Long-Term Results of Slipped Capital Femoral Epiphysis Treated with the Modified Dunn Procedure in a Colombian Cohort.

BACKGROUD: Slipped capital femoral epiphysis (SCFE) is a severe and catastrophic disorder that affects the hips of adolescents. Many reports about surgical procedures to treat this condition have been published, but to our knowledge, there are no published results of treatment in Latin American patients. This study describes the clinical and radiological results of the modified Dunn procedure with the surgical approach described by Ganz to treat mild to severe SCFE in a cohort of Colombian pediatric patients. METHODS: We retrospectively analyzed 21 patients (22 hips) with SCFE treated with surgical dislocation of the hip from 2005 to 2017. The same pediatric orthopedic surgeon performed all operations. Clinical outcome was assessed using the range of movement and Merle d'Aubigné score, while radiological measurements and assessment included the slip angle and Tönnis score. RESULTS: The average duration of follow-up was 29 months (range, 12-72 months). Of all cases, 17 presented with acute-on-chronic symptoms. Preoperatively, all 22 hips were classified as poor according to the Merle d'Aubigné score. Preoperative radiological classification showed compromise grade II or III in 20 hips. Last follow-up Merle d'Aubigné score rated 17 cases as good or excellent (p < 0.05). The postoperative radiological classification was grade I or II in all 22 cases, and the Tönnis score was stage II in 3 cases and stage III in 4 cases. CONCLUSIONS: Our results suggest that the modified Dunn osteotomy performed through the Ganz technique could be safely and effectively used to treat patients with mild to severe SCFE.

Syncope due to non-sustained episodes of Torsade de Pointes associated to androgen-deprivation therapy use: a case presentation.

BACKGROUND: Abiraterone is a medication frequently used for metastatic castrate-resistant prostate cancer. We report a case of non-sustained episodes of TdP associated with severe hypokalemia due to androgen-deprivation therapy. Few case presentations describe this association; the novelty lies in the potentially lethal cardiovascular events among cancer patients receiving hormonal therapy. CASE PRESENTATION: A 70-year-old male presented with recurrent syncope without prodrome. ECG revealed frequent ventricular ectopy, non-sustained episodes of TdP, and severe hypomagnesemia and hypokalemia. During potassium and magnesium infusion for repletion, the patient underwent temporary transvenous atrial pacing. As part of the work-up, coronary angiography revealed a mild coronary artery disease, and transthoracic echocardiogram showed a moderately depressed ejection fraction. After electrolyte disturbances were corrected, the QT interval normalized, and transvenous pacing was no longer necessary. Abiraterone was discontinued during the admission, and the patient returned to baseline. CONCLUSIONS: Cancer treatment is complex and requires a multidisciplinary approach. We presented a case of non-sustained TdP associated with androgen-deprivation therapy in an elderly patient with mild coronary artery disease and moderately reduced ejection fraction. Close follow-up and increased awareness are required in patients with hormonal treatment, especially in the setting of other cardiovascular risk factors.

Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS-TIMI 54 Trial.

Background A proposed cause of dyspnea induced by ticagrelor is an increase in adenosine blood levels. Because caffeine is an adenosine antagonist, it can potentially improve drug tolerability with regard to dyspnea. Furthermore, association between caffeine and cardiovascular events is of clinical interest. Methods and Results This prespecified analysis used data from the PEGASUS TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54) trial, which randomized 21 162 patients with prior myocardial infarction to ticagrelor 60 mg or 90 mg or matching placebo (twice daily). Baseline caffeine intake in cups per week was prospectively collected for 9694 patients. Outcomes of interest included dyspnea, major adverse cardiovascular events (ie, the composite of cardiovascular death, myocardial infarction, or stroke), and arrhythmias. Dyspnea analyses considered the pooled ticagrelor group, whereas cardiovascular outcome analyses included patients from the 3 randomized arms. After adjustment, caffeine intake, compared with no intake, was not associated with lower rates of dyspnea in patients taking ticagrelor (adjusted hazard ratio (HR), 0.91; 95% CI, 0.76-1.10; P=0.34). There was no excess risk with caffeine for major adverse cardiovascular events (adjusted HR, 0.78; 95% CI, 0.63-0.98; P=0.031), sudden cardiac death (adjusted HR, 0.98; 95% CI, 0.57-1.70; P=0.95), or atrial fibrillation (adjusted odds ratio, 1.07; 95% CI, 0.56-2.04; P=0.84). Conclusions In patients taking ticagrelor for secondary prevention after myocardial infarction, caffeine intake at baseline was not associated with lower rates of dyspnea compared with no intake. Otherwise, caffeine appeared to be safe in this population, with no apparent increase in atherothrombotic events or clinically significant arrhythmias. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT01225562.

Os Escores HEART, TIMI e GRACE para Predição de Eventos Cardiovasculares Adversos Maiores no Período de 30 Dias na Era de Troponina I de Alta Sensibilidade / HEART, TIMI, and GRACE Scores for Prediction of 30-Day Major Adverse Cardiovascular Events in the Era of High-Sensitivity Troponin

Resumo Fundamento Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. Objetivo Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. Métodos Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. Resultados Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. Conclusão O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Efficacy and Safety of Ticagrelor Over Time in Patients With Prior MI in PEGASUS-TIMI 54.

BACKGROUND: Ticagrelor reduces ischemic risk in patients with prior myocardial infarction (MI). It remains unclear whether ischemic risk and the benefits of prolonged P2Y12 inhibition in this population remain consistent over time. OBJECTIVES: The study sought to investigate the pattern of ischemic risk over time and whether the efficacy and safety of ticagrelor were similar early and late after randomization. METHODS: The PEGASUS-TIMI (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction) 54 trial randomized patients with prior MI (median 1.7 years prior) to ticagrelor 90 mg, ticagrelor 60 mg, or placebo on a background of aspirin. The rates of cardiovascular (CV) death, MI, and stroke as well as TIMI major bleeding were analyzed at yearly landmarks (years 1, 2, and 3). RESULTS: A total of 21,162 patients were randomized and followed for 33 months (median), with 28% of patients ≥5 years from MI at trial conclusion. The risk of CV death, MI, or stroke in the placebo arm remained roughly constant over the trial at an ∼3% annualized rate. The benefit of ticagrelor 60 mg was consistent at each subsequent landmark (year 1 hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.67 to 0.99; year 2 HR: 0.90; 95% CI: 0.74 to 1.11; and year 3 HR: 0.79; 95% CI: 0.62 to 1.00). TIMI major bleeding was increased with ticagrelor 60 mg at each landmark, but with the greatest hazard in the first year (year 1 HR: 3.22; year 2 HR: 2.07; year 3 HR: 1.65). CONCLUSIONS: Patients with a history of MI remain at persistent high risk for CVD, MI, and stroke as late as 5 years after MI. The efficacy of low-dose ticagrelor is consistent over time with a trend toward less excess bleeding. (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562).

Discrepancias entre las frecuencias de los desenlaces primarios propuestos y obtenidos en ensayos clínicos aleatorizados / Differences between the proposed frequencies of the research protocols of randomized clinical trials with outcomes obtained at the end of the primary study outcomes

Resumen Objetivo: Determinar las diferencias entre las frecuencias de los desenlaces propuestos en el protocolo inicial de los ensayos clínicos aleatorizados respecto a los desenlaces obtenidos al final del estudio. Metodología: Estudio observacional, de corte transversal, que incluyó ensayos clínicos de cardiología publicados en The New England Journal of Medicine desde 2002 a 2013. Resultados: Se identificaron 28 ensayos clínicos. En el 60,7 % de los estudios la incidencia estimada del desenlace fue mayor que la encontrada, y se presentó discrepancia (diferencia mayor al 10 %) en 13 (46.4 %) estudios. El 10,7 % de los estudios presentaba discrepancia entre el tamaño de muestra estimado por los autores y el calculado por nosotros. Conclusión: Encontramos de que a pesar que los autores de los ensayos clínicos tienen un buen cálculo del tamaño de la muestra, sus supuestos no son buenos, ya que la incidencia esperada en el grupo control suele ser sobreestimada en el 60 % de los casos.

Abstract Objective: To determine the differences between the frequencies of the outcomes proposed in the initial protocol of randomized clinical trials for the outcomes obtained at endpoint. Methods: An observational, cross-sectional that included cardiology clinical trialspublished in The New England Journal of Medicine from 2002-2013. Results: We identified 28 trials. In 60.7 % of the estimated outcome studies incidence was higher than that found, showing discrepancy (differencegreater than 10 %) in 13 (46.4%) studies. 10.7 % of the studies showed a discrepancy between the size estimated by the authors and the sample calculated by us. Conclusión: We found that although the authors of clinical trials have a good estimate of the sample size, its assumptions are not good, because the expected incidence in the control group is often overestimated in 60 % of cases.

El virus Chikungunya en Colombia: aspectos clínicos y epidemiológicos y revisión de la literatura / Chikungunya virus in Colombia: Clinical and epidemiological aspects, and literature review / Vírus chicungunha na Colômbia: aspectos clínicos e epidemiológicos e revisão da literatura

En años recientes, con el movimiento de las poblaciones y la globalización, algunas infecciones y enfermedades han cambiado su patrón endémico por uno epidémico; es el caso del virus chikungunya, un arbovirus reemergente que ha activado las alarmas mundiales. Según datos de los Centros para el Control y Prevención de Enfermedades (CDC), de los Estados Unidos, hasta enero del 2015 se habían detectado más de un millón de casos sospechosos y alrededor de treinta mil habían sido confirmados por laboratorio en 42 países del Caribe, Centroamérica, Suramérica y Norteamérica. Según el Instituto Nacional de Salud de Colombia, el número total de casos de esta infección confirmados por clínica era de 231.392; por laboratorio se habían confirmado 1.528 y había 3.848 casos sospechosos, para un total general de 236.768. En esta revisión se incluyen los siguientes aspectos de la infección por el virus chikungunya: virología, transmisión por vector, patogenia, epidemiología, manifestaciones clínicas, pruebas de laboratorio, medidas de prevención y perspectivas futuras.

In recent years, with the movement of populations and with globalization, some infections and diseases have changed from endemic to epidemic in certain regions. Such is the case of chikungunya virus (CHIKV), a re-emerging arbovirus that has triggered global alarm. According to the Center for Disease Control and Prevention (CDC), until January 2015, there had been case reports from 42 countries in the Caribbean, and Central, South, and North America, with more than one million suspected cases and about thirty thousand laboratory-confirmed cases. The latest report in Colombia by Instituto Nacional de Salud refers to a total of 231.392 clinically confirmed cases (suggestive symptoms associated with CHIKV), 1.528 cases confirmed by laboratory, and 3.848 suspected cases, for an overall total of 236.768. In this review, the following aspects of CHIKV infection are included: virology, transmission by vector, pathogenesis, epidemiology, clinical manifestations, laboratory tests, preventive measures and future prospects.

Nos anos recentes, com o movimento das populações e a globalização, algumas infecções e doenças mudaram seu padrão endémico por um epidêmico; é o caso do vírus chicungunha, um arbovírus reemergente que ativou os alarmes mundiais. Segundo dados do Centro para o Controle e Prevenção de Doenças (CDC), dos Estados Unidos, até janeiro de 2015 se tinham detectado mais de um milhão de casos suspeitos e ao redor de trinta mil tinham sido confirmados por laboratório em 42 países do Caribe, América Central, América do Sul e América do Norte. Segundo o Instituto Nacional de Saúde da Colômbia, o número total de casos desta infecção confirmados por clínica era de 231.392; por laboratório se tinham confirmado 1.528 e tinha 3.848 casos suspeitos, para um total geral de 236.768. Nesta revisão se incluem os seguintes aspectos da infecção pelo vírus chicungunha: virologia, transmissão por vector, patogenia, epidemiologia, manifestações clínicas, provas de laboratório, medidas de prevenção e perspectivas futuras.

Efficacy and safety of ticagrelor for long-term secondary prevention of atherothrombotic events in relation to renal function: insights from the PEGASUS-TIMI 54 trial.

AIMS: We evaluated the relationship of renal function and ischaemic and bleeding risk as well as the efficacy and safety of ticagrelor in stable patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients with a history of MI 1-3 years prior from PEGASUS-TIMI 54 were stratified based on estimated glomerular filtration rate (eGFR), with <60 mL/min/1.73 m(2) pre-specified for analysis of the effect of ticagrelor on the primary efficacy composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events, MACE) and the primary safety endpoint of TIMI major bleeding. Of 20 898 patients, those with eGFR <60 (N = 4849, 23.2%) had a greater risk of MACE at 3 years relative to those without, which remained significant after multivariable adjustment (hazard ratio, HRadj 1.54, 95% confidence interval, CI 1.27-1.85, P < 0.001). The relative risk reduction in MACE with ticagrelor was similar in those with eGFR <60 (ticagrelor pooled vs. placebo: HR 0.81; 95% CI 0.68-0.96) vs. ≥60 (HR 0.88; 95% CI 0.77-1.00, Pinteraction = 0.44). However, due to the greater absolute risk in the former group, the absolute risk reduction with ticagrelor was higher: 2.7 vs. 0.63%. Bleeding tended to occur more frequently in patients with renal dysfunction. The absolute increase in TIMI major bleeding with ticagrelor was similar in those with and without eGFR <60 (1.19 vs. 1.43%), whereas the excess of minor bleeding tended to be more pronounced (1.93 vs. 0.69%). CONCLUSION: In patients with a history of MI, patients with renal dysfunction are at increased risk of MACE and consequently experience a particularly robust absolute risk reduction with long-term treatment with ticagrelor.

Artritis postestreptocócica en un paciente adulto: reporte de caso / Post-streptococcal arthritis in an adult patient: case report

La artritis postestreptocóccica es una entidad que se manifiesta por compromiso articular secundario a infección orofaríngea secundaria a Streptococcus beta hemolítico del grupo A. Se presenta el caso de un paciente de 43 años, previamente sano, que siete semanas después de un episodio de faringoamigdalitis desarrolló un cuadro oligoarticular, aditivo, no migratorio, con lesiones dermatológicas. Se documentaron títulos elevados de antiestrep-tolisina O, cumpliendo con los criterios propuestos por Ayoub y Ahmed, y se diagnosticó artritis postestreptocóccica. El paciente presentó respuesta adecuada a dosis moderadas de corticoesteroides.

Post-streptococcal reactive arthritis is an entity that includes joint involvement secondary to oropharyngeal infectious process associated with beta hemolytic group A Streptococcus. We report a clinical case of 43 year-old man, previously healthy, that seven weeks after a tonsillopharyngitis, developed an additive, non-migratory oligoarthritis, with skin lesions. High titers of antistreptolysin O antibodies are documented, with fulfillment of Ayoub and Ahmed proposed criteria for post streptococcal reactive arthritis. The patient presented adequate response to moderate doses of corticosteroids.

Hemoglobin and B-type natriuretic peptide preoperative values but not inflammatory markers, are associated with postoperative morbidity in cardiac surgery: a prospective cohort analytic study.

INTRODUCTION: Risk stratification in cardiac surgery significantly impacts outcome. This study seeks to define whether there is an independent association between the preoperative serum level of hemoglobin (Hb), leukocyte count (LEUCO), high sensitivity C-reactive protein (hsCRP), or B-type natriuretic peptide (BNP) and postoperative morbidity and mortality in cardiac surgery. METHODS: Prospective, analytic cohort study, with 554 adult patients undergoing cardiac surgery in a tertiary cardiovascular hospital and followed up for 12 months. The cohort was distributed according to preoperative values of Hb, LEUCO, hsCRP, and BNP in independent quintiles for each of these variables. RESULTS: After adjustment for all covariates, a significant association was found between elevated preoperative BNP and the occurrence of low postoperative cardiac output (OR 3.46, 95% CI 1.53-7.80, p = 0.003) or postoperative atrial fibrillation (OR 3.8, 95% CI 1.45-10.38). For the combined outcome (death/acute coronary syndrome/rehospitalization within 12 months), we observed an OR of 1.93 (95% CI 1.00-3.74). An interaction was found between BNP level and the presence or absence of diabetes mellitus. The OR for non-diabetics was 1.26 (95% CI 0.61-2.60) and for diabetics was 18.82 (95% CI 16.2-20.5). Preoperative Hb was also significantly and independently associated with the occurrence of postoperative low cardiac output (OR 0.33, 95% CI 0.13-0.81, p = 0.016). Both Hb and BNP were significantly associated with the lengths of intensive care unit and hospital stays and the number of transfused red blood cells (p < 0.002). Inflammatory markers, although associated with adverse outcomes, lost statistical significance when adjusted for covariates. CONCLUSIONS: High preoperative BNP or low Hb shows an association of independent risk with postoperative outcomes, and their measurement could help to stratify surgical risk. The ability to predict the onset of atrial fibrillation or postoperative low cardiac output has important clinical implications. Our results open the possibility of designing studies that incorporate BNP measurement as a routine part of preoperative evaluation, and this strategy could improve upon the standard evaluation in terms of reducing adverse postoperative events.

Cardiomiopatia chagasica cronica: relacion entre severidad y presencia de Trypanosoma cruzi circulante detectado por la reaccion en cadena de la polimerasa / Chronic chagasic cardiomiopathy

Introducción: en la enfermedad de Chagas, con los métodos parasitológicos convencionales sólo se detecta un número reducido de parásitos en los individuos infectados crónicamente lo que ha conducido a la teoría que sugiere que los hallazgos clínicos y anatomopatológicos pueden ser primariamente autoinmunes en su origen. Objetivo: establecer si la detección de antígenos de T. cruzi circulantes por la reacción en cadena de la polimerasa (PCR) en pacientes con diagnóstico de cardiomiopatía chagásica crónica (criterios OMS) puede relacionarse con la severidad de la enfermedad. Métodos: evaluación clínica y paraclínica (electrocardiograma de rutina, radiografía de tórax, ecocardiograma doppler color, test de Holter de 24 horas y/o estudio electrofisiológico) asociada a la realización de una prueba de PCR efectuada en sangre y suero. La severidad en la cardiomiopatía fue definida por la presencia de uno o más de los siguientes hallazgos: disfunción ventricular izquierda (<40 por ciento), disfunción del nodo sinusal, bloqueo auriculoventricular completo y taquicardia ventricular sostenida. Tipo de estudio: observacional analítico de corte transversal. Análisis estadístico: se comparó la prevalencia de los hallazgos definidos como severidad de la cardiomiopatía entre los pacientes con y sin detección de antígenos circulantes por PCR. Se calcularon los riesgos relativos con intervalos de confianza del 95 por ciento. El valor de p considerado como estadísticamente significativo fue de ¿0.05. Resultados: se estudiaron 64 pacientes, 29 hombres y 35 mujeres , edad media 55.5 ±13 años. En 34 de los 64 pacientes (55 por ciento) se encontraron antígenos de T. cruzi circulantes por PCR. No se observó una diferencia estadísticamente significativa con relación a la edad, el género, ni con la severidad de la cardiomiopatía entre el grupo de pacientes con antígenos de T. cruzi circulantes comparado con el grupo en el que este hallazgo no fue encontrado. Conclusión: Se detectó una infección activa o la presencia de antígenos circulantes de T. cruzi por la PCR en el 55 por ciento de los pacientes con diagnóstico de cardiomiopatía chagásica crónica. No se encontró ninguna relación entre la presencia de antígenos de T. cruzi circulantes y la severidad de la cardiomiopatía en esta población. Otros mecanismos posiblemente de tipo autoinmune pueden estar relacionados con la severidad de la cardiomiopatía en estos casos.

Evolución a corto y largo plazo del infarto de miocardio no Q y del infarto Q

El objetivo del presente trabajo es comparar la evolución intrahospitalaria y el seguimiento a largo plazo (1-64 meses) de 110 pacientes con infarto de miocardio no Q contra 113 pacientes con infarto Q, que ingresaron en forma consecutiva a la Unidad de Cuidados Coronarios, durante el período comprendido entre enero de 1991 y junio de 1996. Se realizó la comparación con base en la información recogida en forma retrospectiva en cuanto a la evolución intrahospitalaria y el seguimiento a largo plazo se hizo por encuesta telefónica que se completó en el 87 por ciento de los pacientes. La edad promedio de los pacientes con infarto no Q fue de 61 años (37-88 años) y de 55 años (28-82 años) para aquellos con infarto Q. Fueron de sexo masculino 90 pacientes (80 por ciento) en el grupo con infarto Q y 85 pacientes (77 por ciento) de infarto no Q. Las características basales de las poblaciones mostraron diferencias significativas en cuanto a la frecuencia de: hipertensión arterial (61.5 por ciento) en no Q vs 46 por ciento en Q), historia de enfermedad coronaria previa (47 por ciento en el grupo no Q vs 59 por ciento en el grupo Q), angina previa (43 por ciento en el grupo no Q vs 22 por ciento en el grupo Q), infarto previo (28 por ciento en el grupo no Q vs 7 por ciento en el grupo Q). El seguimiento intrahospitalario mostró que ingresaron en Killip I-II el 96 por ciento de los pacientes del grupo no Q vs 97 por ciento de los pacientes del grupo Q; el electrocardiograma mostró supradesnivel del segmento ST en el 23 por ciento de los apcientes con infarto no Q vs 87 por ciento en el grupo Q. Requirieron procedimientos de revascularización del tipo angiplastia o cirugía el 54.5 por ciento de los pacientes con infarto no Q vs 73 por ciento de los pacientes con infarto Q. La evolución intrahospitalaria mostró una mortalidad de 4.6 por ciento para eñl grupo con infarto no Q vs 3,5 por ciento para el grupo Q (diferencia significativa); las arritmias se presentaron en el 17 por ciento de los pacientes con infarto no Q vs 26 por ciento del grupo Q; la presencia de reinfarto fue del 7 por ciento para el grupo con infarto no Q vs 3.5 por ciento para el grupo con infarto Q; falla cardíaca se presentó en el 11 por ciento del grupo con infarto no Q vs 15 por ciento del grupo Q. El seguimiento tardío mostró una mortalidad del 4 por ciento en ambos grupos; falla cardíaca se presentó en el 4 por ciento del grupo con infarto no Q ...

Electrocardiografía de alta resolución en infarto agudo de miocardio y arritmia ventricular: seguimiento a un año

La electrocardiografía de alta resolución ha demostrado ser sumamente útil para la detección de potenciales tardíos en pacientes con infarto agudo de miocardio, pues éstos se asocian a la producción de arritmias y éstas a su vez se correlacionan con la muerte súbita. Los potenciales tardíos se correlacionan también con el vaso ocluido, asociado con el infarto y mala fracción de eyección. Se estudiaron durante un período de 14 meses, 50 pacientes ingresaron con diagnóstico de IAM. Se realizó monitoreo de su ritmo cardíaco y en los primeros siete días se les realizó ECG de alta resolución con un equipo Markette con positividad para QSR filtrado de 120 m/seg, voltaje RMS terminal de 20 mV, duración de señales FTABS más de 38 ms. Con dos o más factores se da como positivo el exámen. Los resultados mostraron positividad para la prueba en 36 por ciento de los pacientes. Dentro del grupo de potencial positivo, prersentó arritmia un 34 por ciento, vaso ocluido 69,9 por ciento, fracción de eyección menos del 40 por ciento un 76 por ciento. En el grupo potencial negativo, las arritmias fueron de 2,8 por ciento, el vaso ocluido de sólo un 31 por ciento y con fracción de eyección mayor del 40 por ciento, el 24 por ciento. La presencia de potencial tardío positivo se cotrrelaciona adecuadamente con pacientes con vaso ocluido, mala fracción de eyyeción y arritmia ventricular. El seguimineto a un año no mostró negativización de los valores, ni positivización espontánea de los mismos. No se encontró correlación entre la mortalidad y la presencia de potenciales tardíos positivos

Cardiología intervensionista: 1982-1990

The results of several cardiovascular invasive procedures performed at Shaio Foundation of Bogotá (Colombia) between 1982 and 1990 are the subject of this report. Patient's age ranged between 8 months and 76 years. The attempted procedure was succesful in 95 percent of the cases. Among all procedures there were 80 atrioseptostomies for trasposition of great vessels; 400 intravenous streptokinase infusions; 1.100 coronary angioplasties; 169 peripheral angioplasties; 35 pulmonary valvuloplasties; 125 mitral valvuloplasties and 11 aortic valvuloplasties. For each one of the procedures a discussion of its indications, results, morbidity and mortality is done