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Resumen: El Congreso de la American Heart Association 2018 tuvo lugar en la ciudad de Chicago, Illinois, del 10 al 12 de noviembre. Contó con múltiples novedades, se presentaron tres nuevas guías de recomendaciones (abordaje de las bradicardias y trastornos de conducción, actividad física, y tal vez la más esperada, la nueva guía de tratamiento de las dislipemias). Al revisar las recomendaciones de 2013, los expertos norteamericanos introdujeron varios cambios, el más importante de los cuales quizá sea disminuir la trascendencia que se le da al cálculo del riesgo a diez años para volver a enfocarse en la meta de las lipoproteínas de baja densidad (LDL), bajo la premisa de que cuanto más bajo, mejor. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados durante este evento que, sin duda, tendrán una influencia importante en el futuro próximo de la cardiología mundial. - Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial - REDUCE-IT. - Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease - VITAL. - Angiotensin Receptor-Neprilysin Inhibition in Patients Hospitalized With Acute Decompensated Heart Failure: Primary Results of the PIONEER - HF Randomized Controlled Trial. - Pre-hospital Resuscitation Intra-arrest Cooling Effectiveness Survival Study - the PRINCESS Trial.
Summary: The American Heart Association 2018 Congress was held in the city of Chicago, Illinois, from November 10 to 12. There were many news, three new recommendations guidelines were presented (approach to bradycardia and driving disorders, physical activity, and perhaps the most anticipated, the new treatment guide for dyslipidemia). In reviewing the 2013 recommendations, US experts introduced several changes, the most important of which may be to reduce the significance of the 10-year risk calculation to refocus on the LDL goal, under the premise of that the lower, the better. We will make a brief summary of some of the main scientific papers presented during this event that will undoubtedly have an important influence in the near future of global cardiology. - Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial - REDUCE-IT. - Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease - VITAL. - Angiotensin Receptor-Neprilysin Inhibition in Patients Hospitalized With Acute Decompensated Heart Failure: Primary Results of the PIONEER-HF Randomized Controlled Trial. - Pre-hospital Resuscitation Intra-arrest Cooling Effectiveness Survival Study - the PRINCESS Trial.
Resumo: O Congresso da American Heart Association 2018 foi realizado na cidade de Chicago, Illinois, de 10 a 12 de novembro. Havia muitos novos recursos, três novos guias de recomendações foram apresentados (abordagem para bradicardia e transtornos de direção, atividade física e talvez o mais aguardado, o novo guia de tratamento para dislipidemia). Ao rever as recomendações de 2013, os especialistas norte-americanos introduziram várias mudanças, a mais importante das quais pode ser reduzir a significância do cálculo do risco de 10 anos para reorientar a meta de LDL, sob a premissa de que quanto menor, melhor. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados durante este evento que, sem dúvida, terão uma influência importante no futuro próximo da cardiologia global. - Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial - REDUCE-IT. - Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease - VITAL. - Angiotensin Receptor-Neprilysin Inhibition in Patients Hospitalized With Acute Decompensated Heart Failure: Primary Results of the PIONEER - HF Randomized Controlled Trial. - Pre-hospital Resuscitation Intra-arrest Cooling Effectiveness Survival Study - the PRINCESS Trial.
ABSTRACT
Resumen: El Congreso Europeo de Cardiología se llevó a cabo en la ciudad de Múnich del 25 al 29 de agosto. Sin duda, uno de los eventos más importantes e innovadores de la comunidad cardiológica reunió a más de 32.000 profesionales, con destacados invitados internacionales y múltiples actividades científicas. Además de las tradicionales presentaciones de estudios, se inauguró un área de Salud Digital: Digital Health Area donde se llevaron a cabo sesiones continuas sobre E-Cardiology, con múltiples presentaciones de apps móviles, telemedicina y tecnología digital tanto para los profesionales como para la comunidad. Se presentaron las nuevas guías europeas sobre Hipertensión Arterial, tan esperadas luego del debate planteado en relación con las guías americanas en 2017. Las pautas europeas se mantendrán dentro del umbral de diagnóstico de 140/90 mmHg y se centrarán en mejorar las tasas de control a través de combinaciones iniciales de dos fármacos antihipertensivos para la mayoría de los pacientes. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados: - Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease: ARRIVE. - Coronary CT Angiography and 5-Year Risk of Myocardial Infarction: The SCOT-HEART Investigators. - Partial Oral Treatment of Endocarditis: POET. - Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: GLOBAL LEADERS. - One-Year Outcomes after PCI Strategies in Cardiogenic Shock: CULPRIT-SHOCK.
Summary: The European Congress of Cardiology was held at Munich from August 25th to 29th. Undoubtedly one of the most important and innovative events of the cardiology community, it brought together more than 32.000 professionals, with prominent international guests and multiple scientific activities. In addition to the traditional presentations of studies, ESC 2018 inaugurated a: Digital Health Area, where continuous sessions on E-Cardiology were held with multiple presentations of mobile apps, telemedicine and digital technology for both, the professionals and the community. The new european guidelines on Arterial Hypertension, awaited after the discussion related with the American guidelines in 2017, were presented. European blood pressure guidelines will stick with the 140/90 mmHg diagnostic threshold and will focus on improving control rates through initial two-drug antihypertensive combinations for most patients. We will make a brief summary of some of the main scientific trials presented: - Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease: ARRIVE. - Coronary CT Angiography and 5-Year Risk of Myocardial Infarction: The SCOT-HEART Investigators. - Partial Oral Treatment of Endocarditis: POET. - Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: GLOBAL LEADERS. - One-Year Outcomes after PCI Strategies in Cardiogenic Shock: CULPRIT-SHOCK
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A pesar de la tragedia que el último atentado terrorista provocó en las ramblas de Barcelona, la comunidad cardiológica catalana tuvo que reponerse rápidamente para ser anfitriona del mayor evento cardiovascular de Europa: el ESC CONGRESS 2017. Del 26 al 30 de agosto, en decenas de mesas redondas, más de 31.000 cardiólogos de todo el mundo se reunieron para actualizar sus conocimientos e intercambiar novedades en ciencia, innovación e investigación en cardiología en más de 500 sesiones y más de 4.500 presentaciones de abstracts (1). Se presentaron nuevas guías para el manejo del infarto agudo de miocardio, enfermedad valvular, enfermedad arterial periférica y recomendaciones para el uso de terapia antiplaquetaria dual. Se celebraron los 40 años de la intervención coronaria percutánea (PCI), realizada por Andreas Grüntzig por primera vez el 16 de setiembre de 1977(1). Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados durante este evento que sin duda tendrán un impacto en nuestra práctica clínica diaria. - Canakinumab Anti-Inflammatory Thrombosis Outcome Study: CANTOS. - Global Anticoagulant Registry in the Field-Atrial Fibrillation (Registro Global de Anticoagulantes en el Campo de la Fibrilación Auricular): GARFIELD-AF. - Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation: CASTLE-AF. - Cardiovascular OutcoMes for People using Anticoagulation StrategieS (COMPASS) trial: Primary Results
Despite the last terrorist attack tragedy at La Rambla in Barcelona, Catalonian cardiologic community had to quickly recover from the episode to host the major European cardiovascular event: the ESC CONGRESS 2017. From august 26th to 30th, more than 31.000 cardiologists from all over the world met to update their knowledge and share the state of the art science, innovation and cardiologic investigation in more than 500 sessions and more than 4.500 abstracts presentations. New guidelines for the management of acute ST-segment elevation myocardial infarction, valvular heart disease, peripheral vascular disease and recommendations on dual antiplatelet therapy were presented. Fourty years of percutaneous coronary intervention (PCI), performed for the first time by Andreas Grüntzig on September 16th, 1977, was celebrated. We will expose a brief summary of some of the main scientific works presented at the congress which will undoubtedly have an impact on our daily clinical practice. - Canakinumab Anti-Inflammatory Thrombosis Outcome Study: CANTOS. - Global Anticoagulant Registry in the Field-Atrial Fibrillation: GARFIELD-AF. - Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation: CASTLE-AF. - Cardiovascular OutcoMes for People using Anticoagulation StrategieS (COMPASS) trial: Primary Results
Subject(s)
Congress , CardiologyABSTRACT
Introducción: la terapia de resincronización cardíaca (TRC) mediante estimulación biventricular (BiV) es un tratamiento establecido que ha demostrado disminuir la mortalidad y mejorar la capacidad funcional y la calidad de vida en un subgrupo de pacientes con insuficiencia cardíaca avanzada. En nuestro país existen escasos reportes acerca del número de implantes, de la evolución clínica de los pacientes y de datos de seguimiento prolongado. Material y método: cohorte prospectiva de 85 pacientes consecutivos con implante de TRC reclutada en el período junio de 2000 a mayo de 2011, que se cerró el 31 de julio de 2011. Edad media: 62 años, 65% hombres, 35% cardiopatía isquémica. Veintidós pacientes recibieron TRC con desfibrilador (TRC-D), 63 TRC solo marcapaso (TRC-P), 71 primo implante y 9 upgrade. Se valoró la evolución clínica de acuerdo a la modificación en la clase funcional (CF). La probabilidad acumulada de supervivencia se estimó a través de un modelo de Kaplan-Meier, utilizando el SPSS V20.0. Resultado: de los 80 pacientes resincronizados, 2 (3%) que se encontraban en CFII evolucionaron a CFI. El 68% (54) del total de pacientes se encontraban en CFIII antes del implante: 30 pacientes (55,5%) pasaron a CFI y 7 pacientes (13%) a CFII. De los 24 (30%) que se encontraban en CFIV, 7 (29%) pasaron a CFII y 8 (33%) a CFI. Supervivencia de pacientes: luego de una mediana de seguimiento de 21 meses, la probabilidad acumulada de supervivencia a los dos años fue de 75,5% y a los cinco años de 67%. La media de supervivencia fue de 83,5 meses (IC95% 68,1-98,8). Conclusión: la TRC en nuestro medio se asoció a mejora de CF y menor mortalidad que la esperada en la población estudiada. El tratamiento médico de la población referida para TRC es subóptimo. Las tasas de implante exitoso por vía venosa e incidencia de complicaciones son semejantes a los reportes internacionales.
Introduction: Cardiac resynchronization therapy (CRT) by biventricular pacing (BiV) is an established treatment that has been shown to reduce mortality and improve functional capacity and quality of life in a subgroup of patients with advanced heart failure. In Uruguay, reports about the number of implants, the clinical course of patients and follow-up data are scarce. Methods: A prospective cohort of 85 consecutive patients with CRT implantation was enrolled between June/2000 and May/2011. The follow up period was closed on 31/07/2011. Clinical characteristics: average age 62 y.o., 65% were men, 35% had coronary artery disease. Twenty-two patients received a CRT with defibrillator (CRT-D) device and 63 patients a CRT pacemaker only (CRT-P) device; 71 patients received de novo CRT implantations and in 9 patients were upgrades. Clinical outcome according to the change in NYHA functional class (FC) was assessed. Survival curves were calculated by the Kaplan-Meier method (KM), using the SPSS V20.0. Results: At the time of implant, 2 (3%) patients who were in FC II progressed to FCI. 68% (54) of the patients were in FC III before implantation: 30 patients (55.5%) improve to FC I and 7 patients (13 %) a FCII. Of the 24 patients (30%) who were in class IV, 7 patients (29%) improve to FCII and 8 patients (33%) to FCI. Survival of patients: After a median follow up of 21 months, the cumulative probability of survival at 2 years was 75.5% and at 5 years of 67%. The median survival was 83.5 months [CI95% 68.1 to 98.8]). Conclusion: The CRT in our centre was associated with improvement in FC and lower mortality than expected in the population studied. Medical treatment of that population for CRT is suboptimal. The implant success rates and incidence of venous complications are similar to international reports.