática del NT proBNP y la necesidad de soporte crónico con oxigenoterapia se asocian a mal pronóstico al año de seguimiento.
"Background": The left ventricle ejection fraction (LVEF) has been proposed as a defining trait of heart failure (HF) in two different clinical entities. Hospitalized patients for heart failure with preserved ejection fraction (HF PEF) present a specific profile. "Aims": The aims of this study were to describe the main features of hospitalized patients for HF PEF and to identify the prognostic factors related to mortality or readmission for HF. "Methods and results": We prospectively evaluated 154 consecutive patients hospitalized for HF PEF (LVEF ≥50%) in a secondary hospital between 2011 and 2012. All patients were followed for one year after discharge. Data related to HF rehospitalization and/or to all-cause mortality were collected during this period. Average patient age was 81 and 63% were women. Anaemia, hypertension and atrial fibrillation were the most prevalent comorbidities among these patients. The mortality rate was 24%. In multivariable analysis, age over 80 years (OR 5.59; 1.60-22.48 CI 95%, p = 0.008), plasma N-terminal brain natriuretic peptide (NT proBNP) higher than the median (OR 5.36; 1.84-15.65 CI 95%, p = 0.002) and the need of chronic oxygen therapy (OR 4.19; 1.51-11.59 CI 95%, p = 0.006) were associated with a higher risk of death. Out of the 82 patients without a prior history of HF, the Cox regression model indentified plasma levels of NT proBNP higher than 1822.5ng/l (HR 3.67; 1.22-11.05 CI 95%, p = 0.021) as the single most important independent predictor of readmission for HF. "Conclusions": HF PEF is common among octogenarians. Age, increased plasma levels of NT proBNP and long-term supplemental oxygen therapy are related to poor prognosis at follow up
"Background": The left ventricle ejection fraction (LVEF) has been proposed as a defining trait of heart failure (HF) in two different clinical entities. Hospitalized patients for heart failure with preserved ejection fraction (HF PEF) present a specific profile. "Aims": The aims of this study were to describe the main features of hospitalized patients for HF PEF and to identify the prognostic factors related to mortality or readmission for HF. "Methods and results": We prospectively evaluated 154 consecutive patients hospitalized for HF PEF (LVEF ≥50%) in a secondary hospital between 2011 and 2012. All patients were followed for one year after discharge. Data related to HF rehospitalization and/or to all-cause mortality were collected during this period. Average patient age was 81 and 63% were women. Anaemia, hypertension and atrial fibrillation were the most prevalent comorbidities among these patients. The mortality rate was 24%. In multivariable analysis, age over 80 years (OR 5.59; 1.60-22.48 CI 95%, p = 0.008), plasma N-terminal brain natriuretic peptide (NT proBNP) higher than the median (OR 5.36; 1.84-15.65 CI 95%, p = 0.002) and the need of chronic oxygen therapy (OR 4.19; 1.51-11.59 CI 95%, p = 0.006) were associated with a higher risk of death. Out of the 82 patients without a prior history of HF, the Cox regression model indentified plasma levels of NT proBNP higher than 1822.5ng/l (HR 3.67; 1.22-11.05 CI 95%, p = 0.021) as the single most important independent predictor of readmission for HF. "Conclusions": HF PEF is common among octogenarians. Age, increased plasma levels of NT proBNP and long-term supplemental oxygen therapy are related to poor prognosis at follow up
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 15-09-2014