Argentine Journal of Cardiology最新文献

{"title":"Treatment of a Complicated Chronic Aortic Dissection with Distal False Lumen Embolization","authors":"L. Ferreira, M. Ferrer, A. Macias, Ricardo La Mura","doi":"10.7775/RAC.86.4.12858","DOIUrl":"https://doi.org/10.7775/RAC.86.4.12858","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"606 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123260708","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":"Triple Contractile Imaging in the Stress Echo Lab: the Additive Prognostic Value of Pressure–Volume and Preload Recruitable Stroke Work Relationships","authors":"T. Bombardini, F. Rigo, A. Djordjevic-Dikic, L. Cortigiani, M. Marzilli, E. Picano","doi":"10.7775/RAC.85.6.12856","DOIUrl":"https://doi.org/10.7775/RAC.85.6.12856","url":null,"abstract":"Introduccion: La positividad del ecoestres a traves de alteraciones de la motilidad parietal ha ido cediendo terreno frente a nuevas propuestas basadas en la reserva contractil del ventriculo izquierdo (indice stress/reposo de la elastancia ventricular izquierda). Por otra parte, la pendiente del trabajo latido reclutable por precarga, es decir, la pendiente de la relacion trabajo latido y volumen de fin de diastole proporciona una medida independiente de la precarga y la poscarga. Objetivo: El proposito de este estudio fue evaluar el valor pronostico adicional de la reserva contractil ventricular izquierda y la pendiente del trabajo latido reclutable por precarga. Metodos: Se seleccionaron 692 pacientes de la base de datos del estudio multicentrico de ecoestres del Consejo Nacional de Investigaciones (Consiglio Nazionale delle Ricerche, CNR), con edad media de 62 ± 12 anos, ecoestres negativo (ejercicio = 130; dipiridamol = 438; dobutamina n = 124) y sin dilatacion (n = 470) o miocardiopatia idiopatica dilatada (n = 22). Todos los pacientes fueron sometidos a triple imagen: 1) evaluacion de alteraciones de la motilidad parietal; 2) evaluacion de la reserva contractil ventricular izquierda; y 3) evaluacion de la pendiente del trabajo latido reclutable por precarga.  Resultados: De acuerdo a la norma de seleccion, todos los pacientes tuvieron un estudio de ecoestres negativo segun el criterio de motilidad parietal alterada; la tasa de positividad global fue de 49% para la reserva contractil, 36% para la pendiente del trabajo latido reclutable por precarga (criterio de positividad ≤ 64 erg × cm−3 × 103), 19% para ambos criterios de positividad y 33% para ambos criterios de negatividad. En los 692 pacientes con una mediana de seguimiento de 20 meses, hubo 132 eventos. La tasa de eventos fue menor en pacientes con doble negatividad y mayor en aquellos con doble positividad (c2=51, p<0,001). Conclusiones: La tasa de positividad del ecoestres y el rendimiento pronostico aumentan marcadamente si la reserva contractil con estres y la pendiente del trabajo latido reclutable por precarga se suman a las alteraciones de motilidad parietal regional convencionales.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129682572","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":"Use of High-Intensity Statin Strategy. Are the Guidelines Followed?","authors":"Y. C. Costa, V. Mauro, Adrián Charask, Enrique B. Fairman, Hugo Buhezo, C. Barrero","doi":"10.7775/RAC.86.1.11430","DOIUrl":"https://doi.org/10.7775/RAC.86.1.11430","url":null,"abstract":"Background: Secondary prevention in patients < 76 years with history of a vascular event or previous revascularization includes the use of high intensity-statin therapy. Objective: The aim of this study is to evaluate the 1-year adherence to treatment since patients’ discharge from the coronary care unit. Methods: We conducted a prospective study of consecutive patients between January and November 2015. Median follow-up was 9 months. Results: A total of 210 patients were included; 83% were men and median age was 59 years (52-67.5). Most patients (74.5%) were discharged with atorvastatin 40 mg/day, 19% with rosuvastatin 20 mg/day, 2.7% with atorvastatin 80 mg/day and 3.9% with rosuvastatin 40 mg/day. Half of the patients continued with high-intensity statins, 28% reduced the dose and 22% stopped the treatment. Conclusions: Only half of the patients with high vascular risk or history of recent revascularization continues with the treatment after one year.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129623476","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":"Speckle tracking of left atrium: the importance of rest and stress measurements!","authors":"I. Dentamaro, P. Colonna","doi":"10.7775/rac.85.6.12694","DOIUrl":"https://doi.org/10.7775/rac.85.6.12694","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"85 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115734456","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":"Implant of Cardiac Resynchronization Therapy Device in Patients with High Percentage of Right Ventricular Pacing and Refractory Heart Failure","authors":"G. Albina, S. Rivera, I. Mondragon, N. Vecchio, A. Giniger, F. Scazzuso","doi":"10.7775/rac.85.5.10146","DOIUrl":"https://doi.org/10.7775/rac.85.5.10146","url":null,"abstract":"Background: Implant of a cardiac resynchronization therapy device in patients with pacemaker or implantable cardioverter defibrillator who develop heart failure with left ventricular dysfunction is controversial. Objective: The aim of this study was to evaluate the outcome of these patients after upgrading to cardiac resynchronization therapy. Methods: Patients undergoing therapy upgrade between 2011 and 2015 were evaluated. Results: A total of 21 patients were included with mean age of 70.7±10.8 years. Mean QRS duration was 180.9±23.2 ms and left ventricular ejection fraction was 26.8 ± 7.7%. The frequency of right ventricular pacing was 90.5±19.3%. Ten patients were in functional class II and 11 in FC III. The implant was successful in 18 patients (85.7%). Left ventricular ejection fraction was 33.9±10.4% one year after upgrading (p=0.028). Among the total number of patients, 13 improved their functional class in at least one category and only 4 were rehospitalized due to heart failure (p=0.048). The rate of complications was 14.28%. Conclusions: Therapy upgrade improved symptoms and reduced hospitalizations due to heart failure.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"183 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120917947","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":"In-hospital and Long-term Outcomes of Aortic Arch Surgery","authors":"A. Domenech, R. Marenchino, R. Posatini, R. Battellini, J. C. Vázquez, E. Rossi, V. Kotowicz","doi":"10.7775/RAC.85.5.11688","DOIUrl":"https://doi.org/10.7775/RAC.85.5.11688","url":null,"abstract":"Background: Treatment of patients with acute or chronic aortic arch disease has been historically associated with poor outcomes. Objective: The aim of this study was to analyze in-hospital and long-term outcomes of aortic arch replacement comparing emergency and elective procedures. Methods: We conducted a retrospective cohort study in patients undergoing aortic arch surgery in a high complexity center between January 2010 and December 2016, with one-year follow-up. Results: A total of 65 patients were included; 65% were men and median age was 71 years. Among postoperative complications, prolonged mechanical ventilation was more common in the emergency than in the elective surgery group (52% vs. 19%, p=0.006). The incidence of reoperation due to bleeding, mediastinitis, stroke, and renal failure requiring dialysis in the postoperative period was not significantly different between both groups. In-hospital mortality was 15% and observed mortality 24%, without significant differences according to emergency or elective procedure. Conclusions: In this cohort of patients undergoing aortic arch surgery, in-hospital mortality and 1-year mortality was similar in patients undergoing emergency or elective surgeries. The risk of mortality during the first year was 4 times greater in patients >75 years than in younger ones. The incidence of mortality and postoperative stroke was similar to that reported by recent registries. The incidence of reoperations due to bleeding was remarkably low. The rate of complications (reoperations due to bleeding, stroke, acute renal failure or infection) was not statistically different between both groups, probably because of lack of power of the sample","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123401220","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":"Looking for Perfection in the Evaluation of Mitral Regurgitation","authors":"Marta L. Nacke, J. Parras, Francisco G. Fazio, E. M. Assaf","doi":"10.7775/RAC.85.6.12553","DOIUrl":"https://doi.org/10.7775/RAC.85.6.12553","url":null,"abstract":"Background: Currently, there is no single echocardiographic parameter for assessing the severity of mitral regurgitation. Two conceptually similar methods have been published. One method is the mitral valve to LVOT velocity time integral ratio (MOTVTI), and the other the mitral E wave peak velocity to LVOT velocity time integral ratio (EVTI). Objectives: Our goals were to compare the ability of both methods to diagnose severe mitral regurgitation and establish the best cutoff points for the diagnosis. Methods: We included patients with and without mitral regurgitation. The area under the ROC curve for MOTVTI and EVTI was analyzed to compare their diagnostic ability of both methods and estimate the best diagnostic cutoff points. Results: A total of 135 patients were included in the study, 51 with various degrees of mitral regurgitation and the rest as controls. Patients with severe mitral regurgitation had an effective regurgitant orifice area of 0.73±0.34 cm2, vena contracta of 8.3±2.2 mm and regurgitant volume of 99±42 ml. The analysis showed an area under ROC curve of 0.83 (95% CI: 0.75 to 0.89) for MOTVTI and 0.92 (95% CI: 0.86 to 0.96) for EVTI, without significant differences. The best cutoff point was> 1.84 for MOTVTI (sensitivity 80%, specificity 94%) and >6.25 for EVTI (sensitivity 100%, specificity 79%). Conclusions: Both methods are useful for the diagnosis of severe MR and have similar diagnostic capacity. The best cutoff points differ from those originally published.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117224016","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":"Making the Myocardial Infarction Mortality Iceberg Visible in Argentina","authors":"C. Tajer","doi":"10.7775/RAC.85.5.12466","DOIUrl":"https://doi.org/10.7775/RAC.85.5.12466","url":null,"abstract":"Las enfermedades cardiovasculares tienen una elevada incidencia en nuestro país y encabezan históricamente las causas de muerte referidas en los certificados de defunción. El infarto de miocardio es una de las formas más frecuentes y agresivas de presentación, con una significativa morbimortalidad. (1) Las sociedades científicas han encarado desde 1987 encuestas periódicas que nos han permitido conocer datos epidemiológicos sobre la evolución de las modalidades de presentación y mortalidad, así como epidemiológicos-clínicos sobre la forma en que los pacientes son tratados. (2) (3) La mayor limitación de estas encuestas es su representatividad, dado que la participación es voluntaria y, como consecuencia, refleja la práctica de instituciones con motivación académica o comunitaria. Son muy escasos los intentos de relevamiento de la patología infarto desde una mirada poblacional. Hace algunos años Caccavo y cols. publicaron un registro efectuado en la ciudad de Coronel Suárez en la Provincia de Buenos Aires con la intención de estimar la incidencia poblacional de infarto. (4) Sus resultados permitieron estimar para el año 2005 una incidencia de infarto con elevación del segmento ST de 90 por 100000 habitantes, que, corregido para la población de 35 a 64 años, resultó de 41,9 por 100000 habitantes. La cifra de infartos con elevación del ST internados anualmente proyectada para todo el país fue de 31435, y, considerando los infartos sin elevación del ST con los criterios de aquel momento, el total de infartos de pacientes internados ascendía a 42025. (5) En este número de la Revista de Cardiología, se publica el REGIBAR, un estudio cuyo objetivo fue conocer la incidencia y letalidad del infarto en la Ciudad de Bariloche. (6) El REGIBAR difiere mucho del estudio de Coronel Suárez, porque se orientó a la detección de todos los infartos y no solo los de pacientes internados y siguió las recomendaciones del registro MONICA promovido 30 años atrás por la organización mundial de la Salud. (7) Registraron así todos los infartos internados sobre la base de los diagnósticos de egreso, corrigieron, luego, por una exploración guiada por pacientes con niveles de troponina elevados y alcanzaron un total de 80 infartos confirmados en un año. Un primer hallazgo fue que a raíz de esta exploración a partir de los niveles de troponina, uno de cada cinco infartos de pacientes internados no se hubiera registrado partiendo solo de los diagnósticos de egreso. A diferencia del estudio de Caccavo y cols. y de los registros históricos de infarto, solo el 54% tenía elevación del segmento ST o bloqueo de rama izquierda, y el 46% se consideró como infarto sin elevación del segmento ST. Sumaron a estos infartos los que los médicos clínicos y cardiólogos podían detectar en sus consultorios, aunque fueron solo una pequeña cantidad (3 casos). La mayor novedad de este estudio es que revisaron sistemáticamente todas las defunciones en ese año, para establecer la posibilidad de diagnós","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126915858","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":"Listado de Artículos - Año 2017","authors":"Revista Cardiologia","doi":"10.7775/rac.86.1.12314","DOIUrl":"https://doi.org/10.7775/rac.86.1.12314","url":null,"abstract":"Introduccion : El estudio ecocardiografico de la funcion global auricular izquierda, segun guias, se basa en la medicion de dimensiones, areas, volumenes y la funcion diastolica mediante la interrogacion con Doppler pulsado. Su importancia es trascendental, ya que su dilatacion ha demostrado ser un predictor de eventos cardiovasculares adversos. Con el advenimiento de las nuevas tecnicas ecocardiograficas es posible evaluar la mecanica de la deformacion de la pared auricular (strain) con curvas que identifican la funcion de reservorio, conducto y contraccion. Sin embargo, aun no hay consenso para definir el valor de strain auricular izquierdo determinado mediante speckle tracking en pacientes normales y su respuesta con el ejercicio. Objetivos: Establecer el valor de referencia de strain auricular izquierdo en pacientes sanos en reposo y durante el pico de un ecoestres de esfuerzo. Ademas, analizar la relacion de la deformacion con la E/e´ para determinar los cambios de rigidez auricular. Metodologia: Estudio descriptivo, prospectivo, observacional. Se incluyeron los pacientes mayores de 18 anos, sanos, sin factores de riesgo cardiovascular, ni antecedentes patologicos a los que se realizo un ecoestres con ejercicio entre enero y marzo 2017. Se utilizo un Vivid E 95 (GE Healthcare), con transductor 5MS MHz, con adquisicion de las imagenes con un frame rate entre 60 - 70 en reposo y entre 80 - 90 en el esfuerzo. Los loops se obtuvieron en las vistas de 4 camaras y 2 camaras, tanto en reposo como a la maxima carga de ejercicio y se analizaron offline (EchoPac Version 201). Para la medicion de strain se trazaron los bordes de la AI, a 1 mm de distancia del anillo de la valvula mitral, ajustando de manera manual el ancho de la zona de interes en relacion al espesor  de la pared auricular. Se consideraron los 6 segmentos por cada vista y se analizo el valor promedio de la curva correspondiente al reservorio por ser la mas representativa y reproducible.  Para el valor de rigidez auricular se calculo el promedio E/e´/strain AI x 100. En el analisis estadistico las variables categoricas se expresan como porcentaje y las cuantitativas como media ± DS y se comparan con test de t para muestras pareadas. Se considero significativa una p < 0.05. Resultados: De 34 pacientes pacientes con criterios de inclusion se excluyeron a 3 por mala ventana ecocardiografica en reposo y 2 en el esfuerzo. De los 29 pacientes analizados (factibilidad total 85 %) 16 fueron hombres con una media de edad de la poblacion de 50 ± 10.6 anos. La variabilidad intraobservador del calculo del reservorio en reposo y esfuerzo   fue del 2.2 %±1.6 y 2.3% ± 2.5 e interobservador de 6% ±7 y 4.6% ± 4 respectivamente. Conclusiones: En una poblacion normal resulto factible evaluar la funcion del reservorio de la auricula izquierda en reposo y durante el esfuerzo maximo con un incremento significativo de la deformacion, sin cambios de la rigidez auricular.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133354270","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":"Patient-Centered Care. Humanization of Coronary Care Units","authors":"M. González","doi":"10.7775/RAC.85.5.12289","DOIUrl":"https://doi.org/10.7775/RAC.85.5.12289","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128283633","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}