Altération de la variabilité sinusale chez les malades en hémodialyse chronique

Background and aim

Decrease in heart rate variability (HRV) is a known risk factor for cardiovascular morbidity and mortality. The aim of our study is to evaluate HRV in chronic hemodialysis patients and to determine factors that might decrease or increase it.

Methods

This is a retrospective study including 51 patients, 23 males and 28 females, with a mean of age of 64.5 years (23-84 years) on chronic hemodialysis for end stage renal disease due to various causes. Twenty-four-hour heart rate monitoring was recorded in all patients to evaluate HRV. HRV of hemodialysis patients was compared to normal patients (control). We also looked for correlation between HRV and a number of clinical and biological factors.

Results

All HRV parameters were decreased in chronic hemodialysis patients compared to normal controls with a significant difference (p < 0.0005). HRV decreases with age (p = 0.012), and is lower in diabetic patients (p = 0.026). Interestingly, we found that chronic hemodialysis patients on beta-blockers had higher HRV with p = 0.011.

Conclusion

HRV is reduced in chronic hemodialysis patients mainly in old and diabetic patients, but this decrease is less important in those receiving beta-blockers.     

Évaluation du risque hémorragique de différents protocoles d’anticoagulation péri-opératoire lors d’une primo-implantation ou un remplacement d’un stimulateur ou d’un défibrillateur cardiaque : analyse d’une cohorte de patients en centre hospitalier général

Aims

Perioperative management of anticoagulation in patients referred for pacemaker or cardiac defibrillator implantation isn’t consensual. Our objective was to evaluate, in a large cohort, hemorrhagic complications in patients having implantation or replacement of a cardiac pacemaker or defibrillator, and to assess perioperative anticoagulation effect on hemorrhagic risk.

Methods and results

A cohort of 461 consecutive patients having implantation or replacement of a cardiac pacemaker or defibrillator has been analyzed. Thirty patients (6,5%) had oral anticoagulants (OAC) switched to heparin/low-molecular-weight heparin, while 76 (16,5%) had their oral anticoagulation disrupted habitually for 48 hours. A total of six over 30 (20%) and two over 76 (2.6%) patients in the bridge and OAC, respectively experienced a pocket hematoma (bridge vs. OAC, p < 0.05), while ten over 355 (2.8%) had a pocket hematoma in the control group (bridge vs. control p = 0.006). Duration of the hospital stay was longer in the bridge group in comparison with OAC and control groups (9 vs. 7 vs. 6 days, respectively, p = 0.006).

Conclusion

Oral anticoagulation bridging with heparin or low-molecular-weight heparin is associated with a higher risk of pocket hematoma and a longer duration of hospitalization, in comparison with a strategy allowing a temporary disruption of OAC adapted to the thromboembolic risk.     

Résultats à court et long terme du remplacement valvulaire mitral par prothèse mécanique à bille et à ailettes (à propos d’une série de 236 patients consécutifs avec un suivi moyen de 11 ans)

Objectives

To study the early and late results of mitral valve replacement (MVR) by Starr-Edwards caged-ball and bileaflet mechanical prosthesis.

Material and methods

We retrospectively analyzed 236 MVR performed in 236 patients: 127 by Starr-Edwards prosthesis (group 1) and 109 by bileaflet prosthesis (group 2).

Results

During the early period (30 days), the mortality rate was higher in group 1 (6.3 % vs 1.8 %; p = 0.0001), while hemorrhagic, thromboembolic and infectious complications were comparable in the two groups. In the late period (> 30 days) and with an average follow-up of 11.5 ± 5.7 years, mortality was higher in group 1 (9.4 % vs 4.6 %; p < 0.0001). The same was true for thromboembolic complications (20.8 % vs 6.4 %; p < 0.0001), hemorrhagic complications (13.4 % vs 7.3 %; p = 0.02), infectious complications (3.1 % vs 0.9 %; p = 0.02) and cardiac complications that were not due to the prosthesis (32.3 % vs 14.7 %; p = 0.02). The hemodynamic profile of the bileaflet prostheses was better than that of the Starr-Edwards prostheses (average functional prosthetic surface area was 2.37 ± 0.44 cm² and average pressure gradient was 5.6 ± 1.1 mmHg vs 2.04 ± 0.52 cm² and 7.6 ± 4.9 mmHg).

Conclusion

Our work confirms the superiority of bileaflet mechanical prostheses, with rates of early and late mortality, thromboembolic and hemorrhagic complications lower than those of the Starr-Edwards prostheses in more than 11 years of follow-up. However, one should not forget that the prevention of infective endocarditis, good observance of oral anticoagulant treatment and early surgery before left ventricular dysfunction occurs remain the best guarantee a good result of the MVR.     

La sténose radique de l’artère rénale : une complication inhabituelle de la radiothérapie

Introduction

Renal artery stenosis represented 1 to 5% of all arterial hypertensions and is the leading cause of secondary hypertension. Renovascular hypertension is more common among women less than 30 years old (fibrodysplasia, 33%) and men older than 50 years old (66% atherosclerosis). Other causes are rare, especially radiation-induced renal artery stenosis.

Materials and methods

We report the case of Mr. D., 49 years old, with severe high blood pressure (230/125 mmHg) seven years after abdominal radiotherapy for Hodgkin's disease. Echo-Doppler was performed and found a subocclusive right ostial renal artery stenosis probably radiation-induced taking into account the history of the patient. Renal angiography confirmed this diagnosis and percutaneous transluminal renal artery angioplasty was performed with a final acceptable result (residual stenosis < 50%).

Discussion

Radiation-induced renal artery stenosis is rare (0.5/1000 to 1%). Most of the cases are proximal and the median time from radiation to referral is nine years. Radiation-induced nephritis disease was often referred to occurrence high blood pressure after abdominal radiotherapy but various data shows that radiation can also cause damage to larger vessels sizes (such as renal arteries) induced by atherosclerosis radiation. Patients should be successful treated by percutaneous intervention, as demonstrated by Fakhouri et al. [Am J Kidney Dis 38 (2001) 302-309] in a study of 11 patients.

Conclusion

This case shows that radiation-induced renal artery stenosis may occur many years after initial treatment, and patients developing severe arterial hypertension after abdominal radiation should be investigated for renal artery stenosis.     

Approche multifactorielle et typologique du concept de fragilité chez les patients hypertendus non contrôlés. Enquête Eclat

Objective

The aim of the Eclat survey was to evaluate the frequency of frailty in uncontrolled hypertensives and to individualize different frailty profiles.

Patients and methods

This was an observational, prospective, longitudinal survey conducted in the cohort of uncontrolled hypertensive patients aged 55 years or more. Morbid events having occurred between two visits at a 6-month interval were reported. Patients with at least one event were considered to be frail. Predictive factors of at least one event were identified (logistic regression). The analysis was completed by a typological analysis (principal components analysis and clustering).

Results

At least one event occurred in 211 (9%) of 2306 patients (males 55%, 67 ± 9 years old, blood pressure [BP] = 160 ± 11/93 ± 8 mmHg, diabetes 23%): cardiovascular (1.7%), gerontological (5.5%), onset of diabetes (1.3%), worsening of renal impact (2%). Three frailty profiles were identified: patients at low risk (n = 1507, event rate = 6%), with neither cardiovascular risk factors nor target organ damage; patients at moderate risk (n = 335, event rate = 12%) with numerous risk factors but no target organ damage and patients at high risk (n = 243, event rate = 23%), the older ones, in bad general condition, with target organ damage, sensorial deficits and cognitive disorders. In a population of uncontrolled hypertensives aged 55 years or more, 9% could be considered as frailty.

Conclusion

Therapeutic measures might be adapted according to the frailty profile of the patient. With respect to treatment management, healthcare behaviour could differ depending on these frailty profiles.     

Influence de la fonction rénale sur la pertinence diagnostique du BNP chez l’insuffisant cardiaque âgé

Aim of the study

BNP levels are accurate in the diagnosis of heart failure and useful in clinical practice. Relationship between BNP, heart failure (HF) and renal function are little known in the elderly. Renal function influence the optimal cut point of BNP in patients with a Glomerular Filtration Rate (eGFR) lesser than 60 ml/min/1.73 m².

Methodology

A total of 71 patients (mean age = 85 years) were admitted in a Cardiogeriatric Unit. We noted several parameters, age, gender, the presence or the absence of Systolic Heart Failure (clinical history and physical examination), the echographic measure of the left ventricular ejection fraction, the eGFR value calculated by simplified MDRD formula and the BNP value. We divided these patients into six groups according the presence of HF and eGFR value higher than 60ml/min/1.73m²,or between 30 and 60 or between 15 and 30.

Results

Our results show that the BNP value is higher in all the three groups of patients with Heart Failure with or without diminution of the eGFR: for example, 1220 pg/ml in the presence of HF versus 788 pg/ml in the absence of HF in the two groups with the eGFR is calculated between 15 and 30 ml/min/1.73m².

Conclusion

BNP is a helpful tool in clinical practice for the diagnosis of Systolic Heart Failure in the presence of renal impairment in the elderly with a higher biomarker cut point.     

Enquête sur le poids de la rhinite allergique en France

Background

This paper presents the results from France of a prospective, cross-sectional, international survey conducted among patients and physicians to identify symptom perception and the impact of allergic rhinitis on health-related quality of life.

Methods

Data about the presence, severity and impact of symptoms were recorded by 504 patients and matched with data from their physicians. Health-related quality of life was assessed using the Mini Rhinoconjunctivitis Quality of Life Questionnaire.

Results

According to the physicians’ assessments, a large proportion (71%) of patients had moderate or severe disease, persistent disease (48.3%), and comorbidities such as asthma (32.3%) and anxiety (19%). Persistent disease was present in 55.3% of patients with perennial allergic rhinitis and 44.9% with seasonal allergic rhinitis. Physicians tended to underestimate the incidence of some symptoms reported by the patients, most notably cough, headache, and itchy eyes. Health-related quality of life was negatively correlated with disease severity and number of symptom-free days. Allergic rhinitis had a significantly greater impact on patients with more persistent disease compared with those with intermittent disease (2.0 ± 1.3 versus 1.8 ± 1.2; p < 0.05); nevertheless, 73.9% of patients with intermittent disease reported some impairment of their daily life.

Conclusions

Allergic rhinitis remains a significant health problem in France due to the high prevalence of moderate or severe, persistent disease in patients presenting during routine care as well as to the impact of the disease on health-related quality of life. Patients and physicians differed significantly in their perception of disease severity and in the reporting of some symptoms, including ocular symptoms and cough.     

Aspects cliniques et étiologiques des uvéites : étude rétrospective de 121 patients adressés à un centre tertiaire d’ophtalmologie

Purpose

Uveitis consists of a large group of diseases characterized by intraocular inflammation involving the uveal tract. This heterogeneity makes the diagnosis and the treatment of uveitis frequently challenging. The purpose of this study was to describe the various clinical and etiologic aspects of uveitis, through the new standardized uveitis classification and the use of modern investigations for its diagnostic work-up.

Methods

The medical records of 121 new patients with uveitis referred to our tertiary ophthalmologic centre between January 2002 and December 2006 were retrospectively reviewed. Uveitis associated to human immunodeficience virus and secondary to exogenous endophthalmitis were excluded. All patients had a complete ophthalmological examination and appropriate clinical and paraclinical examination. The diagnosis was established according to the recent international criteria.

Results

One hundred and twenty-one patients were included. The four main etiologies were: toxoplasmosis (14%), sarcoidosis (11.6%), spondylarthritis or HLA B27-associated uveitis (13.2%) and Herpes virus infections (9.1%) that represented almost half of the uveitis causes (47.9%). Various diseases constituted the remaining causes of the uveitis (20.9%). Uveitis remained unexplained in the remaining 36 patients (29.7%). Overall, associated systemic diseases were diagnosed in 35.5% of our uveitis patients (34 patients), associated infectious conditions in 26.4% (32 patients) and specific ocular diseases in 8.3% (12 patients).

Conclusion

Despite a limited number of patients, our study showed an etiologic distribution similar to that of the main series reported in the literature. Nevertheless, we observed an elevated frequency of sarcoidosis and systemic diseases, which emphasizes a management that takes into account standardized clinical and paraclinical criteria and the usefulness of a collaboration with the internist.     

Associations des facteurs environnementaux avec le risque de la maladie coronaire à Tlemcen (Algérie)

Purpose

In the purpose of studying the effect of the environmental factors on risk of coronary artery disease, we established a case-control study in Tlemcen.

Method and results

A sample of 568 men and women aged 25 to 64 years, was studied; 170 had had myocardial infarction or angina and 398 controls. Variables associated with CAD were age, sex, tobacco consumption, hypertension, diabetes, obesity, family history of cardiovascular disease, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. Adjusted odds-ratio and their 95 % CIs were calculated by logistic regression. Hypertension (OR = 2.48 [1.68; 3.67]), diabetes (OR = 2.86 [1.89; 4.34]), obesity (OR = 1.21 [0.76; 1.92]), family history of cardiovascular disease (OR = 3.49 [1.39; 8.73]), total cholesterol (OR = 0.99 [0.51; 1.92]), triglycerides levels (OR = 1.76 [0.93; 3.35]), HDL-cholesterol (OR = 2.48 [1.69; 3.66]) and LDL-cholesterol (OR = 1.09 [0.59; 2.01]). The variables differing most significantly and independently between cases and controls were identified by stepwise logistic regression analysis (p < 0.05), variables concerned hypertension and diabetes (p < 0.0001), decrease HDL-cholesterol (p = 0.0002) and tobacco consumption (p = 0.005), with stronger associations in cases than in controls.

Conclusion

It is concluded that hypertension and diabetes, decrease HDL-cholesterol in both sexes, an increase in concentration of triglyceride only in women and tobacco consumption in men, were significantly related to coronary artery disease in Tlemcen.     

Utilité diagnostique de l’hypo-uricémie dans l’hyponatrémie par sécrétion inadéquate d’hormone antidiurétique

Purpose

Hypo-uricemia is still considered as a hallmark of the syndrome of inappropriate secretion of antidiuretic hormone.

Methods

We analyzed prospectively 98 hospitalized patients with hyponatremia (≤135 mmol/L), excluding those receiving diuretic treatment. Gold standard for the syndrome of inappropriate secretion of antidiuretic hormone combined plasma hypoosmolality, inappropriately concentrated urine, and normal volemia.

Results

A final diagnosis of inappropriate secretion of antidiuretic hormone was obtained in 55 patients. They were significantly hypo-uricemic (188 μmol/L [153–245], median [interquartile range]) versus 241 μmol/L, [179–333]; p < 0,02) but hypo-uricemia (≤240 μmol/L) performed poorly as a diagnostic test: 71 % sensitivity, 53 % specificity. Positive and negative likelihood ratios were 1,67 and 0,49, respectively.

Conclusions

The syndrome of inappropriate secretion of antidiuretic hormone is associated with a lower plasma uric acid concentration, but in routine clinical practice, contrary to what has been previously published, this difference is insufficient for hypouricemia to discriminate reliably between the syndrome of inappropriate secretion of antidiuretic hormone and other causes of hyponatremia.     

« Paradoxe des fumeurs » et stratégie de reperfusion à la phase aiguë de l’infarctus du myocarde

Previous studies have shown that smokers with acute myocardial infarction (AMI) treated by thrombolysis have lower mortality rates than nonsmokers, a phenomenon often termed “smoker's paradox”. This “smoker's paradox” has been rarely studied in case of primary angioplasty.

Aim of the study

To evaluate the impact of smoking status on the early mortality of patients admitted with AMI with regard to the strategy of reperfusion (intravenous thrombolysis versus primary angioplasty).

Patients and methods

Study undertaken from the Monsatir registry of ST elevation MI including 688 patients having had either a hospital or a prehospital thrombolysis (n = 397) or a primary angioplasty (n = 291). Among those patients, 482 (70.1%) were active smokers.

Results

In the thrombolysis group, the prevalence of hypertension, diabetes and anterior location of MI was significantly less among smokers. In the group primary angioplasty, only diabetes and hypertension were less frequent. The immediate mortality was significantly less among smokers in case of thrombolysis comparatively to non-smokers (5.3 vs 13%; p = 0.008). By multivariate analysis, cardiogenic shock (p < 0.0001), anterior MI (p = 0.03) and active smoking (p = 0.03) were independent predictive factors of mortality in case of thrombolysis. A trend toward a lower mortality among smokers was observed in the primary angioplasty group (10 vs 17.6%; p = 0.07).

Conclusion

“The smoker's paradox” seems to be observed mainly among patients having had thrombolysis.     

Observance médicamenteuse chez un échantillon d’hypertendus dans la région de Sfax (Tunisie)

The aim of the study

Medication noncompliance is one of the daily problems of the physician. Improving the medication adherence allows better management of hypertension. The aim of this work was to determine the level of compliance for patients with hypertension and to identify factors that determine compliance.

Methods

A cross-sectional study was carried out among a sample of hypertensive patients attending general and specialist practitioners in public or private clinics of Sfax. Two hundred and seventy-three participants had accepted to be interviewed. Patients were identified as noncompliants using a questionnaire developed by the Comité de lutte contre l’hypertension artérielle (CFLHTA).

Results

Non-compliance rate was 63.4%. The low level of education was associated with a lower adherence. The monotherapy, the once-daily regimen with fewer number of tablets were associated with a better adherence (p < 10⁻⁶). The welcome and the availability of drugs in the public clinic affect positively the adherence of patients (p < 0.0002). A patient very satisfied with his consultation and the explanation given by the doctor about his illness and its treatment had a better adherence (p < 0.00003).

Conclusion

Our study had demonstrated a low compliance with antihypertensive drug therapy. Tunisian health care system should elaborate a management plan which takes into account our particular predictors of compliance to improve adherence to antihypertensive medication.     

Infarctus du myocarde chez le sujet fumeur de moins de 50 ans traité par angioplastie coronaire. Évolution hospitalière et sur le long terme d’une série consécutive de 93 patients

Aims of the study

The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty.

Patients and method

This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008.

Results

We included 93 patients aged 42,8 ± 5,2 years old with smoking estimated at 27,7 ± 12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5 ± 3.0 hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0 ± 15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24 months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers.

Conclusion

Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation.     

Évaluation de la ration calcique dans la population de Marrakech et de sa région : à propos de mille cas

Objectives

The aim of our work is to evaluate the calcium intake in population of Marrakesh and its region by the translated version in Moroccan Arabic dialect of Fardellone questionnaire.

Subjects and methods

The version translated into Arabic dialect Fardellone questionnaire is tested on a sample of 1000 subjects. The subjects aged less than 15 years accounted for 30.9% (n = 309), those aged 15 to 59 62% (n = 620) and those aged over 60 years 7.1% (n = 71). The distribution by age group is calculated on the distribution of the Moroccan population.

Results

The study population includes 60.6% women (n = 606), 39.4% of men (n = 394). The mean calcium intake was respectively 5875 mg by week (that means 839 mg/day), 4899 mg by week (that means 699 mg/day), 3053 mg by week (that means 436 mg/day), in subjects aged less than 15, those aged 15 to 59, and those aged over 60 years. The average consumption of calcium per day is significantly lower than the recommended daily amount for the three age groups. Patients aged over 60 years is the age group most under nourished calcium. The comparison of both gender found a deficit higher among women than among men.

Conclusion

Evaluation of the calcium intake is an essential tool for better management of metabolic bone diseases.     

Infarctus par occlusion aiguë du tronc commun non protégé : à propos de six cas traités par angioplastie

Aim

Acute main left coronary artery occlusion is rarely observed during primary angioplasty in myocardial infarction. This retrospective study reports the results of six patients treated by angioplasty in a hospital without cardiac surgery department.

Patients and methods

From 2002 to 2009, 746 patients were treated by primary angioplasty for acute coronary syndromes with ST elevation. Among those patients, six (0,7%) had acute non protected main left coronary occlusion. We report clinical, angiographical data and follow-up.

Results

The population was composed of six patients (five males) with an average age of 64 ± 7 years. Five patients were admitted with cardiogenic shock and four were mechanically ventilated. Distal occlusion of main left coronary artery and dominant right coronary artery were noted in all cases. Sub-occluded lesion of right coronary artery was noted in one case. Successful procedure with bare metal stent was achieved in five cases. Mortality rate was 66% (n = 4): three patients died in hospital and another 1 or 2 months later of congestive heart failure. Coronary artery bypass grafting was performed at 4 and 12 months later for two patients. They are alive after 12 and 72 months of follow-up.

Conclusion

We demonstrate the feasibility of percutaneous coronary intervention of acute main left coronary occlusion. Inspite successful procedure, intrahospital mortality rate is still high and prognosis is related to cardiogenic shock.     

Immune profile of elderly patients admitted in a geriatric short care unit

Introduction

Immunosenescence embraces the whole of age-induced changes observed in the immunomodulatory functions of a living organism, and is mostly characterized by a decrease in cell-mediated immunity and important modifications of the immunological repertoire. The impact of the pathology on ageing immunity is poorly understood and few data are available on the immunological status of old polypathological patients.

Methods

We report the results of a prospective study aiming at characterizing several established immunological parameters in patients of 75 years old or more, and admitted for diverse pathologies in a unit of acute geriatric ward.

Results

Among the 51 included patients (35 women and 16 men), 90% displayed poly-pathologies. We found a prevalence of 86% of immunological abnormalities, with lymphopenia among 41% of the patients (<1500/mm³) and abnormal lymphocytes phenotypes among 95% of the oldest patients (>85 years). A strong skewing towards memory T lymphocytes (CD45RO+) over naive T lymphocytes (CD45RA+) was found in 80% of the cases and inverted CD4/CD8 T cells ratio was observed in 12% of our patients. Vitamin D insufficiency (<30 ng/ml), which is frequent among the patients (94%), is a predictive factor for T and B cell lymphopenia.

Conclusion

Immunological abnormalities are frequent in this frail population and lymphopenia, in particular, could constitute a reinforcing factor of fragility. Vitamin D deficiency could also affect elderly patients’ immunity.     

Higher Cardiovascular Disease Prevalence and Mortality among Younger Blacks Compared to Whites

Background

Blacks have higher rates of cardiovascular disease than whites. The age at which these differential rates emerge has not been fully examined.

Objective

We examined cardiovascular disease prevalence and mortality among black and white adults across the adult age spectrum and explored potential mediators of these differential disease prevalence rates.

Methods

We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 1999-2006. We estimated age-adjusted and age-specific prevalence ratios (PR) for cardiovascular disease (heart failure, stroke, or myocardial infarction) for blacks versus whites in adults aged 35 years and older and examined potential explanatory factors. From the National Compressed Mortality File 5-year aggregate file of 1999-2003, we determined age-specific cardiovascular disease mortality rates.

Results

In young adulthood, cardiovascular disease prevalence was higher in blacks than whites (35-44 years PR 1.9; 95% confidence interval [CI], 1.1-3.4). The black-white PR decreased with each decade of advancing age (P for trend = .04), leading to a narrowing of the racial gap at older ages (65-74 years PR 1.2; 95% CI, 0.8-1.6; ≥75 years PR 1.0; 95% CI, 0.7-1.4). Clinical and socioeconomic factors mediated some, but not all, of the excess cardiovascular disease prevalence among young to middle-aged blacks. Over a quarter (28%) of all cardiovascular disease deaths among blacks occurred in those aged <65 years, compared with 13% among whites.

Conclusions

Reducing black/white disparities in cardiovascular disease will require a focus on young and middle-aged blacks.     

Comparaison entre endocardite « certaine » et endocardite « possible » selon la classification de la Duke University, dans une série de 45 patients

Aim of the study

To compare definite endocarditis (DE) and possible endocarditis (PE) according to the Duke criteria, in a monocentric cohort of 45 patients.

Method

From the registers of the Cardiology Department and medical database of the hospital informatic department, 45 cases of endocarditis are colliged, 29 DE and 16 PE.

Results

DE age is 66 years, PE age is 74 years, (p < 0,02), 17 male (59%) in DE, eight in PE, 21 (72%) DE have a preexisting cardiopathy versus 15 (94%) PE, seven native valve and six prosthetic valve in PE, 11 native valve and nine prosthetic valve in DE. Twenty-six (90%) DE and 16 (100%) have fever, 14 (48%) DE and nine (56%) PE have a cardiac failure, one DE (3%) and 14 (87%) have no echographic sign of endocarditis (transthoracic echo or transthoracic and transesophagal echo) (p < 0.001). Blood cultures are positive in 23 DE (79%), and 14 (87%) PE (NS) Streptococcus and Enterococcus are the most common bacterial species (62%) in the two groups. Treatment duration is 64 days for DE and 43 days for PE, hospitalisation duration is 33 days for the DE and 27 days in PE.

Conclusions

PE group and DE group are similar concerning fever cardiac failure, preexisting cardiopathy, blood cultures and bacterial species. PE group is older than DE group, echography is more often negative in PE group.A patient with a preexisting valvulopathy and a septicemia without echographic sign of endocarditis is the most frequent clinical pattern in PE.     

Valeur prédictive comparée de mortalité hospitalière du peptide natriurétique de type B et de l’albuminémie chez le sujet âgé hospitalisé pour insuffisance cardiaque aiguë sévère

Objective

To address the clinical relevance of serum albumin and B-type natriuretic peptide (BNP) concentration in the prediction of in-hospital death in elderly patients with acute severe heart failure.

Patients and methods

Seventy-four consecutive patients >70 years of age admitted for acute heart failure in NYHA class IV were prospectively included. BNP concentration was measured on admission and serum albumin concentration after clinical stabilization.

Results

Mean age was 86.6 ± 5.7 years. Sixty-five percent of patients had a normal left ventricular ejection fraction. Eighteen patients died during the in-hospital stay. Those patients who died were older, had higher blood urea nitrogen and BNP concentration, had lower systolic blood pressure and serum albumin concentration than patients who survived. Heart rate, rhythm, left ventricular ejection fraction, serum creatinine and hemoglobin did not differ according to outcome. By multivariate analysis, albumin (p = 0.0017), BNP (p = 0.016) and age (p = 0.03) were independent predictors of in-hospital death. Serum troponin I measured on admission in 71 patients was predictive of in-hospital death (p = 0.01), as well as serum total cholesterol measured after stabilization in 66 patients (p = 0.004). However, these two variables no longer predicted outcome in multivariate models, unlike serum albumin and BNP.

Conclusion

Serum albumin and BNP offer independent, additional information for the prediction of in-hospital death in elderly patient with acute severe heart failure regardless of left ventricular ejection fraction.