[Targeted use of comprehensive geriatric assessment tools in cardiology. Part I (literature review).]

The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician's office, justifying the need for advanced training for cardiologists in geriatrics.

Medical staff monitoring in interventional cardiology: over apron dosemeter placement based on measurements and simulations.

Interventional cardiology is characterized by high radiation exposure for both the patient and the operator. Adequate shielding and monitoring of the operator are fundamental to comply with radiation protection principles. In a previous work, the effect on the dose of the dosemeter position on the chest was studied. In this paper, the investigation has been completed, employing an anthropomorphic thorax phantom, equipped with arms. Although there are differences between the Monte Carlo simulations and the measurements, similar trends are observed, showing that the reduction in dose, due to the arms, is between 20 and 60%, compared with the situation without arms. For that reason, considering a dosemeter placed on the chest, the upper position, which is the least affected by the arms, should be preferred while the extreme lateral position, near the armpit, should be avoided.

2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults.

Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.

Assessment of the vertebral heart scale and cardiothoracic ratio to standardize the heart size of collared peccaries (Tayassu tajacu Linnaeus, 1758) restrained with ketamine and midazolam / Avaliação do vertebral heart scale e índice cardiotorácico na padronização do tamanho cardíaco de cateto (Tayassu tajacu Linnaeus, 1758) contidos com cetamina e midazolam

Wild species, especially those threatened with extinction, are increasingly being investigated to obtain information that can be useful for their preservation. The objective of the present study was to standardize the vertebral heart scale (VHS) and cardiothoracic ratio (CTR) of the collared peccary (Tayassu tajacu Linnaeus, 1758) sedated with ketamine and midazolam. Fourteen clinically healthy collared peccaries were examined in the two-year age group weighing 15-22kg. The animals were submitted to digital radiography of the thorax in lateral and dorsal ventral projections to calculate the VHS and CTR. The VHS mean values for males and females was 8.88±0.51v for right recumbency and 8.84±0.39v for left decubitus, and there were no significant between-gender differences regarding recumbency (p>0.05). The CTR showed mean values of 0.50±0.05 (males) and 0.45±0.04 (females), but the gender-differences were not significant (p>0.05). A positive correlation was shown between VHS and CTR (r=0.98, right decubitus; r=0.96, left decubitus). Establishing reference values for heart measurements in collared peccaries using digital radiography of the thorax permitted standardization of the VHS and CTR values for this wild species. In the studied wild animal model, the VHS and CTR heart assessment indexes were shown to be essential diagnostic tools for investigations of alterations in the size of the cardiac silhouette.(AU)

Espécies silvestres têm sido cada vez mais exploradas como forma de obter informações que favoreçam sua conservação, especialmente aquelas ameaçadas de extinção. Este trabalho teve por objetivo a padronização dos valores de VHS (vertebral heart scale) e índice cardiotorácico (ICT) de catetos (Tayassu tajacu Linnaeus, 1758) contidos com Cetamina e Midazolam. Foram avaliados 14 catetos clinicamente saudáveis, com faixa etária de 2 anos e variação média de peso entre 15 a 22Kg. Os animais foram submetidos a radiografia digital de tórax em projeções laterolaterais e dorsoventrais para o cálculo do vertebral heart scale (VHS) e Índice Cardiotorácico (ICT). O VHS evidenciou valores médios entre machos e fêmeas de 8,88±0,51v para decúbito direito e 8,84±0,39v para decúbito esquerdo, não ocorrendo diferença estatística entre os decúbitos (p>0,05). O ICT revelou valores médios de 0,50±0,05 (machos) e de 0,45±0,04 (fêmeas), não sendo verificada diferença estatística significativa entre os sexos (p>0,05). Verificou-se correlação positiva entre VHS e o ICT (r=0,98, decúbito direito, r= 0,96, decúbito esquerdo). O estabelecimento dos valores de referência para mensurações cardíacas em catetos, a partir de radiografias digitais do tórax, permitiu a padronização do VHS e ICT para esta espécie silvestre. No modelo animal silvestre estudado, os índices de avaliação cardíaca VHS e ICT mostraram-se como uma ferramenta diagnóstica imprescindível para investigações sobre as alterações do tamanho da silhueta cardíaca.(AU)

Reperfusion therapy of myocardial infarction in Mexico: A challenge for modern cardiology / La reperfusión en el infarto del miocardio en México: un reto para la cardiología moderna

Abstract: Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises. Several studies have demonstrated pharmacoinvasive strategy as effective and safe as primary angioplasty ST-elevation myocardial infarction, which is postulated as the choice to follow in communities where access to PPCI is limited. The Mexico City Government together with the National Institute of Cardiology have developed a pharmaco-invasive reperfusion treatment program to ensure effective and timely reperfusion in STEMI. The model comprises a network of care at all three levels of health, including a system for early pharmacological reperfusion in primary care centers, a digital telemedicine system, an inter-hospital transport network to ensure primary angioplasty or early percutaneous coronary intervention after fibrinolysis and a training program with certification of the health care personal. This program intends to reduce morbidity and mortality associated with myocardial infarction.

Resumen: México se ha posicionado como el país con mayor mortalidad atribuible al infarto del miocardio entre los países de la Organización de Cooperación y Desarrollo Económico. Esta tasa responde a múltiples factores, incluyendo una baja tasa de reperfusión y la ausencia de un sistema único y coordinado para la atención del infarto. Aun cuando la angioplastia es el método de reperfusión recomendado, requiere un sistema coordinado con personal entrenado y recursos materiales, condiciones que no siempre pueden ser alcanzadas. La reperfusión farmacológica temprana, seguida de angiografía coronaria temprana (estrategia farmacoinvasiva) es la solución al problema logístico que representa la angioplastia primaria. Múltiples estudios han demostrado que la estrategia farmacoinvasiva es tan segura y efectiva como la angioplastia primaria en el infarto agudo del miocardio con elevación del segmento ST, y se plantea como la estrategia de elección en comunidades donde el acceso a angioplastia está limitado por factores económicos, geográficos o socioculturales. El gobierno de la Ciudad de México en conjunto con el Instituto Nacional de Cardiología ha desarrollado un programa de estrategia farmacoinvasiva para asegurar la reperfusión temprana en el infarto del miocardio. El modelo comprende una red de atención en los 3 niveles, incluyendo un sistema de reperfusión farmacológica en centros de primer contacto, transferencia de electrocardiogramas mediante telemedicina entre el primer nivel y el Instituto Nacional de Cardiología, una red de transporte interhospitalario y un programa de entrenamiento y educación continua. El objetivo de este programa es reducir la morbilidad y la mortalidad asociadas al infarto del miocardio.

Considerações referentes à influência do posicionamento dos membros superiores sobre o resultado da cintilografia de perfusão do miocárdio / Considerations about the influence of upper arms positioning on myocardial perfusion scintigraphy results

INTRODUÇÃO: Na cintilografia de perfusão do miocárdio, contrariamente ao desenvolvimento tecnológico ao longo do tempo, manteve-se desde o princípio a mesma forma, por vezes desconfortável ou mesmo inviável, de posicionamento na aquisição das imagens: decúbito dorsal com os braços elevados. OBJETIVOS: O objetivo da pesquisa foi o de avaliar se na aquisição da cintilografia de perfusão do miocárdio o posicionamento com os membros superiores abaixados(T) apresenta os mesmos resultados que os obtidos com os membros superiores elevados(C), tanto em termos de alterações perfusionais como em relação aos parâmetros funcionais. . MÉTODOS: Foram estudados 120 pacientes, 83 (69%) do sexo masculino, com idade 59,4 ± 11,4 anos e peso 72,8 ± 14 kg. Foi realizada primeiramente a aquisição C e na seqüência a aquisição T, utilizando protocolo de um dia de repouso-estresse (dose 370 MBq e 1110 MBq de sestamibi-99mTc), com estresse sincronizado ao eletrocardiograma (gated- SPECT). Três modelos distintos de equipamentos de dois detectores foram utilizados no estudo. Os estudos foram processados usando reconstrução iterativa (OSEM). Na interpretação foi utilizado o modelo de segmentação miocárdica de 17 segmentos, pontuados de 0 a 4 (normal a ausente) segundo o grau de captação. Baseada na análise de um observador dentre um grupo de sete, foi realizada a comparação da totalidade dos segmentos e também segmento a segmento das aquisições C e T nas etapas de estresse e de repouso. Foi comparada também a somatória das pontuações das etapas de estresse(SSS) e repouso(SRS). Os pacientes foram divididos segundo dois critérios: primeiramente, normais (SSS=0) e anormais (SSS>1) e posteriormente, em de baixo risco (SSS3) e de maior risco (SSS>3) A comparação dos parâmetros funcionais de fração de ejeção do ventrículo esquerdo (FEVE), volume diastólico final (VDF), volume sistólico final(VSF), somatória dos escores de motilidade (SMS) e somatória dos escores de espessamento (STS)...

Contrary to the advances in imaging technology for nuclear cardiology applications, we keep using the same often uncomfortable and sometimes impracticable patient position- supine with arms raised above the head (C). We tested another position modality: supine with arms down at the sides of the trunk (T). The purpose of this study was to verify if the functional and perfusion results of the acquisition T are equivalent to those of the acquisition mode C. We studied 120 patients (pts), 83 (69%) male, aged 59.4±11.4 years and weighting 72.8±14 kg. We performed a one-day protocol (rest gated/stress), using 99mTc-sestamibi (370 MBq and 1110 MBq). In both times (rest and stress), we first performed acquisition in C and in sequence the acquisition in T. The studies were performed in three types of dual detector SPECT systems. T mode was executed successfully in all pts. Images were processed by the iterative reconstruction method (OSEM). Each study was independently interpreted by one nuclear medicine specialist from a group of seven physicians using the 17-segment model. The segments were scored using a 5-point model ranging from 0 (normal uptake) to 4 (uptake absent). The total score of the left ventricle at stress is referred to as the summed stress score (SSS) and at rest as the summed rest score (SRS). The patients were categorized in subgroups by two criteria: normal (SSS=0) or abnormal (SSS1) and low risk (SSS3) or risk (SSS>3). The values of the functional parameters of left ventricular ejection fraction (LVEF), end diastolic volume (EDV), end systolic volume (ESV), stress motion score (SMS) and stress thickening score (STS) for both C and T were automatically obtained by the quantitative gated SPECT (QGS) program and results were compared. Shoulder and/or back pain occurred in 23.3% of C patients and in 5% of T patients. There was no agreement between the 2040 segmental scores of both rest and stress in C and T modes (p<0.05)...

Impacto clínico e econômico da redefinição dos critérios diagnósticos de infarto do miocárdio

Pretende avaliar o impacto diagnóstico, prognóstico e econômico da nova definição de Infarto do Miocárdio (IAM) proposta pela AHA/ESC usando troponina T(TnT)como marcador de lesão cardíaca. Foram incluídos no estudo 740 pacientes com dor torácica admitidos na Emergência do Hospital de Clínicas de Porto Alegre, no período de julho/1999 a janeiro/2002. Creatinina quinase total ( CK), CK-MB atividade e TnT foram dosados em uma amostra de 363 pacientes, representativa de todo o coorte. O novo diagnóstico de IAM acrescenta um número expressivo de indivíduos com infarto aos serviços de emergência. A incorporação deste critério é importante na medida que estes pacientes têm um prognóstico semelhante aos demais casos tradicionalmente diagnosticados. Como a identificação destes casos poderia resultar em um manejo mais qualificado e eficiente destes pacientes, esforços deveriam ser adotados para reforçar a adoção da redefinição de IAM.