RESUMO
Resistive random access memory (RRAM) is an important candidate for both digital, high-density data storage and for analog, neuromorphic computing. RRAM operation relies on the formation and rupture of nanoscale conductive filaments that carry enormous current densities and whose behavior lies at the heart of this technology. Here, we directly measure the temperature of these filaments in realistic RRAM with nanoscale resolution using scanning thermal microscopy. We use both conventional metal and ultrathin graphene electrodes, which enable the most thermally intimate measurement to date. Filaments can reach 1300°C during steady-state operation, but electrode temperatures seldom exceed 350°C because of thermal interface resistance. These results reveal the importance of thermal engineering for nanoscale RRAM toward ultradense data storage or neuromorphic operation.
RESUMO
Acute coronary syndromes without coronary lesions have gained relevance in recent years. However, local data on this condition is scarce. We aimed to explore this entity in a National registry of acute myocardial infarction that was carried out prospectively in hospitals with cardiology residence programs from Argentina. We included 1182 patients from 45 centers, where 33 did not present coronary lesions on angiography. The mean age was 64.5 ±13.0 and 69.7% were male, without differences compared to participants with epicardial disease. The most common electrocardiographic presentation was ST segment deviation. In addition, presented lower biomarkers (peak CPK 203.5 IU / l, range [IQR] 102-422.5 vs. 895.5 IU / l IQR 350-1891, p < 0.0001). The median hospitalization was 4.0 days (IQR 3-5.5), lower than the group with intermediate and severe coronary disease (5.5 days, RIC 4-7, and 6, RIC 4-7, p = 0.003). At discharge, less use of ACE/ARB (54.6% vs.78.0% y 79.7%, p = 0.002) and statins (78.8% vs. 87.9% y 91.9%, p = 0.017). No deaths during hospitalization were reported. Our data suggested that infarcts without significant coronary lesions are frequent, although they are probably underdiagnosed. Their prognosis seems to be more favorable, but they receive fewer drugs to prevent recurrence. New studies are necessary to deepen the knowledge of the disease.
Los síndromes coronarios agudos sin lesiones coronarias han cobrado relevancia en los últimos años, pero aún no se dispone de datos locales. Analizamos un registro de pacientes con infarto agudo de miocardio, en 45 centros del país con residencias de cardiología. Se analizaron 1182 participantes de los cuales 33 (2.8%) no presentaron lesiones coronarias en angiografía, mientras que 89.5% tenían lesiones graves y 7.7% lesiones intermedias. La edad promedio de los pacientes sin lesiones coronarias fue 64.5 ± 13.0 años, 69.7% eran varones, sin diferencias respecto a aquellos con enfermedad epicárdica. La presentación electrocardiográfica más frecuente fue la desviación del segmento ST (13 supradesnivel y 10 infradesnivel del segmento). Además, este subgrupo presentó biomarcadores más bajos (CPK pico 203.5 UI/l, rango [RIC] 102-422.5 vs. 895.5 UI/l RIC 350-1891, p < 0.0001). La mediana de días de internación fue 4.0 (RIC 3-5.5), siendo menor que la del grupo con enfermedad coronaria intermedia y grave (5.5 días, RIC 4-7, y 6 RIC 4-7, p = 0.003). Al alta, aquellos sin lesiones coronarias recibieron menor prescripción de IECA/ARA II (54.6% vs. 78.0% y 79.7%, p = 0.002) y estatinas (78.8% vs. 87.9% y 91.9%, p = 0.017). Ninguno de este subgrupo falleció durante la internación. Nuestros datos sugieren que los infartos sin lesiones coronarias significativas son frecuentes en nuestro medio, aunque probablemente se encuentren subdiagnosticados. Si bien su pronóstico parece más favorable, resulta importante señalar que recibieron menos fármacos para prevenir su recurrencia. Nuevos estudios son necesarios para profundizar el conocimiento de esta enfermedad.
Assuntos
Vasos Coronários , Infarto do Miocárdio , Idoso , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Argentina/epidemiologia , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Sistema de Registros , Fatores de RiscoRESUMO
Los síndromes coronarios agudos sin lesiones coronarias han cobrado relevancia en los últimos años, pero aún no se dispone de datos locales. Analizamos un registro de pacientes con infarto agudo de miocardio, en 45 centros del país con residencias de cardiología. Se analizaron 1182 participantes de los cuales 33 (2.8%) no presentaron lesiones coronarias en angiografía, mientras que 89.5% tenían lesiones graves y 7.7% lesiones intermedias. La edad promedio de los pacientes sin lesiones coronarias fue 64.5 ± 13.0 años, 69.7% eran varones, sin diferencias respecto a aquellos con enfermedad epicárdica. La presentación electrocardiográfica más frecuente fue la desviación del segmento ST (13 supradesnivel y 10 infradesnivel del segmento). Además, este subgrupo presentó biomarcadores más bajos (CPK pico 203.5 UI/l, rango [RIC] 102- 422.5 vs. 895.5 UI/l RIC 350-1891, p < 0.0001). La mediana de días de internación fue 4.0 (RIC 3-5.5), siendo menor que la del grupo con enfermedad coronaria intermedia y grave (5.5 días, RIC 4-7, y 6 RIC 4-7, p = 0.003). Al alta, aquellos sin lesiones coronarias recibieron menor prescripción de IECA/ARA II (54.6% vs. 78.0% y 79.7%, p = 0.002) y estatinas (78.8% vs. 87.9% y 91.9%, p = 0.017). Ninguno de este subgrupo falleció durante la inter nación. Nuestros datos sugieren que los infartos sin lesiones coronarias significativas son frecuentes en nuestro medio, aunque probablemente se encuentren subdiagnosticados. Si bien su pronóstico parece más favorable, resulta importante señalar que recibieron menos fármacos para prevenir su recurrencia. Nuevos estudios son necesarios para profundizar el conocimiento de esta enfermedad.
Abstract Acute coronary syndromes without coronary lesions have gained relevance in recent years. However, local data on this condition is scarce. We aimed to explore this entity in a National registry of acute myocardial infarction that was carried out prospectively in hospitals with cardiology residence programs from Ar gentina. We included 1182 patients from 45 centers, where 33 did not present coronary lesions on angiography. The mean age was 64.5 ±13.0 and 69.7% were male, without differences compared to participants with epicardial disease. The most common electrocardiographic presentation was ST segment deviation. In addition, presented lower biomarkers (peak CPK 203.5 IU / l, range [IQR] 102-422.5 vs. 895.5 IU / l IQR 350-1891, p < 0.0001). The median hospitalization was 4.0 days (IQR 3-5.5), lower than the group with intermediate and severe coronary disease (5.5 days, RIC 4-7, and 6, RIC 4-7, p = 0.003). At discharge, less use of ACE/ARB (54.6% vs.78.0% y 79.7%, p = 0.002) and statins (78.8% vs. 87.9% y 91.9%, p = 0.017). No deaths during hospitalization were reported. Our data suggested that infarcts without significant coronary lesions are frequent, although they are probably underdiagnosed. Their prognosis seems to be more favorable, but they receive fewer drugs to prevent recurrence. New studies are necessary to deepen the knowledge of the disease.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/diagnóstico por imagem , Argentina/epidemiologia , Inibidores da Enzima Conversora de Angiotensina , Sistema de Registros , Fatores de Risco , Angiografia Coronária , Antagonistas de Receptores de AngiotensinaAssuntos
Embolia Pulmonar , Sociedades Médicas , Doença Aguda , Ecocardiografia , Humanos , Fatores de RiscoRESUMO
Una de cada 4 coronariografías realizadas por isquemia miocárdica presenta lesiones menores al 50% Este dato desencadenó un creciente interés en la comunidad médica. La Sociedad Americana de Cardiología publicó recientemente un artículo que describe la posición consensuada de un grupo de expertos sobre la fisiopatología, el diagnóstico y el tratamiento de esta entidad. Nuestro trabajo refleja una revisión narrativa y la posición de un grupo de expertos pertenecientes a diferentes instituciones con servicios de Cardiología jerarquizados. Aborda aspectos fisiopatológicos y diagnósticos para comprender el enfoque actual del tratamiento, tanto en pacientes que ingresan con diagnóstico de MINOCA (infa rto de miocardio con lesiones angiográficas no graves) o de INOCA (angina e isquemia demostradas, pero sin lesiones coronarias que justifiquen este síndrome).
One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome).
Assuntos
Humanos , Masculino , Feminino , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/diagnóstico por imagem , Tomada de Decisão Clínica , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/diagnóstico por imagem , Prognóstico , Imageamento por Ressonância Magnética/métodos , Cineangiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Fatores de Risco , Angiografia Coronária/métodos , Vasos Coronários/fisiopatologia , Vasos Coronários/diagnóstico por imagemRESUMO
One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome).
Una de cada 4 coronariografías realizadas por isquemia miocárdica presenta lesiones menores al 50% Este dato desencadenó un creciente interés en la comunidad médica. La Sociedad Americana de Cardiología publicó recientemente un artículo que describe la posición consensuada de un grupo de expertos sobre la fisiopatología, el diagnóstico y el tratamiento de esta entidad. Nuestro trabajo refleja una revisión narrativa y la posición de un grupo de expertos pertenecientes a diferentes instituciones con servicios de Cardiología jerarquizados. Aborda aspectos fisiopatológicos y diagnósticos para comprender el enfoque actual del tratamiento, tanto en pacientes que ingresan con diagnóstico de MINOCA (infa rto de miocardio con lesiones angiográficas no graves) o de INOCA (angina e isquemia demostradas, pero sin lesiones coronarias que justifiquen este síndrome).
Assuntos
Tomada de Decisão Clínica , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Cineangiografia/métodos , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios X/métodosRESUMO
RESUMEN Introducción: Los scores de riesgo se encuentran recomendados para estratificar y predecir mortalidad en el infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Los modelos ProACS y Simple Risk Index (SRI) son scores simples que demostraron una buena capacidad predictiva de mortalidad intrahospitalaria en otros países. Objetivo: Validar y comparar los scores ProACS y SRI como predictores de mortalidad intrahospitalaria en pacientes con IAMCEST. Material y métodos: Análisis retrospectivo de una cohorte compuesta por pacientes ingresados de forma consecutiva con diagnóstico de IAMCEST, en el que se utilizaron datos del registro CONAREC XVII. Se estimó el valor predictivo para muerte intrahospitalaria y se evaluó la validez mediante la discriminación y la calibración. Resultados: Se analizaron 694 pacientes. La mortalidad intrahospitalaria fue del 8,78%. En aquellos que presentaron el evento, la mediana del score ProACS fue de 4 (Pc 25-75, 2,5-5); y una mediana de 2 (Pc 25-75 1-3) en aquellos que no presentaron (p < 0,001). La mediana del score SRI fue de 41,3 (Pc 25-75, 29,8-62,5) y de 20,8 (Pc 25-75 15,4-30) en aquellos que fallecieron y los que no, respectivamente (p < 0,001), y demostró una excelente discriminación (AUC 0,83, IC95% 0,78-0,88, p = 0,001) y el score ProACS presentó una buena discriminación del desenlace (AUC 0,78, IC95% 0,71-0,86, p = 0.001). La prueba de HL aplicada al score Proacs presentó χ2 = 8,6 (p = 0,3), y el score SRi χ2 = 5,4 (p = 0,7). Conclusiones: Los puntajes de riesgo de ProACS y SRI para la predicción de mortalidad intrahospitalaria fueron validados adecuadamente en pacientes con IAMCEST en Argentina. Esto sugiere su idoneidad para el uso clínico en esta población.
ABSTRACT Background: Risk scores are recommended to stratify and predict mortality in ST-segment elevation acute myocardial infarction (STEMI). The ProACS and Simple Risk Index (SRI) models are simple scores that have demonstrated adequate predictive capacity of in-hospital mortality in other countries. Objective: The aim of this study was to validate and compare the ProACS and SRI scores as predictors of in-hospital mortality in patients with STEMI. Methods: This was a retrospective analysis of a cohort composed of consecutive patients from the CONAREC XVII registry hospitalized with STEMI diagnosis. The predictive value for in-hospital mortality was estimated and validity was assessed by discrimination and calibration. Results: The study analyzed 694 patients. In-hospital mortality was 8.78%. The median ProACS score was 4 (IQR 25-75, 2.5-5) in patients who presented the event, and 2 (IQR 25-75 1-3) in those without the event (p<0.001) and the median SRI score was 41.3 (IQR 25-75, 29.8-62.5) and 20.8 (IQR 25-75 15.4-30) in those who died and those who did not, respectively (p<0.001). The SRI score showed excellent discrimination (AUC 0.83, 95% CI 0.78-0.88, p=0.001) and the ProACS score evidenced good discrimination (AUC 0.78, 95% CI 0.71-0.86, p= 0.001) for the outcome. The HL test applied to the ProACS score presented χ2=8.6 (p=0.3), and the SRI score χ2=5.4 (p=0.7). Conclusions: The ProACS and SRI risk scores for the prediction of in-hospital mortality were adequately validated in patients with STEMI in Argentina. This suggests their suitability for clinical use in this population.
RESUMO
Resumen Los avances en el tratamiento oncológico han generado un aumento de la expectativa de vida en este grupo de pacien tes. Consecuentemente, las complicaciones relacionadas al tratamiento oncológico se han convertido en un tema crucial, siendo la toxicidad cardiovascular una de las más temidas.1 La radioterapia sobre el tórax, utilizada fundamentalmente en el linfoma de Hodgkin, el cáncer de mama y de pulmón puede generar potenciales efectos colaterales como la enfermedad coronaria, afecciones a nivel pericárdico, miocardio patía, trastornos de la conducción y valvulopatías. Se presenta a continuación el caso de un paciente de 43 años que desarrolló múltiples manifestaciones de cardiotoxicidad inducida por radioterapia.
Abstract Advances in cancer therapy have led to an increase in life expectancy in this group of patients. Consequently, complications related to cancer treatment have become a crucial issue, with cardiovascular toxicity being the most feared. Radiation therapy on the thorax, used primarily in Hodgkin's lymphoma, breast and lung cancer can generate potential side effects such as coronary disease, pericardial conditions, cardiomyopathy, conduction disorders and valvulopathies. The case of a 43-year-old patient who developed multiple manifestations of cardiotoxicity induced by radiotherapy is presented below.
Assuntos
Humanos , Masculino , Adulto , Argentina , Lesões por Radiação , Radioterapia , Anormalidades Induzidas por Radiação , Doenças Cardiovasculares , CardiotoxicidadeRESUMO
Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). In patients with STEMI who cannot undergo timely primary PCI, pharmacoinvasive treatment is recommended, comprising immediate fibrinolytic therapy with subsequent coronary angiography and rescue PCI if needed. Improving clinical outcomes following fibrinolysis remains of great importance for the many patients globally for whom rapid treatment with primary PCI is not possible. For patients with acute coronary syndrome who underwent primary PCI, the PLATO trial demonstrated superior efficacy of ticagrelor relative to clopidogrel. Results in the predefined subgroup of patients with STEMI were consistent with the overall PLATO trial. Patients who received fibrinolytic therapy in the 24 hours before randomization were excluded from PLATO, and there is thus a lack of data on the safety of using ticagrelor in conjunction with fibrinolytic therapy in the first 24 hours after STEMI. The TREAT study addresses this knowledge gap; patients with STEMI who had symptom onset within the previous 24 hours and had received fibrinolytic therapy (of whom 89.4% had also received clopidogrel) were randomized to treatment with ticagrelor or clopidogrel (median time between fibrinolysis and randomization: 11.5 hours). At 30 days, ticagrelor was found to be non-inferior to clopidogrel for the primary safety outcome of Thrombolysis in Myocardial Infarction (TIMI)-defined first major bleeding. Considering together the results of the PLATO and TREAT studies, initiating or switching to treatment with ticagrelor within the first 24 hours after STEMI in patients receiving fibrinolysis is reasonable.
Assuntos
Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Terapia Trombolítica/métodos , Ticagrelor/uso terapêutico , Saúde Global , Humanos , Incidência , Inibidores da Agregação Plaquetária/uso terapêutico , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Taxa de Sobrevida/tendênciasRESUMO
Introducción Los registros de síndromes coronarios agudos realizados por la Sociedad Argentina de Cardiología aportan información actualizada y comparativa sobre su evolución, cuyo análisis permite conocer la tasa de mortalidad, diferentes patrones de tratamiento regionales y evaluar la relación entre los resultados y variables demográficas, características clínicas y terapéutica aplicada en la vida real. Objetivos Analizar las características clínicas, terapéuticas y evolutivas del infarto agudo de miocardio con supradesnivel del segmento ST (IAMST) del registro multicéntrico realizado por la Sociedad Argentina de Cardiología durante 2011. Material y métodos Se analizaron pacientes con diagnóstico de IAMST incluidos en el registro multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Se compararon datos de centros que participaron en los registros de 2005 y de 2011. Resultados Se incluyeron 476 pacientes. Una cuarta parte fueron mujeres, la edad media fue de 61 ± 12,3 años, el 70% recibió tratamiento de reperfusión: 20% (n = 92) con trombolíticos y 50% (n = 238) con angioplastia primaria. La mortalidad hospitalaria de los IAMST fue del 8%. Fueron predictores independientes de muerte la edad mayor de 70 años (OR 2, IC 95% 1,2-3,3; p = 0,003), no haber recibido tratamiento de reperfusión (OR 1,72, IC 95% 1,1-2,0; p = 0,01) y el shock cardiogénico (OR 37, IC 95% 12-117; p < 0,0001). Comparando los mismos centros, en 2011 se redujo en un 30% el número de casos que no recibieron tratamiento de reperfusión, con un incremento del uso de la angioplastia primaria [OR 3,7 (IC 95% 1,6-4; p < 0,001)]. Se detectó también una reducción de la mortalidad hospitalaria [OR 0,40 (IC 95% 0,23-0,83; p = 0,01)]. Conclusiones El 70% de los pacientes con IAMST del SCAR recibió tratamiento de reperfusión, mientras que la mortalidad fue del 8%. Respecto de 2005 se observó, entre otros hallazgos, un incremento de la angioplastia primaria y una disminución de la mortalidad hospitalaria.
Introduction Acute coronary syndrome registries made by the Argentine Society of Cardiology provide current and comparative information on their evolution, whose analysis allows to know mortality rate and different regional treatment patterns, and to evaluate the relationship between outcomes and demographic variables, clinical characteristics and therapy applied in real life. Objectives To analyze the clinical, therapeutic and outcome characteristics of ST segment elevation acute myocardial infarction (STEMI) included in a multicenter registry conducted by the Argentine Society of Cardiology in 2011. Methods Patients diagnosed with STEMI included in the multicenter SCAR (Acute Coronary Syndromes in Argentina) registry were analyzed. Data from centers that participated in the 2005 and 2011 registries were compared. Results The study included 476 patients. Twenty-five percent of patients were women, mean age was 61 ± 12.3 years, and 70% received reperfusion therapy: 20% (n = 92) with thrombolytics and 50% (n = 238) with primary angioplasty. In-hospital mortality rate due to STEMI was 8%. Independent predictors of death were age over 70 years (OR 2, 95% CI 1.2-3.3, p = 0.003), not having received reperfusion therapy (OR 1.72, 95% CI 1.1-2.0, p = 0.01) and cardiogenic shock (OR 37, 95% CI 12-117, p < 0.0001). Comparison of the same centers showed that in 2011 the number of cases that did not receive reperfusion therapy was reduced by 30%, with increased use of primary angioplasty [OR 3.7 (95% CI 1.6-4, p < 0.001)]. A reduction of in-hospital mortality [OR 0.40 (95% CI 0.23-0.83, p = 0.01)] was also identified. Conclusions Seventy percent of patients with STEMI included in the SCAR registry received reperfusion therapy, while mortality rate was 8%. Compared with 2005, an increase of primary angioplasty and decreased in-hospital mortality was found, among other findings.
RESUMO
Obesity and the metabolic syndrome are closely related to the cases of cardiovascular disease; they are usually regarded as belonging to the adult population but are seen with increasing frequency in children and adolescents. There is evidence that atherosclerotic lesions occur most often in young people with obesity. The factors involved in this pandemic are manifold and range from genetic-biological to cultural changes. The family and the environment in which the child develops play a key role in the adoption of habits related to diet and physical activity. This problem does not respect borders and cultures but all countries are being affected, even more those of middle-income. State and Society as a whole can play a role oriented to modify this environment. The restriction on sales of unhealthy food and the fight against the sedentary lifestyle are urgently needed to be applied. The impact that these disorders will have in terms of cardiovascular disease, has not yet reached its true dimension.
Assuntos
Doenças Cardiovasculares , Síndrome Metabólica , Obesidade Infantil , Adolescente , Distribuição por Idade , Argentina/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Criança , Comportamento Alimentar , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Obesidade Infantil/complicações , Obesidade Infantil/epidemiologia , Fatores de Risco , Comportamento Sedentário , Fatores de TempoRESUMO
La obesidad y el síndrome metabólico se encuentran íntimamente relacionados con los casos de enfermedad cardiovascular; son considerados habitualmente como propios de la población adulta aunque se observan con una frecuencia creciente en niños y adolescentes. Existe evidencia de que las lesiones ateroescleróticas se presentan con más frecuencia en jóvenes obesos. Los factores involucrados en esta pandemia son múltiples e incluyen desde variables genético-biológicas hasta cambios culturales. La familia y el entorno en el que el niño se desarrolla juegan un papel fundamental en la adopción de los hábitos relacionados con la alimentación y la actividad física. Esta problemática no respeta fronteras ni culturas sino que todos los países están siendo afectados, más aún aquellos de ingresos medios. El papel que le cabe al Estado y a la sociedad en su conjunto se orienta a modificar este medio ambiente. La restricción en las ventas de alimentos poco saludables y la lucha contra el sedentarismo son políticas que urgen ser aplicadas. El impacto que estos trastornos tendrán en términos de enfermedad cardiovascular, no ha cobrado aún su verdadera dimensión.
Obesity and the metabolic syndrome are closely related to the cases of cardiovascular disease; they are usually regarded as belonging to the adult population but are seen with increasing frequency in children and adolescents. There is evidence that atherosclerotic lesions occur most often in young people with obesity. The factors involved in this pandemic are manifold and range from genetic-biological to cultural changes. The family and the environment in which the child develops play a key role in the adoption of habits related to diet and physical activity. This problem does not respect borders and cultures but all countries are being affected, even more those of middle-income. State and Society as a whole can play a role oriented to modify this environment. The restriction on sales of unhealthy food and the fight against the sedentary lifestyle are urgently needed to be applied. The impact that these disorders will have in terms of cardiovascular disease, has not yet reached its true dimension.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Doenças Cardiovasculares , Síndrome Metabólica , Obesidade Infantil , Distribuição por Idade , Argentina/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Comportamento Alimentar , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Obesidade Infantil/complicações , Obesidade Infantil/epidemiologia , Fatores de Risco , Comportamento Sedentário , Fatores de TempoRESUMO
Introducción El infarto agudo de miocardio (IAM) representa una de las principales causas de morbimortalidad en nuestro país. Tener datos sobre la realidad de esta entidad en la Argentina es de suma importancia como punto de partida para el desarrollo de políticas de prevención, así como para mejorar su tratamiento. Objetivo Describir variables demográficas, situaciones de estrés asociadas, tratamientos instaurados, tiempos en los que se implementaron, complicaciones intrahospitalarias y medicación al alta de pacientes ingresados con IAM en centros asociados al Consejo Argentino de Residentes de Cardiología (CONAREC). Material y métodos Entre diciembre de 2009 y julio de 2010 se incluyeron 1.182 pacientes consecutivos ingresados en 45 centros de todo el país con diagnóstico de IAM con o sin supradesnivel del segmento ST. Resultados La edad promedio fue de 64 ± 12 años; 705 pacientes presentaron IAM con supradesnivel del segmento ST (IAMCEST) y 477 IAM sin supradesnivel del segmento ST (IAMSEST). En el IAMCEST, la tasa de reperfusión fue del 92% de los pacientes elegibles, con la angioplastia como principal método (80%), con una demora prehospitalaria de 165 minutos y un tiempo puerta-balón de 80 minutos. En el IAMSEST se realizó coronariografía al 75% de los pacientes, con angioplastia al 46% de ellos. La principal complicación fue el desarrollo de insuficiencia cardíaca (22% en IAMCEST y 11% en IAMSEST), seguida por el sangrado y las arritmias. La mortalidad resultó del 8,8% en los IAMCEST y del 5,1% en los IAMSEST. Conclusiones Los pacientes con IAM que ingresan en centros con residencia médica presentan una tasa alta de reperfusión y tratamiento al egreso hospitalario, acorde a las recomendaciones internacionales. Encontramos aspectos para mejorar, como la elevada prevalencia de los factores de riesgo y los tiempos prehospitalarios prolongados, situaciones que no se han modificado en los últimos 15 años.
Introduction Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in our country. It is very important to have data on the reality of this entity in Argentina as a starting point for the development of prevention policies and treatment improvement. Objective The aim of the study was to describe demographic variables, situations associated to stress, established treatments, implementation times, in-hospital complications and medication at discharge of patients with AMI admitted to centers associated to the Argentine Council of Residents in Cardiology (CONAREC). Methods Between December 2009 and July 2010, 1182 consecutive patients admitted to 45 centers across the country with a diagnosis of AMI with or without ST segment elevation were included in the study. Results Mean age was 64 ± 12 years; 705 patients presented AMI with ST segment elevation (STEMI) and 477 without ST segment elevation (NSTEMI). In the STEMI group, the reperfusion rate was 92% of eligible patients, with primary angioplasty in 80% of cases. In this group, prehospital time delay was 165 minutes and door-to-balloon time was 80 minutes. In the NSTEMI group), coronary angiography was performed in 75% of patients and 46% underwent angioplasty. The main complication was the development of heart failure (22% in the STEMI group and 11% in the NSTEMI group, followed by bleeding and arrhythmias. Mortality was 8.8% in the STEMI group and 5.1% in the NSTEMI group. Conclusions Patients with AMI admitted to centers with medical residency present with a high rate of reperfusion and treatment at hospital discharge, in agreement with international recommendations. We have found aspects to be improved such as the high prevalence of risk factors and prolonged prehospital time delays, situations which have not changed in the last 15 years.
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Introducción. El agua es fundamental para la vida; sin embargo, la aparición de información errónea generó dudas en la población. Objetivo. Determinar el porcentaje de acuerdo y de influencia sobre el consumo de líquidos de creencias erróneas vinculadas a la hidratación en la población argentina. Material y métodos. Estudio descriptivo, prospectivo, observacional y transversal. Se realizaron 1014 entrevistas directas, domiciliarias, con una cobertura nacional a individuos de ambos sexos >18 años de edad. Se aplicó un muestreo probabilístico, polietápico y estratificado. Resultados. El 80% (IC 95%:75,8%-84,2%) de la población entrevistada estuvo de acuerdo con la creencia que"para cuidar el corazón, hay que tomar agua baja en sodio". Fue más arraigada en: mujeres (p=0,0169), > 65 años (p=0,005), mayor nivel educacional (p=0,026) y nivel socioeconómico medio (p=0,019), Ciudad Autónoma de Buenos Aires (p=0,005) y Gran Buenos Aires (p=0,000). La influencia de esta creencia en el consumo de líquidos fue del 77% (IC 95%: 72,8%-81,2%). El 62% (IC 95%: 57,8%-66,2%) estuvo de acuerdo con la creencia "para cuidar que los chicos no engorden, hay que fijarse más en la comida que en la bebida", principalmente en el nivel educacional (p=0,015) y socioeconómico más bajo (p=0,014). La influencia en la ingesta de líquidos fue del 74% (IC 95%: 69,8%-78,2%). Mientras que el grado de acuerdo fue menor en: "cualquier bebida hidrata por igual, no es necesario tomar agua" (33%, IC 95%: 28,8%-37,2%), "hay que tomar agua sólo cuando se tiene sed" (31%, IC 95%: 26,8%-35,2%), "tomar agua durante las comidas dificulta la digestión" (27%, IC 95%: 22,8%-31,2%); la influencia sobre la ingesta de líquidos fue alta: 70% (IC 95%: 65,8%-74,2%), 65% (IC 95%: 60,8%-69,2%) y 60% (IC 95%: 55,8%-64,2%) respectivamente. Conclusión. Se observó alto grado de acuerdo sólo en 2 creencias, aunque las 5 tuvieron influencia en la ingesta de líquidos.
Introduction. Water is essential for life, but the emergence of misinformation created doubts in the population. Objective. To determine the percentage of agreement and influence on fluid intake of misconceptions related to hydration argentine population. Material and methods. In this prospective, observational and transversal study, we conducted 1014 direct interviews, home, with a national coverage to individuals of both genders> 18 years of age. We applied a probabilistic sampling, multistage and stratified. Results. The 80% (95% CI: 75.8%-84.2%) of those interviewed agreed with the belief that "to care your heart, take water low in sodium". It was more prevalent in: women (p=0.0169), >65 years (p=0.005), higher educational level (p=0.026) and middle socioeconomic status (p=0.019), Buenos Aires city (p=0.005) and Gran Buenos Aires (p=0.000). The influence of this belief in fluid intake was 77% (95% CI: 72.8%-81.2%). The 62% (95% CI: 57.8%-66.2%) agreed with the belief "to take care that the kids do not get fat, you have to focus more on the food than the drink", mainly at the level education (p=0.015) and lower socioeconomic (p=0.014). The influence on fluid intake was 74% (95% CI: 69.8%-78.2%). While the level of agreement was lower in "any beverage hydrates alike, do not need to drink water" (33%, 95% CI: 28.8%-37.2%), "you have to drink water only when thirst" (31%, 95% CI: 26.8%-35.2%), "drink water during meals hampers digestion" (27%, 95% CI: 22.8%-31.2%), the influence of fluid intake was high: 70% (95% CI: 65.8%-74.2%), 65% (95% CI: 60.8%-69.2%) and 60% (95% CI: 55.8%-64.2%), respectively. Conclusion. There was high agreement in only two beliefs, although five had an influence on fluid intake.
Introdução. A água é essencial para a vida, mas o surgimento de desinformação criou dúvidas na população. Objetivo. Determine o percentual de concordância e influência sobre a ingestão de líquidos de equívocos relacionados à hidratação em a população argentina. Material e métodos. Neste estudo prospectivo, observacional e transversal, foram realizadas 1.014 entrevistas diretas, em casa, com uma cobertura nacional de indivíduos de ambos os sexos >18 anos de idade. Nós aplicamos uma amostragem probabilística, polietápico e estratificada. Resultados. O 80% (IC 95%: 75,8%-84,2%) dos entrevistados concordaram com a crença de que "para cuidar o coração, tomar água baixo teor de sódio." Foi mais enraizada em mulheres (p=0,0169), >65 anos (p=0,005), nível superior de escolaridade (p=0,026) e nível sócio-econômico médio (p=0,019), cidade de Buenos Aires (p=0,005 ) e Grau Buenos Aires (p=0,000). A influência desta crença na ingestão de líquidos foi de 77% (IC 95%: 72,8%-81,2%). A 62% (IC 95%: 57,8%-66,2%) concordaram com a crença de "tomar cuidado para que as crianças não engordar, você tem que se concentrar mais na comida do que a bebida", principalmente ao nível educação (p=0,015) e menor socioeconômico (p=0,014). A influência sobre a ingestão de líquidos foi de 74% (IC 95%: 69,8%-78,2%). Enquanto o nível de concordância foi menor em "nenhum hidratos de bebidas iguais, não precisa beber água" (33%, IC 95%: 28,8%-37,2%), "você tem que beber água apenas quando sede" (31%, IC 95%: 26,8%-35,2%), "beber água durante as refeições dificulta a digestão" (27%, IC 95%: 22,8%-31,2%), a influência da ingestão de líquidos foi alta: 70% (IC 95%: 65,8%-74,2%), 65% (IC 95%: 60,8%-69,2%) e 60% (IC 95%: 55,8%-64,2%), respectivamente. Conclusão. Houve alta concordância em apenas duas crenças, embora cinco tiveram influência na ingestão de líquidos.
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BACKGROUND: MAZE IV surgery is effective in restoring sinus rhythm (SR) and atrial contraction (AC) in patients with nonrheumatic persistent atrial fibrillation (AF). However, there is less information on its effectiveness to restore AC in patients with rheumatic disease. AIMS: To assess the effectiveness of the MAZE IV surgery in restoring AC in patients with rheumatic disease and long persistent AF. METHODS: Prospective, consecutive study in patients who underwent cardiovascular surgery and had long persistent AF in whom MAZE IV surgery was performed. The presence of AC was assessed by lateral mitral annulus tissue Doppler. RESULTS: A total of 75 patients were included. Mean age 60 years (±11.7); 27 men (36%). AF duration was 63 months (±34.1). Primary indication for surgery: rheumatic mitral stenosis 67 patients and mitral insufficiency eight patients. Mean left ventricular ejection fraction (LVEF) was 51.8% (±12.1) and mean left atrial area was 37 cm(2) (±10.3). After a mean follow-up of 28 months (±9.3), 69 patients remained alive and 59 were in SR. AC was detected in 37.3% (Group A) and absent in 62.7% (Group B). The mean difference between groups was the high prevalence of AF longer than 5 years in group B (P = 0.000001). There were no differences related to left atrial size, LVEF, and age. CONCLUSIONS: In patients with rheumatic disease, the absence of correlation between SR recovery and AC recovery post MAZE IV surgery is significant. A history of long persistent AF lasting more than 5 years was a strong predictor for the absence of AC.
Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Átrios do Coração/cirurgia , Contração Miocárdica/fisiologia , Cardiopatia Reumática/complicações , Cardiopatia Reumática/cirurgia , Idoso , Fibrilação Atrial/etiologia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/cirurgia , Estudos Prospectivos , Cardiopatia Reumática/fisiopatologia , Resultado do TratamentoRESUMO
In Argentina, one out of three deaths is of cardiovascular origin and acute myocardial infarction (AMI) is one of the most aggressive and frequent. In our country epidemiological data related to infarction are scarce. Various surveys and reports have been carried out in the past 25 years by different scientific societies, which, even though they provide valuable information, enclose only a small range of the population with access to high complexity centers. Though these records show a gradual increase in the rate of reperfusion, this has not resulted in a mortality reduction. This review is committed to provide all available information about the AMI in Argentina, in order to provide the necessary resources to the right diagnosis and therapeutic handling of this disease.
Assuntos
Infarto do Miocárdio/terapia , Argentina/epidemiologia , Doenças Cardiovasculares/etiologia , Instalações de Saúde/estatística & dados numéricos , Humanos , Infarto do Miocárdio/epidemiologia , Reperfusão Miocárdica/estatística & dados numéricos , Fatores de RiscoRESUMO
En la Argentina, una de cada tres muertes es de origen cardiovascular y el infarto agudo de miocardio (IAM) es una de sus presentaciones más agresivas y frecuentes. Sin embargo, en nuestro país los datos epidemiológicos relacionados al infarto son escasos. Diversas encuestas y registros se han realizado en estos últimos 25 años por las diferentes sociedades científicas, las cuales, si bien aportan valiosa información, sólo representan a una parte de la población con posibilidades de acceso a centros de alta complejidad. Los datos proporcionados por estos registros evidencian un aumento progresivo en la tasa de reperfusión; sin embargo, esto no se tradujo en una reducción de la mortalidad. Esta revisión tiene como objetivo aportar toda la información disponible sobre el IAM en la Argentina, y busca identificar los recursos necesarios para lograr un adecuado manejo diagnóstico-terapéutico de esta enfermedad.
In Argentina, one out of three deaths is of cardiovascular origin and acute myocardial infarction (AMI) is one of the most aggressive and frequent. In our country epidemiological data related to infarction are scarce. Various surveys and reports have been carried out in the past 25 years by different scientific societies, which, even though they provide valuable information, enclose only a small range of the population with access to high complexity centers. Though these records show a gradual increase in the rate of reperfusion, this has not resulted in a mortality reduction. This review is committed to provide all available information about the AMI in Argentina, in order to provide the necessary resources to the right diagnosis and therapeutic handling of this disease.