Correspondence
Reply to “On the heart failure diagnosis. Is it enough with physical examination?”
Respuesta a la carta «Sobre el diagnóstico de la insuficiencia cardíaca. ¿Es suficiente con la exploración física?»
A. Salinas-Botrána,
, M. Méndez-Bailóna, L.M. Pérez-Belmonteb, on behalf of the SEMI-COVID-19 Network group
Corresponding author
a Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria delHospital Clínico San Carlos (IdISSC), Madrid, Spain
b Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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Is it enough with physical examination?”" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Director,</span>" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "622" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Salinas-Botrán, M. Méndez-Bailón, L.M. Pérez-Belmonte" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Salinas-Botrán" "email" => array:1 [ 0 => "asalinasbotran@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Méndez-Bailón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L.M." "apellidos" => "Pérez-Belmonte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:1 [ "colaborador" => "on behalf of the SEMI-COVID-19 Network group" ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria delHospital Clínico San Carlos (IdISSC), Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a la carta «Sobre el diagnóstico de la insuficiencia cardíaca. ¿Es suficiente con la exploración física?»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We are grateful for the comments on our article that was recently published in <span class="elsevierStyleItalic">Revista Clínica Española</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. The letter’s<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> authors state that the diagnosis of heart failure (HF) based solely on clinical parameters (dyspnea, edema, jugular venous pressure) has a lower sensitivity and specificity than if it is supplemented with analytical (BNP, NT-proBNP) or ultrasound parameters. It merits mention that European guidelines continue defining acute HF as a clinical syndrome<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. In any case, we would like to clarify the reasons why we did not have said determinations in our series.</p><p id="par0010" class="elsevierStylePara elsevierViewall">1. The study was conducted on patients hospitalized in Spanish hospitals from March 1 to October 1, 2020. The extreme pressure that participating healthcare centers were subjected to in this period (first wave) is well known to all<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and made it necessary to diagnose HF based solely on classical procedures which, though they may be less exact, are much quicker when establishing a diagnosis and treatment than the complementary methods which were referenced.</p><p id="par0015" class="elsevierStylePara elsevierViewall">2. Unfortunately, not all Spanish internal medicine departments have a portable ultrasound machine or staff trained on their use. The promotion of clinical ultrasound, both in the undergraduate and postgraduate period, is an essential element that the Spanish Society of Internal Medicine (SEMI, for its initials in Spanish) strives to strengthen. The availability of equipment in all participating centers would have allowed for obtaining said data from a greater number of patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">3. The majority of patients in our study (67.9%) had already been diagnosed with chronic HF. The determination of natriuretic peptides (BNP or NT-proBNP) has value most of all when ruling out the diagnosis of acute HF. Determinations in these patients during acute SARS-CoV-2 infection would therefore have had less value than in the case of an admission for <span class="elsevierStyleItalic">de novo</span> acute HF.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In consequence, we disagree with the letter’s authors and do not believe that the determination of said variables would have led to different conclusions from those drawn. Our results are valid and in line with those obtained in other series<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In any case, prospective multicenter studies that allow for strengthening knowledge and the interrelationship between both entities are desirable for improving the prognosis and management of this type of patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-05-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salinas-Botrán A, Méndez-Bailón M, Pérez-Belmonte LM, en representación del grupo SEMI-COVID-19 Network. Respuesta a la carta «Sobre el diagnóstico de la insuficiencia cardíaca. ¿Es suficiente con la exploración física?». Rev Clin Esp. 2022. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rce.2022.05.003">https://doi.org/10.1016/j.rce.2022.05.003</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características clínicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia cardíaca hospitalizados por COVID-19 en España" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Salinas-Botrán" 1 => "J. Sanz-Cánovas" 2 => "J. Pérez-Somarriba" 3 => "L.M. Pérez- Belmonte" 4 => "L. Cobos-Palacios" 5 => "M. 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