Argentine Journal of Cardiology最新文献

{"title":"Influenza and Pneumococcal Vaccination in Patients with Cardiovascular Disease: Pilot Project","authors":"R. Villarreal, E. Zaidel, Horacio G. Cestari, E. Mele, M. I. S. Liprandi, Á. S. Liprandi","doi":"10.7775/AJC.84.6.5853","DOIUrl":"https://doi.org/10.7775/AJC.84.6.5853","url":null,"abstract":"Introduccion Se recomienda la vacunacion antiinfluenza y antineumococcica en adultos con trastornos cardiovasculares, pero existe una subutilizacion de las mismas. Objetivo Describir la tasa de inmunizacion de los pacientes luego de la indicacion sistematica de las vacunas antigripal y antineumococcica, y las barreras en su implementacion. Evaluar si la indicacion desde la unidad coronaria se asocia con mayor adherencia. Metodos Estudio unicentrico prospectivo. Durante un mes en epoca epidemica, se prescribio sistematicamente vacunacion antigripal y antineumococcica al egreso de unidad coronaria o en consultorios externos a pacientes con indicacion para las mismas. Seguimiento a 30 dias con contacto telefonico. Resultados Se reclutaron 80 pacientes, mediana 65 anos, 67% masculinos, 8% cobertura de salud prepaga y el resto obras sociales. 31% indicacion de inmunizacion al egreso de unidad coronaria.  Durante el seguimiento solo 72% se habian inmunizado con la vacuna antigripal y 45% con la antineumococcica. Los principales motivos descriptos para no inmunizacion fueron decision personal del paciente, problemas de obra social y costos de las vacunas. Se observo tendencia a mayor inmunizacion antineumococcica si la indicacion se realizaba desde la unidad coronaria en comparacion con los consultorios (OR 1,47[0,5-4] p=0,2). Conclusiones Un gran porcentaje de los pacientes a los que se les indican las vacunas no se inmunizan efectivamente, siendo la principal barrera la decision personal. La tendencia a mayor tasa de inmunizacion al egreso de unidad coronaria en comparacion con el consultorio es una potencial oportunidad para mejorar la adherencia, que deberia ser demostrada en estudios de mayor escala.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125488517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging the Right Ventricle: The Ups and Downs and Ins and Outs of Strain","authors":"L. Rudski, J. Grapsa","doi":"10.7775/rac.84.6.10032","DOIUrl":"https://doi.org/10.7775/rac.84.6.10032","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123639746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Coronary Artery Dissection: A Rare Cause of Cardiogenic Shock in Young Women","authors":"D. Pace, Maria Paz","doi":"10.7775/ajc.84.6.8167","DOIUrl":"https://doi.org/10.7775/ajc.84.6.8167","url":null,"abstract":"La diseccion coronaria espontanea (DCE) es una causa infrecuente de SCA. Se presenta en mujeres jovenes, en ocasiones con elevacion del segmento ST y se asocia con displasia fibromuscular (DFM) 1-2,3,5 . Puede manifestarse como diseccion con rotura intimal o como hematoma intramural. En general,  resuelven espontaneamente con buen pronostico a largo plazo, 1,2,4,5 pero en ocasiones la evolucion es mas compleja como los casos que presentaremos a continuacion. Caso 1: Mujer de 46 anos, sin factores de riesgo. Consulto por angor de 3 horas de duracion asociado a sintomas vagales. ECG sin cambios isquemicos, troponina us 281 ng/L(VN < 14 ng/L) y ecocardiograma con hipocinesia anterolateral y medio apical. La CCG evidencio ramo diagonal (Dg) severo ostial, optandose por tratamiento medico. Treinta minutos luego de la CCG presento TV polimorfa (TVP) y paro cardiorespiratorio (PCR). El ECG presentaba supradesnivel del ST (SST) de 3mm de V2-V4. Se repitio la CCG observandose progresion de lesion previa. Se intento angioplastia  (ATC) que resulto fallida. A los 20 minutos repitio angor, TVP y PCR. La 3er CCG mostro  DA ocluida proximal y obstruccion severa de Cx con flap de diseccion en el tronco de CI. Se asistio con balon de contrapulsacion intraortico (BCIAo),  asistencia respiratoria mecanica (ARM) e inotropicos. Se realizo  ATC a DA. Ante la persistencia de inestabilidad hemodinamica se decidio avanzar con Cirugia Coronaria de emergencia (LIMA-DA y PV-Cx). En el postoperatorio persistio en shock cardiogenico, iniciandose asistencia ventricular mecanica (AVM) con ECMO V-A como puente al trasplante. A las 48hs se realizo trasplante cardiaco. En el seguimiento ambulatorio a 8 meses no presento nuevos eventos cardiovasculares. La anatomia patologica cardiaca revelo DFM de las coronarias con diseccion en DA y Cx, focos isquemicos cicatrizales e infartos en diferente periodos evolutivos. Caso 2: Mujer de 30 anos. Migranosa con consumo de ergotamina trisemanal. Consulta por angina en reposo de 10 minutos de duracion con ECG sin cambios isquemicos, troponina US 186 ng/L. Ecocardiograma con hipoquinesia a nivel apical. A los pocos minutos presenta angor y SST V2-V5 realizandose CCG con evidencia de DCE de tercio proximal y medio de DA comprometiendo toda la extension de la arteria, por lo que se realizo a ATC con stent. A las dos horas repitio angor, SST lateral y shock cardiogenico.  La CCG mostro diseccion del TCI distal y de Cx en tercio medio, realizandose ATC a ambas arterias con stent y asistiendose con BCIAo, ARM e inotropicos, respondiendo favorablemente. En el seguimiento ambulatorio a 8 meses no presento nuevos eventos cardiovasculares. Se realizo angiotomografia sin evidencia de enfermedad en otros lechos vasculares.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126478717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus Statement on Chronic Thromboembolic Disease, Prophylaxis and Special Situations / Abridged Version","authors":"J. Ubaldini, J. Bilbao","doi":"10.7775/AJC.84.6.10157","DOIUrl":"https://doi.org/10.7775/AJC.84.6.10157","url":null,"abstract":"Chronic thromboembolic disease refers to a set of conditions that manifest over time after acute pulmonary embolism (PE). In most cases, this episode is associated with acute deep vein thrombosis (DVT). These conditions include chronic pulmonary thromboembolic hypertension (CTEPH), post-thrombotic syndrome (PTS) and chronic venous insufficiency (CVI). (1) A timely diagnosis and treatment may modify the prognosis of this entity during the course of its free progression. (2) Damage caused by DVT may lead to valve dysfunction in the deep venous system. (3) Both CTEPH, PTS and CVI are associated with gradual impairment in the quality of life of those affected. Hence, it is important to postulate prophylaxis strategies in a patient at risk of suffering from a DVT-PE event.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123844075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Ventricle: Echocardiographic Evaluation of Pressure and Volume Overload","authors":"J. M. Castillo, E. Albuquerque, C. Silveira, D. Lamprea, Â. Bandeira, A. Mendes, Carlos G. P. Rocal, C. B. Pereira, Michael Vitor da Silva","doi":"10.7775/AJC.84.6.9467","DOIUrl":"https://doi.org/10.7775/AJC.84.6.9467","url":null,"abstract":"Se analiza la funcion del ventriculo derecho (VD) en pacientes con sobrecarga presorica (SPVD) y volumetrica (SVVD). Objetivo: Analizar alteraciones ecocardiograficas y strain longitudinal y transversal del VD en pacientes SPVD, SVVD y en individuos saludables (CTRL). Material y metodos: Cincuenta CTRL (edad 47±18 anos, 31 femeninos); cincuenta pacientes con SPVD, (edad 48±12 anos, 32 femeninos) y treinta pacientes con SVVD (edad 43±14 anos, 19 femeninos). Analizadas las dimensiones del ventriculo izquierdo (VI), auricula izquierda (AI), VD y auricula derecha (AD), funcion del VI y VD, strain bidimensional longitudinal del VI y VD y transversal del VD. Las medias y desviacion standard fueron comparadas por el analisis de variancia, con significancia de p<0,05. Resultados: Los datos demograficos no mostraron diferencias significativas entre los grupos, asi como la fraccion de eyeccion del VI y el volumen indexado de la AI. En la SPVD los diametros, espesor de la pared del VD, gradiente tricuspide y volumen indexado de la AD fueron mayores. Los parametros de funcion del VD estaban disminuidos en la SPVD y normales en la SVVD. El strain transversal lateral del VD aumentado en la SPVD y SVVD. Conclusion: Los parametros ecocardiograficos y el strain del VD mostraron senales de remodelacion en la SPVD y SVVD y disminucion de la funcion sistolica en la SPVD. El aumento del strain transversal del VD se deberia a la remodelacion y la disminucion del strain longitudinal a la disfuncion sistolica. La disminucion del strain longitudinal del VI puede indicar precozmente la disfuncion biventricular. Palabras clave: Ecocardiografia, strain bidimensional, hipertension pulmonar","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130868973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Constrictive Pericarditis after Cardiac Surgery","authors":"J. Quiñones","doi":"10.7775/rac.84.6.9430","DOIUrl":"https://doi.org/10.7775/rac.84.6.9430","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121059344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Important and the Urgent","authors":"D. Berrocal","doi":"10.7775/RAC.84.6.10053","DOIUrl":"https://doi.org/10.7775/RAC.84.6.10053","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127517144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Melody™ Valve Implantation in Patients with Dysfunctional Right Ventricular Outflow Tract","authors":"Germán Henestrosa, D. Antoni, O. Mendiz","doi":"10.7775/AJC.84.6.9006","DOIUrl":"https://doi.org/10.7775/AJC.84.6.9006","url":null,"abstract":"Background: Percutaneous pulmonary valve implantation is currently considered the treatment of choice in selected cases with previous history of congenital heart disease that present with symptoms of right ventricular outflow tract (RVOT) obstruction and/or pulmonary regurgitation. Objective: The aim of this study was to describe the initial experience with the Melody™ pulmonary valve in a tertiary care center of Argentina. Methods: All patients treated with the Melody™ valve from August 2013 to May 2016 (n=8) were included in the study. Results: Mean age was 25±18 years (range: 13-69), and weight was 56.9±9.3 kg (range: 45-73). Baseline heart diseases were aortic stenosis corrected with the Ross procedure (n=3), truncus arteriosus (n=2), tetralogy of Fallot (n=2) and transposition of the great vessels (n=1). Two patients had severe pulmonary regurgitation, 2 severe stenosis, and 4 double lesion. The number of stents prior to implantation was 2.1±0.64. The overall success rate was 100%. The right ventricular outflow tract gradient and the ratio between right ventricular pressure and systemic pressure diminished significantly (from 57.3±30 to 15±4.2 mmHg, and from 0.67±0.22 to 0.32±0.04, respectively) (p <0.001) with only trace or absent pulmonary regurgitation. No complications were observed. At a mean follow up of 14.3±10.3 months (range 34-1), all patients remained asymptomatic and free from significant pulmonary regurgitation. Conclusion: In our preliminary experience, the Melody™ pulmonary valve was found to be safe and effective, showing drastic right ventricular outflow tract gradient reduction, absence of significant regurgitation and marked clinical improvement. These findings confirm the excellent performance of this valve in patients with dysfunctional right ventricular outflow tract.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126901092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Survey of ST-Segment Elevation Acute Myocardial Infarction in Argentina (ARGEN-IAM-ST)","authors":"J. Gagliardi, Adrián Charask, E. Perna, H. D'Imperio, J. Bono, Y. C. Costa, G. Cerezo, C. Tajer","doi":"10.7775/AJC.84.6.9508","DOIUrl":"https://doi.org/10.7775/AJC.84.6.9508","url":null,"abstract":"Background: ST-segment elevation acute myocardial infarction (STEMI) is one of the most challenging pathologies for the health system; therefore, it is necessary to have a registry with suitably accurate information to adopt public policies and guidelines adjusted to national needs. The Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC) are carrying out a national registry (ARGEN-IAM-ST) that aims to comprise the “universe” of STEMI treatment. Objective: The purpose of this study was to evaluate, as broadly as possible, clinical aspects, delays, treatment strategies and outcomes, as well as eventual barriers that need improvement in STEMI care. Methods: The study included 1,759 patients in 247 centers throughout the country between March and December 2015. Results: Among all patients, 83.5% received reperfusion treatment, and in 78.3% of cases, this was performed by primary angioplasty. Thirty-seven per cent of patients were admitted from another institution, but only 16% of them received fibrinolytic therapy prior to referral. Door-to-needle time was ≤30 minutes in only 25% of patients receiving fibrinolytic agents and door-to-balloon time was ≤90 minutes in 47.7% of patients treated with angioplasty. In-hospital mortality was 8.8%. Conclusions: These data allow delineating a map of acute myocardial infarction in Argentina. Delays in treatment are important and there are aspects to correct. These data suggest the need to implement corrective strategies, such as the application of medical education programs, supportive health policies, considering regional characteristics and on-site cost/benefit of reperfusion strategies, which might help to shorten time to reperfusion, both for thrombolytic therapy as for primary angioplasty.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132313543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation of Argentina in the European Registry of Heart Failure","authors":"Enrique B. Fairman, M. Diez, Alberto Fernández, M. Talavera, E. Perna, S. M. Pereiro, María P. Maturano, María C. Huerta, C. Belziti","doi":"10.7775/ajc.85.4.10972","DOIUrl":"https://doi.org/10.7775/ajc.85.4.10972","url":null,"abstract":"Introduccion: La insuficiencia cardiaca es una patologia que se encuentra en expansion a nivel global y las herramientas terapeuticas disponibles aun son insuficientes. Objetivos: Conocer las caracteristicas epidemiologicas y clinicas de los pacientes con diagnostico de insuficiencia cardiaca en la Republica Argentina, asi como las terapeuticas implementadas y su pronostico, tanto en pacientes ambulatorios como en internados por una reagudizacion. Material y metodos: Se realizo un relevamiento observacional, prospectivo multicentrico de pacientes con insuficiencia cardiaca cronica ambulatorios e internados por insuficiencia cardiaca descompensada en la Republica Argentina durante el periodo agosto 2012-marzo 2013, reclutados para participar en el Registro a largo plazo de Insuficiencia Cardiaca organizado por la Sociedad Europea de Cardiologia. Para facilitar el reclutamiento, el diseno contemplo la inclusion solamente un dia semanal. Se realizo seguimiento al ano de los pacientes. Resultados: Se incluyeron 492 pacientes, de los cuales 122 correspondieron a insuficiencia cardiaca descompensada y 370 a insuficiencia cardiaca cronica. En ambos grupos, las mujeres representaron el 30%. Comparados con los ambulatorios, los internados tuvieron mayor edad [72,5 anos (RIC 64-80) vs. 63 anos (RIC 54-71); p < 0,0001] y un perfil clinico de mayor riesgo. La fibrilacion auricular y la fraccion de eyeccion preservada fueron mas frecuentes en los internados. La mediana de internacion fue de 5 dias y la mortalidad hospitalaria fue del 2,5%. Al ano de seguimiento fallecieron el 20,8% de los reclutados en la internacion y el 10,3% de los ambulatorios. La tasa de readmision para insuficiencia cardiaca descompensada fue del 45,6% y la de hospitalizacion para insuficiencia cardiaca cronica fue del 28%. Conclusiones: Las poblaciones de pacientes internados y ambulatorios no fueron homogeneas; los hospitalizados tuvieron mayor edad y fue mas prevalente la insuficiencia cardiaca con fraccion de eyeccion preservada. La tasa de eventos en el seguimiento a 12 meses fue elevada y aun mayor para aquellos con insuficiencia cardiaca descompensada.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128068087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}