Argentine Journal of Cardiology最新文献

{"title":"Preeclampsia is Preceded by Cardiovascular Function Abnormalities","authors":"O. Páez, P. Puleio, M. Visser, Silvina Mazzeo, Leandro Antelo, J. Alderete, R. Kevorkian, C. Majul","doi":"10.7775/RAC.88.1.17192","DOIUrl":"https://doi.org/10.7775/RAC.88.1.17192","url":null,"abstract":"Introduccion: La preeclampsia (PE) se acompana de cambios en la funcion cardiovascular (FCV). Sin embargo, es desconocido si los cambios preceden y persisten a la manifestacion clinica de PE. Objetivos: Evaluar las diferencias en la FCV, en la semana 22 de gestacion (22sg) y un ano posterior al parto (1app) en las pacientes que evolucionaron a la PE vs. a la normotension (N). Tambien, la asociacion entre la FCV en 22sg y la evolucion a PE. Material y metodos: Estudio prospectivo, que incluyo 260 primiparas normotensas. Se midio en la semana 22sg y a 1app: laboratorio de rutina, proteinuria de 24horas, presion arterial (PA). Por cardiografia por impedancia: indice cardiaco (IC) y de resistencia vascular sistemica (IRVS), velocidad de onda de pulso (VOP). Se formaron 3 grupos segun la evolucion a: PE, G1, HTA gestacional (HG) G2, y N, G3. Los resultados se presentan como media ± DS, ANOVA y test post hoc , p < 0,05. Resultados: 12 pacientes evolucionaron a PE, 18 a HG y 220 a N. El G1 presento en los dos tiempos de medicion, valores inferiores de IC y superiores de PA, IRP y VOP comparados al G3. El G2 presento valores intermedios entre el G1 y el G3. La VOP y el IRP en la S22g de gestacion resultaron predictores de PE. Conclusiones: Las pacientes que evolucionaron a PE presentaron en fase temprana del embarazo diferente FCV respecto a las normotensas. El diagnostico temprano de estos cambios contribuiria a predecir la PE y prevenir sus complicaciones.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125273641","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":"Impact of an Evaluation System of Times to Reperfusion in ST-segment Elevation Acute Myocardial Infarction","authors":"A. Candiello, F. Cohen, L. Lasave, Lorena Villagra, Guillermo Mulinaris, C. Zoni, A. G. Escudero, R. Kevorkian, I. Cigalini, P. Zangroniz","doi":"10.7775/RAC.88.1.17191","DOIUrl":"https://doi.org/10.7775/RAC.88.1.17191","url":null,"abstract":"Introduccion: El tratamiento del infarto con supradesnivel del ST (IAMCEST) es tiempo-dependiente, por lo que los centros con angioplastia primaria (ATCp) deben estar organizados para asegurar una rapida reperfusion. Objetivos: Evaluar el impacto de un sistema de evaluacion sistematica de los tiempos de reperfusion y feedback de resultados en la reduccion de las demoras. Material y metodos: Estudio observacional, prospectivo, realizado en 46 centros con ATCp 24/7 de la Iniciativa Stent-Save a Life! Argentina. Se incluyeron pacientes con IAMCEST sometidos a ATCp antes de las 12 h desde el inicio de los sintomas, asistidos entre marzo de 2016 y febrero de 2019. La poblacion se dividio en tres etapas consecutivas de 1 ano cada una desde la inclusion de cada centro. Resultados: Se incluyeron 3492 pacientes consecutivos (primer ano: 1482; segundo ano: 1166; tercer ano: 844). Se observo una reduccion significativa del tiempo puerta-balon (TPB) (68, 60 y 50 min; p<0,0001) a lo largo de los anos considerados, independientemente de donde haya sido el primer contacto medico (PCM) y del tiempo desde el primer contacto medico (PCM) al balon (115, 112 y 98 min; p<0,0001), sin diferencias en el tiempo desde el inicio de los sintomas al PCM ni en el tiempo total de isquemia (TTI). Asimismo, en aquellos pacientes que tuvieron su PCM en centros sin hemodinamia y fueron derivados para la realizacion de ATCp, se observo una disminucion del TTI (274, 260 y 235 min; p<0,001). Conclusiones: La implementacion de un programa puerta-balon (PPB) en centros con ATCp permitio reducir los tiempos al tratamiento.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116471058","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":"Lipid Goals in Diabetic Patients. Clinical Implications after Application of a New Formula for LDL-cholesterol Calculation","authors":"W. M. Juárez, M. Huerín, M. Lobo, G. Masson, Dona Websmaster, N. Fernández, G. Micali, Mariano Nemec, C. Romero, G. Molinero","doi":"10.7775/RAC.88.1.16342","DOIUrl":"https://doi.org/10.7775/RAC.88.1.16342","url":null,"abstract":"Background: There are clear recommendations for lipid management in diabetic patients. A new formula for the calculation of LDLcholesterol(LDL-C) would improve the inaccuracy of the Friedewald formula.Objectives: The aim of this study was to analyze the use of statins and the fulfillment of lipid goals in diabetic patients, evaluatingthe consequences of applying a new formula for LDL-C calculation.Methods: This was a descriptive, cross-sectional, multicenter study including type 2 diabetic patients over 18 years of age. LDL-Cwas calculated using the classic Friedewald formula and the new formula. Recommendations of the position document for the appropriateuse of statins from the Argentine Society of Cardiology were followed.Results: A total of 528 patients were included in the study. In secondary prevention, 77.2% of patients received statins (23.4% highintensitystatins) and 36.6% and 36.0% of these patients achieved the goals of LDL-C below 70% mg/dl and non-HDL-C below 100mg/dl, respectively. In 20.8% of patients with LDL-C below 70 mg/dl according to the Friedewald formula, this goal was not attainedwhen the new formula was applied. In primary prevention, 62.2% patients with risk factors or white organ damage received statins(14.7% high-intensity statins) and 20.9% and 20.4% achieved the goals of LDL-C below 70% mg/dl and non-HDL-C below 100 mg/dl. In 27.7% of patients with LDL-C below 70 mg/dl using the Friedewald formula, this goal was not reached when applying the newformula. More patients did not achieve the LDL-C goal with the new formula when the triglyceride level was higher.Conclusion: In this population, the appropriate use of statins and the fulfillment of lipid goals were poor. Applying the new LDL-Cformula optimized the evaluation of these patients.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130453714","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":"ST-Segment Elevation ACS: Impact of Time to Diagnosis on Door-To- Balloon Time in the Real World. Data from the ARGEN-IAM-ST Registry","authors":"Y. C. Costa, F. Delfino, V. Mauro, Heraldo D´Imperio, S. Macin, J. Muntaner, M. Marturano, H. Iparraguirre, Adrián Charask, J. Gagliardi","doi":"10.7775/RAC.88.6.19252","DOIUrl":"https://doi.org/10.7775/RAC.88.6.19252","url":null,"abstract":"Background: Time elapsed from the onset of symptoms to diagnosis (TTD) can influence in achieving a door-to-balloon time 120 min (p 120 min (p: 0.003), as well as in patients admitted during non-working hours:41.9% vs. 30.4% (p <0.001). The independent predictors of achieving a DBT <90 min in the multivariate analysis were age<75 years: OR 1.57 (1.1-2.25; p: 0.01), PCI during working hours: OR 1.32 (1.04-1.67; p: 0.002), PCI in situ: OR 2.4 (1.9-3.0;p <0.001), having a pre-hospital ECG: OR 2.22 (1.73-2.86; p <0.001) and a TTD <120 min: OR 1.53 (1.23-1.9; p <0.001). Conclusions : In patients with TTD <120 minutes, a DBT <90 minutes is more frequently achieved, especially in those treated insitu and during working hours. In referred patients, only 1 in 3 achieves a DBT<90 min and there is no relationship with TTD.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127539083","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":"Long-term Non-invasive Hemodynamic Evaluation of Left Endocardial Cardiac Resynchronization Therapy","authors":"M. C. Carrero, G. D. Babio, G. Masson, I. Constantin, F. Verón, M. Mezzadra, G. V. Janavel, P. Stutzbach","doi":"10.7775/RAC.87.6.16591","DOIUrl":"https://doi.org/10.7775/RAC.87.6.16591","url":null,"abstract":"Background: Cardiac resynchronization therapy has 25% to 30% rate of “non-responder” patients. Endocardial cardiac resynchronizationtherapy (eCRT), in which the left ventricular catheter is implanted in the endocardium, would be an alternativefor these patients; however, its long-term outcome has not been investigated.Objectives: The aim of this study was the long-term non-invasive hemodynamic evaluation of eCRT in clinical responders.Methods: Patients implanted according to the criteria for resynchronization, using the Jurdham technique, with more than 6months after the implant, were included in the study. All were clinical responders. The hemodynamic response was evaluatedwith a cardiac function analyzer, which measures the left ventricular systolic intervals (preejection and ejection periods) andautomatically calculates an index of systolic function and estimates the ejection fraction (Systocor mod IS100). To assess themechanical efficacy of eCRT, the cardiac function during biventricular mode was compared with left bundle branch block(LBBB), either spontaneous or by single stimulation of the right ventricle, with patients as their own controls. At least 20beats were averaged in each stimulation mode and only changes >1% with p <0.01 were considered as clinically relevantand statistically significant.Results: Seventeen patients were included, with a median follow-up of 43 months, (9 to 78 months). Endocardial resynchronization,compared with LBBB ventricular activation, showed that all patients shortened the preejection period by an average of31 ms (15%), indicative of decreased interventricular dyssynchrony caused by LBBB. In all patients, systolic function indexincreased by 0.3 (23%) and the EF by 8.3%. In 12/17 of cases (71%) the ejective period increased on average 8.7 ms (2.9%),suggesting an increase in systolic volume. In all changes p was <0.01.Conclusions: Endocardial resynchronization therapy offers significant long-term hemodynamic improvement, detected bysystolic intervals.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"42 10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122743515","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":"Myocardial Torsion. Anatomo-functional Investigation, by Jorge Trainini, Jorge Lowenstein, Mario Beraudo y cols","authors":"García Fernández, M. Ángel","doi":"10.7775/RAC.87.6.16644","DOIUrl":"https://doi.org/10.7775/RAC.87.6.16644","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124181443","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 Ventricular Outflow Tract Stenting as an Option to Blalock-Taussig Shunt for Tetralogy of Fallot","authors":"J. Sandoval, C. Zabal","doi":"10.7775/RAC.87.2.14747","DOIUrl":"https://doi.org/10.7775/RAC.87.2.14747","url":null,"abstract":"Tetralogy of Fallot (TOF) is a complex cardiac condition that includes a wide anatomical spectrum. Surgical repair may have an uneventful outcome between 6 months and the first year of life in most patients with favorable anatomy (e.g. adequate size of branch pulmonary arteries). However, management remains a challenge in symptomatic patients that present early in life, often due to a more severe involvement of right sided obstruction. In this setting, cyanosis becomes evident as a consequence of the progressive narrowing of the pulmonary infundibulum as well as an increased right ventricular stroke volume that faces a semi-fixed resistance and directs flow towards the systemic circulation. In addition, these patients often show underdevelopment of right-sided structures, including a smaller pulmonary annulus, a short and tapered main pulmonary artery, as well as variable degree of diffuse hypoplasia and/or stenosis of the pulmonary arteries. (1) Thus, it is not surprising that most of these children exhibit early progressive cyanosis and are at potential risk of “hypoxic spells” that require early medical stabilization with prostaglandin infusion to maintain arterial duct patency until a more definitive therapy can be established. Today, although some selected centers advocate for early surgical repair within the first 3 months of life (provided anatomical features are considered favorable), many countries (including Latin America) continue to support an initial palliative approach. Creation of a systemic-to-pulmonary shunt, usually a modified BlalockTaussig type (MBTS) followed by complete repair at a later stage is still the most adopted strategy in many centers around the world. Far from being considered an ideal palliative measure, a MBTS can result in disproportionate growth of the pulmonary arteries or stenosis of the involved pulmonary branch that may hinder results at the time of complete repair. (2, 3) Furthermore, according to a recent publication, shunt thrombosis or pulmonary","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131732762","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":"Takotsubo Syndrome in Postoperative Mitral Valve Repair","authors":"S. Krause, Eliana G. Ortis, Guillermo Gutierrez, J. Santucci, S. Baratta, G. Vaccarino","doi":"10.7775/RAC.87.2.14636","DOIUrl":"https://doi.org/10.7775/RAC.87.2.14636","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132655117","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":"Dr. Jorge Omar Vilariño","authors":"Ricardo J. Esper","doi":"10.7775/RAC.87.2.14950","DOIUrl":"https://doi.org/10.7775/RAC.87.2.14950","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130501651","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":"Validación y comparación de dos modelos simples de estratificación de riesgo en pacientes con infarto agudo de miocardio con elevación del segmento ST en Argentina.","authors":"Lucrecia M. Burgos, Elian F. Giordanino, Cristian Garmendia, Casandra Godoy Armando, I. Cigalini, Sebastián García Zamora, Ricardo Iglesias, J. P. Costabel","doi":"10.7775/RAC.87.2.13339","DOIUrl":"https://doi.org/10.7775/RAC.87.2.13339","url":null,"abstract":"Introduccion Los scores de riesgo se encuentran recomendados para estratificar y predecir mortalidad en el infarto agudo de miocardio con elevacion del segmento ST (IAMCEST). Sin embargo, pocos se han validado en Argentina, y existen barreras en su implementacion dada la complejidad de las puntuaciones de riesgo mas difundidas. Los modelos ProACS y Simple Risk Index (SRI) son scores simples y bedside , que han demostrado una buena capacidad predictiva de mortalidad intrahospitalaria en pacientes con IAMCEST en otros paises. Proposito : Validar y comparar los scores ProACS y SRI como predictores de mortalidad intrahospitalaria en pacientes con IAMCEST en Argentina. Metodologia : Analisis retrospectivo de una cohorte compuesta por pacientes ingresados de forma consecutiva en 45 centros de todo el pais con diagnostico de IAMCEST, utilizando los datos del registro CONAREC XVII. Se calculo el puntaje para cada score: el ProACS (Edad ≥72 anos: 2 puntos, presion arterial sistolica  ≤116 mmHg, Killip y Kimbal tipo B o C y la elevacion del segmento ST 1 punto cada uno, y Killip y Kimball D 3 puntos) y el SRI (frecuencia cardiaca x [edad/10]2/presion arterial sistolica). Se estimo el valor predictivo del score para muerte intrahospitalaria, y se evaluo la validez mediante la discriminacion y la calibracion. Resultados Se analizaron 694 pacientes. Con una edad media de 63,35±13,1 anos, siendo hombres el 78.3%. La mortalidad intrahospitalaria fue del 8,78%.  En aquellos que presentaron el evento, la mediana del score ProACS fue de 4 con (Pc 25-75, 2,5-5); y una mediana de 2 (Pc25-75 1-3) en aquellos que no lo presentaron (P<0,001). La mediana del score SRI fue de 41,3 (Pc25-75, 29,8-62,5) y de 20,8 (Pc25-75 15,4-30) en aquellos que fallecieron y los que no, respectivamente (P<0,001), y demostro una excelente discriminacion para mortalidad intrahospitalaria (AUC 0.83, IC95% 0.78-0.88, P=0.001) y el score ProACS presento una buena discriminacion del desenlace (AUC 0.78, IC95% 0.71-0.86, P=0.001).  El test de HL aplicado al Score Proacs presento χ2 de 8,6 (P=0,3), y el score SRi χ2 de 5,4 (P=0,7). Conclusion Los puntajes de riesgo de ProACS y SRI para la prediccion de mortalidad intrahospitalaria fueron validados adecuadamente en pacientes con IAMCEST en Argentina. Esto sugiere su idoneidad para el uso clinico en esta poblacion","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"76 8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127393356","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}