Evaluar mediante indicadores asistenciales las diferencias por sexo y el manejo de los problemas clínicos que presentan los pacientes que presentan fibrilación auricular. Durante 5 meses se incluyó consecutivamente a todos los pacientes atendidos en las consultas de cardiología de 2 hospitales de tercer nivel por presentan un episodio de fibrilación auricular o un proceso clínico debido a ella. Se incluyó a 533 pacientes (el 56,5% mujeres; media de edad, 70,5 ± 12,2 años), de los que el 24,3% eran menores de 65 años. Las mujeres tenían significativamente más problemas clínicos y un riesgo de embolia más elevado: CHADS2 (insuficiencia cardiaca congestiva, hipertensión, edad, diabetes, ictus [doble]) (1,8 ± 1,2 frente a 1,5 ± 1,1; p = 0,001) y CHA2DS2-VASc (insuficiencia cardiaca congestiva, hipertensión, edad ≥ 75 [doble], diabetes, ictus [doble], enfermedad vascular y categoría de sexo [mujeres]) (3,7 ± 1,4 frente a 2,2 ± 1,4; p = 0,0001). Al 94% de los pacientes se los derivaba correctamente a cardiología, el 53,8% procedía de atención primaria u otros servicios del hospital y al 93,4% se le realizó o indicó una ecocardiografía. El tratamiento (antiarrítmico y antiembolígeno) se hace según las recomendaciones de las guías. El índice de Rosendaal en los 3 meses previos fue de 48,4 ± 37,4. Uno de cada 4 pacientes que consultan por problemas derivados de la fibrilación auricular son jóvenes y las mujeres tienen más problemas clínicos y consultan más. A los pacientes se los deriva correctamente a cardiología, y la mayoría no procede de urgencias. Se indican la ecocardiografía y el tratamiento antiarrítmico y antiacoagulante tal como recomiendan las guías de práctica clínica. El control de la anticoagulación con fármacos antagonistas de la vitamina K es deficiente. To assess sex differences and the management of clinical problems in patients with atrial fibrillation through the use of care indicators. Over a 5-month period, the study included all consecutive patients attended in the cardiology outpatient clinics of 2 tertiary hospitals with an atrial fibrillation episode or a clinical process due to atrial fibrillation. A total of 533 patients were included (56.5% women; mean age, 70.5 ± 12.2 years), of whom 24.3% were younger than 65 years. Women had significantly more clinical problems and a higher stroke risk: CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke [doubled]) (1.8 ± 1.2 vs 1.5 ± 1.1; P = .001) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 [doubled], diabetes, stroke [doubled]-vascular disease and sex category [female]) (3.7 ± 1.4 vs 2.2 ± 1.4; P = .0001). Referrals to the cardiology department were appropriate in 94% of the patients, the referral source was primary care or other hospital services in 53.8%, and echocardiography was performed or recommended in 93.4%. Treatment (antiarrhythmics and anticoagulants) was administered according to guideline recommendations. In the previous 3 months, the Rosendaal index was 48.4 ± 37.4. One in every 4 patients seeking care for problems associated with atrial fibrillation are young; women have more clinical problems and seek care more frequently than men. Patients are correctly referred to the cardiology department and most are not referred from the emergency department. Echocardiography and antiarrhythmic and anticoagulant therapy were provided according to the recommendations of clinical practice guidelines. Vitamin K antagonists for anticoagulation therapy are underused. Full English text available from: www.revespcardiol.org/en

Introduction and Objectives: To assess sex differences and the management of clinical problems in patients with atrial fibrillation through the use of care indicators.Methods: Over a 5-month period, the study included all consecutive patients attended in the cardiology outpatient clinics of 2 tertiary hospitals with an atrial fibrillation episode or a clinical process due to atrial fibrillation.Results: A total of 533 patients were included (56.5% women; mean age, 70.5 +/- 12.2 years), of whom 24.3% were younger than 65 years. Women had significantly more clinical problems and a higher stroke risk: CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke [doubled]) (1.8 +/- 1.2 vs 1.5 +/- 1.1; P = .001) and CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 [doubled], diabetes, stroke [doubled]-vascular disease and sex category [female]) (3.7 +/- 1.4 vs 2.2 +/- 1.4; P = .0001). Referrals to the cardiology department were appropriate in 94% of the patients, the referral source was primary care or other hospital services in 53.8%, and echocardiography was performed or recommended in 93.4%. Treatment (antiarrhythmics and anticoagulants) was administered according to guideline recommendations. In the previous 3 months, the Rosendaal index was 48.4 +/- 37.4.Conclusions: One in every 4 patients seeking care for problems associated with atrial fibrillation are young; women have more clinical problems and seek care more frequently than men. Patients are correctly referred to the cardiology department and most are not referred from the emergency department. Echocardiography and antiarrhythmic and anticoagulant therapy were provided according to the recommendations of clinical practice guidelines. Vitamin K antagonists for anticoagulation therapy are underused. (C) 2015 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

La ecocardiografía 3D (E3D) es más precisa que la técnica 2D en la valoración de los volúmenes y la fracción de eyección (FE) del ventrículo izquierdo (VI). Este estudio compara, con respecto a cardiorresonancia magnética (cRM), 2 sistemas de E3D: E3D en un solo latido con detección automática de bordes endocárdicos (Siemens SC2000; A) frente a E3D con adquisición de varios latidos y detección semiautomática de bordes endocárdicos (Philips iE33; B). A 22 pacientes remitidos para estudio mediante cRM se les realizó E3D con sistema de adquisición en un solo latido y detección automática de bordes (A) y con adquisición en varios latidos y detección semiautomática de bordes (B). Los volúmenes y la FE medios por cRM fueron: VTD: 211,07 ± 85,4 ml; VTS: 119,2 ± 89,25 ml; FE: 48,67 ± 20,07%. La correlación entre la cRM y los 2 sistemas de E3D fue excelente para el VTD (rhoA 0,912; rhoB 0,907; p < 0,0001), VTS (rhoA 0,877; rhoB 0,945; p < 0,0001) y FE (rhoA 0,974; rhoB 0,951; p < 0,0001). El análisis mediante Bland-Altman reveló infraestimación de los volúmenes del VI con ambos sitemas de E3D, siendo esta menor con el sistema A que B (–40 ± 50,2 vs –82,2 ± 40,9 ml, respectivamente, para VTD; –16 ± 44,4 vs –43 ± 43,5 ml, respectivamente, para VTS; p = 0,001). No hubo diferencias en la medida de la FE entre las 3 técnicas de imagen. La E3D infraestima los volúmenes del VI. En nuestra serie esta infraestimación fue menor con el sistema de adquisición en único latido y detección automática de bordes. 3-D echocardiography (3DE) is superior to the 2-D technique in assessing left ventricular (LV) volumes and ejection fraction (EF). This study compares two 3DE systems with cardiac magnetic resonance imaging (cMRI): single-beat 3DE with automated endocardiac border detection (Siemens SC2000; A) and 3DE with multi-beat acquisition and semi-automated endocardiac borders detection (Philips iE33; B). A 3DE with single-beat acquisition and automated border detection (A) and 3DE with multi-beat acquisition and semi-automated border detection (B) was performed on 22 patients referred for a study using cMRI. The mean volumes and EF measured by cMRI were: DTV: 211.07 ± 85.4 mL; STV: 119.2 ± 89.25 mL; EF: 48.67 ± 20.07%. The correlation between cMRI and the two 3DE systems was excellent for the DTV (rhoA 0.912; rhoB 0.907; P < .0001), STV (rhoA 0.877; rhoB 0.945; P < .0001) and EF (rhoA 0.974; rhoB 0.951; P < .0001). The Bland-Altman analysis showed an underestimation of the LV volumes with both 3DE systems, with the difference being lower in system A than in system B (–40 ± 50.2 vs –82.2 ± 40.9 mL, respectively for DTV; –16 ± 44.4 vs –43 ± 43.5 mL, respectively for STV; P = .001). There were no differences in the measurement of EF between the 3 imaging techniques. 3DE underestimates LV volumes. In our series, this underestimate was lower in the system with single-beat acquisition and automated border detection.

La fibrilación auricular (FA) es una patología muy prevalente que motiva un elevado número de consultas en los servicios de cardiología. El objetivo de nuestro trabajo es describir las características clínicas de los pacientes que padecen FA atendidos en las consultas de cardiología, el tratamiento antiarrítmico y antitrombótico prescrito por los cardiólogos, y comparar los datos con las recomendaciones de las guías de práctica clínica europeas (GPCE) de FA de 2010. . Analizamos a los pacientes atendidos en las consultas de cardiología de nuestro hospital durante 2 semanas consecutivas de septiembre de 2010. Se recogieron las características clínicas de los pacientes, el tipo de FA que presentaban, el tratamiento farmacológico, y se determinó el riesgo de embolia según diferentes criterios utilizados por las GPCE. De los 759 pacientes atendidos, 160 (21%) presentaban o habían presentado una FA, y fueron incluidos en el registro. Treinta y dos pacientes (20%) era <65 años y 137 padecían FA no valvular. Existen diferencias entre hombres y mujeres en la prevalencia de dislipidemia (49,4 vs 31,6%, p = 0,02), tabaquismo (14,8 vs 3,1%, p = 0,01), valvulopatía (6,2 vs 22,8%, p = 0,003), edad (p = 0,05), arteriopatía periférica (37 vs 8,9%, p = 0,0001), en el ritmo que presentaba el ECG (p = 0,01) y en el tipo de FA (p = 0,05) y en la edad de aparición de estas (p = 0,002), pero no había diferencias en el tratamiento utilizado. Estaban anticoagulados 95 pacientes y se anticoagulaban un 64% con valor CHADS2 ≥2, mientras que solo un 50% con CHA2DS2VASc ≥2. . En nuestras consultas uno de cada 5 pacientes con FA es un paciente joven, la indicación de ACO en los pacientes con FA se va a incrementar y el tratamiento anticoagulante realizado por los cardiólogos se adhiere al recomendado por las guías, pero siguen existiendo discrepancias significativas. Atrial fibrillation (AF) is a prevalent condition that leads to a high number of consultations in clinical practice. The aim of our study is to describe the clinical characteristics of patients with AF treated in the cardiology clinic, to evaluate how cardiologists treat these patients and whether prevention of stroke performed in routine clinical practice is according to the antithrombotics criteria recommended by the 2010 European clinical practice guidelines (ECPG) in AF. We analysed all patients evaluated in the cardiology clinic for two consecutive weeks during September 2010. We collected the clinical characteristics of patients, the type of AF, drug treatment, and determined the risk of stroke according to different criteria used by the ECPG. Of the 759 patients treated, 160 (21%) had AF, and were included in the registry. Thirty-two patients (20%) were <65 years and 137 suffered non-valvular AF. Sex differences were observed in prevalence of dyslipidaemia (49.4% vs 31.6%, P = .02), smoking (14.8% vs 3.1%, P = .01), valve disease (6.2% vs 22.8%, P = .003), age (P = .05), peripheral arterial disease (37% vs 8.9%, P = .0001), in the rhythm in the ECG (P = .01) and the type of AF (P = .05) and age of these (P = .002), but there were no differences in the treatment used. Ninety five patients were anticoagulated, but only 64% of patients with CHADS2 ≥2, and 50% with CHA2DS2VASc ≥2. One out of every 5 patients with AF evaluated in our clinics are under 65 years. The indication for anticoagulant treatment will probably increase in the next few years. The adherence to the recommendations for anticoagulation of the ECPG is good, but could be improved.

Para analizar las diferencias en la respuesta al test de tabla basculante (TTB) entre sujetos sin y con hipertensión arterial (HTA) hemos estudiado consecutivamente a los 338 pacientes con síncope que realizaron el TTB en nuestro servicio entre enero de 2003 y octubre de 2004. En 243 pacientes no se apreció hipertensión (grupo A), mientras que en 95 sí la había (grupo B). Encontramos diferencias entre ambos grupos en la edad (p = 0,0001), el sexo (p = 0,048), el tiempo de evolución de los síncopes (p = 0,0001) y el porcentaje de diabetes mellitus (p = 0,0001). El TTB fue positivo en 168 pacientes (69,1%) del grupo A y 63 (66,3%) del grupo B (p = 0,6; NS). No encontramos diferencias entre ambos grupos en el porcentaje de positividad al TTB durante la fase basal y durante la fase de nitroglicerina (p = 0,673; NS), ni en el tiempo de aparición del síncope en ambas fases (p = 0,69; NS, y p = 0,28; NS), aunque sí en el tipo de respuesta (respuesta vasodepresora del 33% en el grupo A frente al 49% en el grupo B; p = 0,01). En el análisis multivariable no se encontró ninguna variable independiente asociada con el resultado del TTB. We studied the difference in head-up tilt test responses between patients suffering from syncope who had hypertension and those who did not. A total of 338 consecutive patients with syncope underwent head-up tilt testing in our department from January 2003 to October 2004. Of these, 243 did not have hypertension (group A), whereas 95 did (group B). There were significant differences between the groups in age (P=.0001), sex (P=.048), timing of syncope development (P=.0001), and prevalence of diabetes mellitus (P=.0001). The head-up tilt test gave positive results in 168 patients (69.1%) in group A and in 63 (66.3%) in group B (P=.6; NS). There was no significant difference between the groups in the proportion of positive responses that occurred in either the baseline or nitroglycerin-enhanced phase of the test (P=.673; NS), nor in the time to onset of syncope in either phase (P=.69; NS, and P=.28; NS, respectively). However, there was a significant difference in the type of response (vasodepressor response, 33% in group A versus 49% in group B, P=.01). In the multivariate analysis, no independent variable was found to be associated with the result of the head-up tilt test.

BACKGROUND AND OBJECTIVE:The prevalence and morbidity of the vaso-vagal syncope are well-known. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure.PATIENTS AND METHOD:All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test.RESULTS:Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients.CONCLUSIONS:In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Son conocidas la prevalencia del síncope vasovagal y su morbilidad. Con objeto de cuantificar la calidad de vida relacionada con la salud (CVRS) de los pacientes que lo sufren y evaluar la influencia de la edad y el sexo, se compararon los resultados obtenidos tras la administración de la versión española del Cuestionario de Salud SF-36 en esta población con los valores de la población general y de pacientes con insuficiencia cardíaca. Además se ha analizado la influencia de diversos parámetros clínicos. Se incluyó consecutivamente a todos los pacientes con síncope vasovagal sometidos a test de tabla basculante desde enero de 2001 hasta diciembre de 2002. El cuestionario se contestó previamente a la realización del test. Se calcularon los valores utilizando estadísticos apropiados a la distribución de la muestra, se analizaron según la edad y el sexo, y se correlacionaron con diversos parámetros clínicos. Se incluyó a 271 pacientes (50,5% mujeres). La CVRS en estos pacientes fue inferior a los valores poblacionales y similar a la de los pacientes que sufren insuficiencia cardíaca. En el varón sólo 4 dimensiones del SF-36 fueron inferiores a la población general, y en la mujer lo fueron las 8. La mujer tuvo peor percepción de su CVRS que el varón (p < 0,05). La edad influyó negativamente en todas las dimensiones del SF-36, sobre todo en la mujer. El número de síncopes fue el parámetro clínico que más se relacionó con la CVRS. En nuestra serie, los pacientes con síncope vasovagal tienen peor CVRS respecto a la población general de referencia y similar a la que sufre insuficiencia cardíaca. La CVRS es peor en la mujer y empeora con la edad en ambos sexos. Nuestra serie indica que el número de síncopes es el parámetro clínico que mejor se correlaciona con la CVRS. The prevalence and morbidity of the vaso-vagal syncope are wellknown. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure. All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test. Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients. In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.