Cardiac performance after an endurance open water swimming race.

PURPOSE: Endurance exercise competitions have shown a transient negative effect on global right ventricular (RV) performance. Most published studies are based on terrestrial sports. The aim of our study was to evaluate the cardiac effects after an open water swimming race. METHODS: We evaluated 33 healthy swimmers (mean age 40.9 ± 7.2) participating in a 9.5 km open water swimming race. All subjects underwent a standard transthoracic echocardiography including an evaluation of dimensions and myocardial ventricular deformation. Echocardiography was performed 24 h before and within the first hour of arrival at the finish line. Cardiac troponin I (cTn I), NT-ProBNP and leukocytes were also evaluated. RESULTS: No changes in left ventricle (LV) ejection fraction or LV global longitudinal strain were observed. A significant increase in RV end-diastolic area (RVEDA) was noted after the race (RVEDA at baseline 15.12 ± 1.86; RVEDA after race 16.06 ± 2.27, p < 0.05), but no changes were seen in RV fractional area change or RV global longitudinal strain. Cardiac biomarkers and leukocytes significantly increased. No association was detected between the increase in cTn I or NT-proBNP and the RV acute dilatation or LV performance. A significant association was observed between cTn I and leukocytes (r = 0.375, p < 0.05). CONCLUSIONS: An acute RV dilatation but without an impairment in RV deformation was observed after participating in an endurance swimming race. The correlation between the increase in cTn I and leukocytes, but not with ventricular performance, may support the hypothesis of an exercise-induced increase in myocardial sarcolemmal permeability due to an inflammatory response rather than myocardial injury.

Influence of gender on right ventricle adaptation to endurance exercise: an ultrasound two-dimensional speckle-tracking stress study.

BACKGROUND: Characteristic right ventricle (RV) remodelling is related to endurance exercise in male athletes (MAs), but data in female athletes (FAs) are scarce. Our aim was to evaluate sex-related influence on exercise-induced RV remodelling and on RV performance during exercise. METHODS: Forty endurance athletes (>10 training hours/week, 50% female) and 40 age-matched controls (<3 h moderate exercise/week, 50% female) were included. Echocardiography was performed at rest and at maximum cycle-ergometer effort. Both ventricles were analysed by standard and speckle-tracking echocardiography. RESULTS: Endurance training induced similar structural and functional cardiac remodelling in MAs and FAs, characterized by bi-ventricular dilatation [~34%, left ventricle (LV); 29%, RV] and normal bi-ventricular function. However, males had larger RV size (p < 0.01), compared to females: RV end-diastolic area (cm2/m2): 15.6 ± 2.2 vs 11.6 ± 1.7 in athletes; 12.2 ± 2.7 vs 8.6 ± 1.6 in controls, respectively, and lower bi-ventricular deformation (RV global longitudinal strain (GLS) (%): -24.0 ± 3.6 vs -29.2 ± 3.1 in athletes; -24.9 ± 2.5 vs -30.0 ± 1.9 in controls, and LVGLS: -17.5 ± 1.4 vs -21.9 ± 1.9 in athletes; -18.7 ± 1.2 vs -22.5 ± 1.5 in controls, respectively, p < 0.01). During exercise, the increase in LV function was positively correlated (p < 0.01) with increased cardiac output (∆%LV ejection fraction, r = +0.46 and ∆%LVGLS, r = +0.36). Improvement in RV performance was blunted at high workloads, especially in MAs. CONCLUSION: Long-term endurance training induced similar bi-ventricular remodelling in MAs and FAs. Independently of training load, males had larger RV size and lower bi-ventricular deformation. Improvement in RV performance during exercise was blunted at high workloads, especially in MAs. The potential mechanisms underlying these findings warrant further investigation.

Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach.

Differential diagnosis of hypertrophic cardiomyopathy (HCM) vs athlete's heart is challenging in individuals with mild-moderate left-ventricular hypertrophy. This study aimed to assess ECG and echocardiographic parameters proposed for the differential diagnosis of HCM. The study included 75 men in three groups: control (n=30), "gray zone" athletes with interventricular septum (IVS) measuring 13-15mm (n=25) and HCM patients with IVS of 13-18mm (n=20). The most significant differences were found in relative septal thickness (RST), calculated as the ratio of 2 x IVS to left ventricle end-diastolic diameter (LV-EDD) (0.37, 0.51, 0.71, respectively; p<0.01) and in spatial QRS-T angle as visually estimated (9.8, 33.6, 66.2, respectively; p<0.01). The capacity for differential HCM diagnosis of each of the 5 criteria was assessed using the area under the curve (AUC), as follows: LV-EDD<54 (0.60), family history (0.61), T-wave inversion (TWI) (0.67), spatial QRS-T angle>45 (0.75) and RST>0.54 (0.92). Pearson correlation between spatial QRS-T angle>45 and TWI was 0.76 (p 0.01). The combination of spatial QRS-T angle>45 and RST>0.54 for diagnosis of HCM had an AUC of 0.79. The best diagnostic criteria for HCM was RST>0.54. The spatial QRS-T angle>45 did not add sensitivity if TWI was present. No additional improvement in differential diagnosis was obtained by combining parameters.

Arrhythmogenic Cardiomyopathy and Athletes: A Dangerous Relationship.

Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3% to 20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.

Cardiac adaptation to endurance exercise training: Differential impact of swimming and running.

Objectives: High-intensity training has been associated with bi-ventricular and bi-atrial remodelling and a potentially increased risk of arrhythmias. Most of the evidence is based on endurance disciplines mainly involving the lower part of the body, while few data is available on upper body disciplines. The purpose of this study was to compare chronic cardiac remodelling induced by running and swimming as well as the acute response of ventricular and atrial performance after an upper-body and a lower-body endurance race. Methods: Standard and speckle tracking echocardiographic assessment of left ventricle, right ventricle and both atria was performed at baseline and immediately after a 9.5 km open-water swimming race in 26 healthy men and before and after a 35 km-trail-running race in 21 male runners. Results: No significant differences were observed in baseline ventricular dimensions. However, both right ventricular and atrial systolic deformation were greater in runners. This group also showed slightly larger atrial volumes as compared to swimmers. After the race, right ventricular dilatation was observed in both groups, but only runners showed a decrease in right ventricular deformation and a decrease in atrial volumes and deformation. Significant increases in atrial deformation without reduction in atrial volumes were observed only in swimmers after the race. Conclusions: Right ventricular and atrial remodelling is different depending on the endurance training discipline. Long-distance running races induce a greater impairment in right ventricular performance and atrial function compared to endurance swimming competitions.

Aortic root remodelling in competitive athletes.

BACKGROUND: Controversy remains about the cut-off limits for detecting aortic dilatation in athletes, particularly in large-sized individuals. The allometric scaling model has been used to obtain size-independent measurements in cardiovascular structures in the general population. AIM: The purpose of this study was to validate the use of allometric scaling in the measurement of the aortic root for competitive athletes and to offer reference values. METHODS: This was a cross-sectional study that analyses the dimensions of aortic root found in the echocardiogram performed as part of pre-participation sports screening in competitive athletes between 2012-2015. Beta exponents were calculated for height and body surface area in the whole cohort. In order to establish whether a common exponent could be used in both genders the following model was assessed y = axb*exp(c*sex). If a common exponent could not be applied then sex-specific beta exponents were calculated. RESULTS: Two thousand and eighty-three athletes (64% men) were included, from a broad spectrum of 44 different sports disciplines, including basketball, volleyball and handball. The mean age was 18.2 ± 5.1 years (range 12-35 years) and all athletes were Caucasian, with a training load of 12.5 ± 5.4 h per week. Indexed aortic root dimension showed a correlation with ratiometric scaling by body surface area (r: -0.419) and generated size independence values with a very light correlation with height (r: -0.084); and with the allometric scaling by body surface area (r: -0.063) and height (r: -0.070). The absolute value of aortic root was higher in men than in women (p < 0.001). These differences were maintained with allometric scaling. CONCLUSION: Size-independent aortic root dimension values are provided using allometric scaling by body surface area and height in a large cohort of competitive athletes. Aortic root values were larger in men than in women, both in absolute values and after allometric scaling. The use of these indexed aortic reference ranges can be useful for the early detection of aortic pathologies.

Exaggerated blood pressure response to exercise and late-onset hypertension in young adults.

INTRODUCTION: Exaggerated blood pressure response (EBPR) during exercise has been associated with an increased risk of incidental systemic hypertension and cardiovascular morbidity; however, there is no consensus definition of EBPR. We aimed to determine which marker best defines EBPR during exercise and to predict the long-term development of hypertension in individuals younger than 50 years. PATIENTS AND METHODS: We reviewed 107 exercise tests performed in 1992, applied several reported methods to define EBPR at moderate and maximum exercise, and contacted the patients by telephone 20 years after the test to verify hypertension status. Finally, we determined which definition best predicted incidental hypertension at 20-year follow-up. RESULTS: The mean age of the participants at the time of exercise testing was 25.7±11.1 years. Logistic regression showed a significant association of diastolic blood pressure of more than 95 mmHg at peak exercise and systolic pressure more than 180 mmHg at moderate exercise with new-onset hypertension at 20-year follow-up [odds ratio: 6.3 (2.09-18.9) and odds ratio: 7.09 (2.31-21.7), respectively]. If EBPR was present, as defined by at least one of these parameters, the probability of incidental later onset hypertension was 70%. CONCLUSION: In our population, diastolic blood pressure of more than 95 mmHg at maximum exercise or systolic blood pressure more than 180 mmHg at moderate-intensity exercise (100 W) were the best predictors of new-onset hypertension at long-term follow-up. Individuals with EBPR according to these criteria should be monitored closely to detect the early development of hypertension.

Prevention of sudden death in adolescent athletes: Incremental diagnostic value and cost-effectiveness of diagnostic tests.

Introduction Pre-participation screening in athletes attempts to reduce the incidence of sudden death during sports by identifying susceptible individuals. The objective of this study was to evaluate the diagnostic capacity of the different pre-participation screening points in adolescent athletes and the cost effectiveness of the programme. Methods Athletes were studied between 12-18 years old. Pre-participation screening included the American Heart Association questionnaire, electrocardiogram, echocardiogram, and stress test. The cost of test was established by the Catalan public health system. Results Of 1650 athletes included, 57% were men and mean age was 15.09 ± 1.82 years. Positive findings were identified as follows: in American Heart Association questionnaire 5.09% of subjects, in electrocardiogram 3.78%, in echocardiogram 4.96%, and in exercise test 1.75%. Six athletes (0.36%) were disqualified from participation and 10 (0.60%) were referred for interventional treatment. Diagnostic capacity was assessed by the area under the curve for detection of diseases that motivated disqualification for sport practice (American Heart Association questionnaire, 0.55; electrocardiogram, 0.72; echocardiogram, 0.88; stress test, 0.57). The cost for each athlete disqualified from the sport for a disease causing sudden death was €45,578. Conclusion The electrocardiogram and echocardiogram were the most useful studies to detect athletes susceptible to sudden death, and the stress test best diagnosed arrhythmias with specific treatment. In our country, pre-participatory screening was cost effective to detect athletes who might experience sudden death in sports.

Gender influence on the adaptation of atrial performance to training.

BACKGROUND: High-intensity training has been associated with atrial remodelling and arrhythmias in men. Our purpose was to analyse atrial performance in female endurance athletes, compared to male athletes and controls. METHODS: This was a cross-sectional study. We included four groups: female athletes, females controls, male athletes and male controls. Left (LA) and right atrial (RA) volumes and function were assessed using 2D and speckle-tracking echocardiography to determine peak atrial strain-rate at atrial (SRa) and ventricular contraction (SRs), as surrogates of atrial contractile and reservoir function, respectively. ANOVA and Bonferroni's statistical tests were used to compare variables among groups. RESULTS: We included 82 subjects, 39 women (19 endurance athletes, 20 controls) and 43 men (22 endurance athletes, 21 controls). Mean age was similar between groups (36.6 ± 5.6 years). Athletes had larger bi-atrial volumes, compared to controls (women, LA 27.1 vs. 15.8 ml/m2, p < 0.001; RA 22.31 vs. 14.2 ml/m2, p = 0.009; men, LA: 25.0 vs. 18.5 ml/m2, p = 0.003; RA 30.8 vs. 21.9 ml/m2, p < 0.001) and lower strain-rate (women, LASRa -1.60 vs. -2.18 s-1, p < 0.001; RASRa -1.89 vs. -2.38 s-1, p = 0.009; men, LASRa -1.21 vs. -1.44 s-1, p = 1; RASRa -1.44 vs. -1.60 s-1, p = 1). However, RA indexed size was lower and bi-atrial deformation greater in female athletes, compared to male athletes. CONCLUSIONS: The atria of both male and female athletes shows specific remodelling, compared to sedentary subjects, with larger size and less deformation at rest, particularly for the RA. Despite a similar extent of remodelling, the pattern in women had greater bi-atrial myocardial deformation and smaller RA size.

Inter-individual variability in right ventricle adaptation after an endurance race.

BACKGROUND: Right ventricle (RV) dysfunction has been described in athletes after endurance races. We aimed to understand and characterize the RV response to endurance exercise, the impact of individual variability and the effects of the amount of exercise. METHODS AND RESULTS: Echocardiography was performed in 55 healthy adults at baseline and after a three-stage trail race: short (14 km; n = 17); medium (35 km; n = 21); and long (56 km; n = 17). Standard and speckle tracking echocardiographic assessment of the RV was performed with global and separate analysis of the RV basal (inflow) and apical regions. Although no change was observed in the short distance runners, the RV systolic deformation decreased significantly (p < 0.05) after both the medium length and long races (Δ% RV global strain -7.6 ± 20.1 and -8.7 ± 21.8, respectively) with significant RV dilatation (Δ% RV volume +10.6 ± 9.9 and +15.3 ± 12.8, respectively). The RV basal segment made a major contribution to stroke volume during exercise, showing larger increases in size and strain compared with the apex. Various patterns of RV adaptation to exercise, ranging from increases in both RV segmental strains and sizes to an insufficient increase in size and a decrease in strain, were identified; this individual variability was not correlated with prior training. CONCLUSION: An acute RV impairment was demonstrated after a trail-running race and was related to the amount of exercise. A high inter-individual variability was observed. Differences in RV adaptation patterns were independent of prior training, suggesting the influence was due to other individual factors.

Acute, Exercise Dose-Dependent Impairment in Atrial Performance During an Endurance Race: 2D Ultrasound Speckle-Tracking Strain Analysis.

OBJECTIVES: This study sought to understand and characterize the acute atrial response to endurance exercise and the influence of the amount of exercise performed. BACKGROUND: Endurance exercise seems to be recognized as a risk factor for developing atrial arrhythmia. Atrial geometrical and functional remodeling may be the underlying substrate. METHODS: Echocardiography was performed in 55 healthy adults at baseline and after a 3-stage trail race: a short race (S) (14 km), n = 17; a medium race (M) (35 km), n = 21; and a long race (L) (56 km), n = 17. Analysis consisted of standard, speckle-tracking assessment of both the left ventricle (LV) and right ventricle (RV) and both the left atrium (LA) and the right atrium (RA): a-wave strain (Sa) and strain rate (Ra) as a surrogate for atrial contractile function and s-wave strain (St) and strain rate (SR) as reservoir function. RESULTS: After the race, RA reservoir function decreased in group M (Δ% SRs: -12.5) and further in group L (Δ% SRs: -15.4), with no changes in group S. RA contractile function decreased in group L (Δ% SRa: -9.3), showed no changes in group M (Δ% SRa: +0.7), and increased in group S (Δ% SRa: +14.8). A similar trend was documented in LA reservoir and contractile function but with less pronounced changes. The decrease in RA reservoir after the race correlated with the decrease in RV global longitudinal strain (GLS) (Δ% RVGLS vs. RASt and RASRs: +0.44; p < 0.05 and +0.41, respectively; p < 0.05). CONCLUSIONS: During a trail-running race, an acute exercise-dose dependent impairment in atrial function was observed, mostly in the RA, which was related to RV systolic dysfunction. The impact on atrial function of long-term endurance training might lead to atrial remodeling, favoring arrhythmia development.

Echocardiography in the evaluation of athletes.

Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes,  echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.

Usefulness of echocardiography in preparticipation screening of competitive athletes.

INTRODUCTION AND OBJECTIVES: Despite the established diagnostic value of the electrocardiogram in preparticipation screening of athletes, some cardiac structural changes can be missed, particularly in early disease stages. The aim of this study was to evaluate the prevalence of cardiac structural changes via the systematic use of echocardiography in preparticipation screening of competitive athletes. METHODS: Professional athletes or participants in a competitive athletic program underwent a screening that included family and personal medical history, physical examination, electrocardiography, exercise testing, and Doppler echocardiography. RESULTS: A total of 2688 athletes (67% men; mean age [standard deviation], 21 [10] years) were included. Most of the echocardiographic evaluations (92.5%) were normal and only 203 (7.5%) showed changes; the most frequent change was left ventricular hypertrophy, seen in 50 athletes (1.8%). Cessation of athletic activity was indicated in 4 athletes (0.14%): 2 for hypertrophic cardiomyopathy (electrocardiography had shown changes that did not meet diagnostic criteria), 1 pectus excavatum with compression of the right ventricle, and 1 significant pulmonary valve stenosis; the rest of the changes did not entail cessation of athletic activity and only indicated periodic monitoring. CONCLUSIONS: Although rare, some cardiac structural changes can be missed on physical examination and electrocardiography; in contrast, they are easily recognized with echocardiography. These findings suggest the use of echocardiography in at least the first preparticipation screening of competitive athletes to improve the effectiveness of programs aimed at preventing sudden death in athletes.

Eventos cardiovasculares en una población cerrada: Seguimiento a 10 años / Cardiovascular Events in a Closed Population: A 10-Year Follow-Up

Introducción En estudios epidemiológicos previos se observó que poblaciones con igual riesgo por suma de factores clásicos poseían una incidencia y tipos de expresión de enfermedades cardiovasculares diferentes. Objetivo Determinar la incidencia de MACE, compuesta por infarto agudo de miocardio, angina inestable, accidente cerebrovascular, angioplastia transluminal coronaria, cirugía de revascularización miocárdica o muerte cardiovascular, y su asociación con los factores de riesgo en una población cerrada. Material y métodos El presente es un estudio de cohorte prospectivo en el que fueron relevados hombres, de profesión policías, durante el año 1997. Luego se ingresaron en la base de datos hospitalaria aquellos que presentaron eventos en los 10 años posteriores. Se empleó la prueba de la t de Student para variables cuantitativas y regresión logística para las cualitativas. Resultados Se incluyeron 2.379 personas de sexo masculino. La edad promedio fue de 39,5 ± 9,25 años. La prevalencia de factores de riesgo conocidos por las personas fue: HTA 11,1%, dislipidemia 20,3%, diabetes 2,4%, tabaquismo 43,3%. Noventa pacientes presentaron algún tipo de MACE. El odds ratio para diabetes fue 4,54 (IC 95% 2,1-9,81), HTA 2,3 (IC 95% 1,38-3,85), dislipidemia 2,74 (IC 95% 1,77-4,25) y para tabaquismo 1,48 (IC 95% 0,97-2,28). La edad, el LDL, el fibrinógeno y las horas trabajo diarias mostraron asociaciones significativas. El área bajo la curva ROC del puntaje de Framingham fue de 0,72 y para el puntaje europeo fue de 0,71. Conclusión Los factores de riesgo de enfermedad cardiovascular clásicos tuvieron una importancia similar a los ya comunicados por los estudios epidemiológicos; es importante destacar algunos no clásicos como el fibrinógeno. Los puntajes de riesgo fueron predictores regulares en esta población. Las características especiales de la población analizada permiten la ejecución de programas de prevención acordes.

Background Previous epidemiological studies have reported that populations with similar risk factors had a different incidence and manifestation of cardiovascular diseases. Objectives To determine the incidence of MACE, composed by acute myocardial infarction, unstable angina, stroke, coronary angioplasty, coronary artery bypass graft surgery or cardiovascular death, as well as its association with risk factors in a closed population. Material and Methods We conducted a prospective cohort study on policemen during 1997. During the following ten years, those subjects who presented events were registered in a hospital database. Quantitative variables were analyzed with the t Student test and a logistic analysis was performed on qualitative variables. Results A total of 2,379 men were included. Mean age was 39.5±9.25 years. The prevalence of known risk factors was as follows: hypertension 11.1%; dyslipemia 20.3%; diabetes 2.4% and smoking habits 43.3%. Ninety percent of patients presented some type of MACE. The odds ratio were as follows: diabetes 4.54 (95% CI 2.1- 9.81), hypertension 2.3 (CI 95% 1.38-3.85), dyslipemia 2.74 (CI 95% 1.77-4.25) and smoking habits 1.48 (CI 95% 0.97- 2.28). A significant association was demonstrated with age, LDL cholesterol, fibrinogen serum levels and daily working hours. The area under the ROC curve of the Framingham score was 0.72 and for the European score was 0.71. Conclusion The importance of the classic coronary risk factors was similar to the one described by previous epidemiological studies; the relevance of fibrinogen, a non-classic risk factor, should be noted. Risk scores were regular predictors in this population. The special characteristic of the population analyzed enables the performance of the corresponding programs of prevention.

Angioplastia coronaria en la República Argentina: Comparación de los resultados en la fase hospitalaria de los estudios CONAREC V y CONAREC XIV / Coronary Angioplasty in the Argentine Republic: An analysis of the intra-hospital results between CONAREC V and CONAREC XIV registries

La angioplastia coronaria (ATC) es una técnica para el tratamiento de la enfermedad coronaria que se encuentra en constante evolución. El registro CONAREC V relevó características de pacientes sometidos a angioplastia durante el año 1996. Diez años después publicamos los resultados del estudio CONAREC XIV. Objetivo Comparar las características demográficas y clínicas, la utilización de dispositivos y de pruebas funcionales, los resultados y las complicaciones de la ATC en el estudio CONAREC V con el estudio CONAREC XIV. Material y métodos Se unificaron las bases de datos de ambos protocolos. Se compararon las variables continuas por medio de la prueba de la t y las categóricas con la prueba de chi cuadrado. Se construyó un modelo de regresión logística para determinar si disminuyó la tasa de complicaciones en el año 2005, ajustando por confundidores. Resultados Los pacientes del CONAREC XIV fueron más añosos (62,8 ± 10,8 versus 60,6 ± 10,9 años), con mayor prevalencia de hipertensión arterial (72,4% versus 61,3%; p < 0,001) y diabetes (19,2% versus 16,9%; p = 0,017) y menor de tabaquismo (22% versus 38%; p < 0,001); presentaron enfermedad de tres vasos (20,2% versus 14,8%; p < 0,001) y ATC de más de un vaso con mayor frecuencia (25,3% versus 11,8%; p < 0,001); se incrementaron el uso de stents (94,5% versus 48%; p < 0,001) y la indicación por cuadros estables (36,3% versus 18,2%; p < 0,001). El uso de pruebas funcionales en este contexto fue menor en el año 2005 (54% versus 65%; p < 0,001). En pacientes con infarto agudo de miocardio, en el CONAREC XIV se observó una prevalencia menor de infarto anterior (46% versus 57,8%; p < 0,005) y de shock cardiogénico (7,3% versus 13,5%; p = 0,017). La tasa de complicaciones mayores fue menor en el último protocolo, CONAREC XIV (3,1% versus 8,9%; p < 0,001). En el modelo multivariado, pertenecer al último estudio disminuyó el riesgo de padecer eventos (OR 0,41, IC 95% 0,26-0,64; p < 0,001). Conclusiones En el relevamiento del año 2005, la ATC se realizó en pacientes con más factores de riesgo y mayor compromiso angiográfico. Se incrementó la indicación en cuadros estables. La tasa de complicaciones, como infarto, cirugía y muerte, se redujo en forma independiente.

Introduction Percutaneous coronary intervention (PCI) is a constantly evolving procedure for the treatment of coronary disease. The CONAREC V registry assessed the characteristics of patients that underwent an angioplasty during 1996. Ten years later the results of the CONAREC XIV study were published. Objective To compare the demographic and clinical characteristics, use of devices and functional tests, and PCI results and complications in the CONAREC V versus the CONAREC XIV registries. Material and methods Both protocols databases were unified. The continuum variables were compared by means of the t test and the categorical with the chi square test. A logistic regression model, adjusted by confounders, was built in order to determine if the events rate from 2006 had decreased. Results The patients from CONAREC XIV were older (62.8±10.8 versus 60.6±10.9 years), with higher prevalence of arterial hypertension (72.4% versus 61.3%; p<0,001) and diabetes (19.2% versus 16.9%; p=0.017) and less tobacco consumption (22% versus 38%; p<0,001); they showed three vessel disease (20.2% versus 14.8%; p<0,001) and PCI to more than one vessel (25.3% versus 11.8%; p<0.001) more frequently; stent use was increased (94.5% versus 48%; p<0.001) as well as the indication in stable conditions (36,3% versus 18,2%; p<0,001). Use of functional tests in this context was lesser in the year 2005 (54% versus 65%; p<0.001). In patients with acute myocardial infarction (AMI), in the CONAREC XIV a lesser prevalence of anterior infarction (46% versus 57.8%; p<0.005) and cardiogenic shock (7.3% versus 13.5%; p=0.017) were observed. The rate of major events was lower in the last CONAREC XIV protocol (3.1% versus 8.9%; p<0.001). In the multivariate model, the patients included in the last study had decreased risk of events (OR 0.41, IC 95% 0.26-0.64; p<0,001). Conclusions The 2005 registry showed that PCI was performed in patients with more risk factors and increased angiographic risk. Indication under stable conditions increased. The rate of events such as infarction, surgery and death was reduced independently.

Angioplastia coronaria en centros con residencia de cardiología en la Argentina: Estudio CONAREC XIV - Área de Investigación de la SAC / Coronary Angioplasty in Centers of Argentina with Residency in Cardiology: CONAREC XIV Study - Research Area of the Argentine Society of Cardiology (SAC)

Introducción Los nuevos tratamientos médicos y los avances técnicos, junto con la mayor experiencia adquirida en cardiología intervencionista, hicieron necesaria la realización de este nuevo registro, el protocolo CONAREC XIV, sobre empleo de angioplastia coronaria (ATC), un procedimiento que es seguro y eficaz para el tratamiento de la enfermedad coronaria. Objetivo Evaluar las características de los pacientes, las indicaciones y los resultados de la ATC en nuestro país. Material y métodos Se realizó un registro prospectivo y consecutivo durante 6 meses de pacientes tratados con ATC en centros con residencia de cardiología. Se determinaron antecedentes, cuadro clínico de ingreso, tratamiento, resultados y complicaciones intrahospitalarias. Resultados Se registraron 1.500 pacientes. La edad promedio fue de 62,8 ± 10,8 años y el 78,3% eran hombres. Antecedentes: 72% hipertensión arterial, 56,6% dislipidemia, 19,2% diabetes y 22,4% tabaquismo. Los cuadros clínicos de presentación fueron: 20% asintomáticos, 16,2% angina crónica estable, 45% síndrome coronario agudo sin supradesnivel del ST (SCA-SST), 19% síndrome coronario agudo con supradesnivel del ST (IAM-ST). En el 74,7% de los casos se realizó ATC de un vaso. Se utilizaron stents en el 94,5% de los casos y en el 18,7%, stents liberadores de drogas. El uso de pruebas funcionales previas a la ATC en cuadros estables fue del 53,9%, mientras que en el SCA-SST fue del 31,6%. La mediana de tiempo de evolución hasta la ATC en el SCA-SST fue de 1 día con un rango intercuartil 25-75% (RIC) de 0 a 3. En el IAM-ST, el tiempo puerta-balón fue de 60 minutos (RIC 40-105) y la mortalidad fue del 8%. Conclusiones La ATC se utiliza principalmente para el tratamiento de síndromes coronarios agudos. Se evidenció una tasa alta de uso de stents y de stents liberadores de drogas. El empleo de pruebas funcionales fue bajo. La tasa de complicaciones fue similar a la de los registros internacionales.

Introduction New medical therapies and technical advances, as well as the increased experience in interventional cardiology, made it necessary to carry out this new registry, the CONAREC XIV protocol, on the use of percutaneous coronary intervention (PCI), a procedure that is safe and effective for the treatment of coronary disease. Objective To evaluate the characteristics of patients, indications, and results of PCI in our country. Material and Methods A prospective consecutive registry was performed during 6 months in patients that underwent PCI at centers that had a Residency in Cardiology. Background, clinical condition upon admission, therapy, results and in-hospital complications were assessed. Results The recorded patients were 1,500. The average age was 62,8 ± 10,8 years and 78,3% were males. Background: 72% arterial hypertension, 56,6% dyslipemia, 19,2% diabetes and 22,4% smokers. Clinical conditions were: 20% asymptomatic, 16,2% stable chronic angina, 45% non ST segment elevation acute coronary syndrome (NSTE-ACS), 19% ST elevation acute coronary syndrome (STE-ACS). In 74,7% of the cases PCI was performed in one of the vessels. Stents were used in 94,5% of the cases and in 18,7%, drug eluting stents were used. The use of functional tests previous to PCI in stable patients was of 53,9%, whereas in STE-ACS was of 31,6%. The median evolution time up to PCI in the STEACS was 1 day with 25-75% (ICR) interquartile range of 0 to 3. In ST-AMI, the door-to-balloon time was 60 minutes (ICR 40-105) and mortality was 8%. Conclusions PCI is used mainly in the treatment of acute coronary syndromes. High use rate of stents and drug eluting stents was evident. The use of functional tests was low. The complications rate was similar to those shown in international registries.