Hallazgos ecocardiográficos en pacientes con diabetes tipo 1 descompensados en hiperglucemia: Hospital Central Universitario Dr. Antonio María Pineda / Echocardiographic findings in type 1 diabetic patients in hyperglycemia: Hospital Central Universitario Dr. Antonio Maria Pineda

Con el objetivo de describir las características ecocardiográficas de pacientes con diabetes tipo 1 (DT1) descompensados en hiperglucemia de la Unidad de Cuidados Intermedios del Hospital Central Universitario Dr. Antonio María Pineda durante el mes de diciembre 2018-enero 2019, se desarrolló una investigación tipo descriptiva transversal con un total de 25 pacientes los cuales se caracterizaron por un promedio de edad de 20,28 años ± 3,49 años, 56% eran del sexo masculino, 92% asintomáticos cardiovasculares y con un promedio de años de diagnóstico de DT1 de 4,96 ± 3,29 años. Los resultados indican que 20% de los pacientes presentaron disfunción diastólica leve y 44% trastornos de motilidad regional. El promedio de glicemia basal en estos pacientes fue de 209 mg/dL. Los hallazgos funcionales ecocardiográficos no guardaron relación con los años de diagnóstico de la DT1. En conclusión, en estos pacientes se pueden encontrar hallazgos subclínicos de enfermedad cardiovascular en asociación a hiperglucemia persistente por lo que es importante implementar medidas de prevención que retarden las complicaciones micro y macrovasculares de esta enfermedad(AU)

With the aim of describing echocardiographic findings in type 1 diabetic patients with hyperglycemia admitted to the Intermediate Care Unit of the Hospital Central Universitario Dr. Antonio Maria Pineda during the December 2018-January 2019 period, a cross-sectional descriptive study was done in 25 patients with an average age of 20.28 ± 3.49 years, 56% were males, 92% were asymptomatic and had a mean time of diagnosis of 4.96 ± 3.29 years. The results show that 20% of patients had mild diastolic dysfunction and 44% regional motility alterations. Mean glycemic values of these patients was 209 mg/dL. Echocardiographic functional findings were not associated with time of diagnosis of diabetes. Subclinical findings of cardiovascular disease associated with persistent hyperglycemia was found in this group of patients. It is important to implement measures that prevent micro and macrovascular complications of this disease(AU)

Clinical significance of cys-c and hs-crp in coronary heart disease patients undergoing percutaneous coronary intervention

Abstract Objective: To investigate the clinical significance of serum cystatin C (Cys-C) and high-sensitivity C-reactive protein (hs-CRP) in coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). Methods: One hundred and twenty-eight CHD patients were divided into drug treatment (56 cases) and PCI treatment (72 cases) groups, receiving conventional drug treatment and PCI plus conventional drug treatment, respectively. At admission time and 4 weeks after treatment, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, and left ventricular end systolic diameter were measured. At admission time and 24h, 72h, 1 week, and 4 weeks after treatment, the serum levels of Cys-C and hs-CRP were determined. Results: After 4 weeks of treatment, LVEF in the PCI treatment group was significantly higher than that before treatment (P<0.01) and it was significantly higher than in the drug treatment group at the same time (P<0.01). Cys-C and hs-CRP level in the PCI treatment group were significantly higher than in the drug treatment group 72h and 1 week after treatment (P<0.05 or P<0.01), respectively, but they were significantly lower than in the drug treatment group 4 weeks after treatment (P<0.01). There were obvious interaction effects between grouping factor and time factor in Cys-C (F=3.62, P<0.05) and hs-CRP (F=17.85, P<0.01). Conclusion: Serum levels of Cys-C and hs-CRP are closely related to the heart function in CHD patients undergoing PCI, and they may be used for predicting the outcome of PCI.

Consideraciones en torno a las Guías USA 2017 de hipertensión arterial / A word of caution about the 2017 hypertension management guidelines

The 2017 Guidelines on hypertension of the American College of Cardiology and American Heart Association, which proposed values of 130/80 mmHg as the cutoff points for the onset of hypertension, aroused great interest. This recommendation is based in the SPRINT study (The Systolic Pressure Intervention Trial), which included hypertensive patients over 50 years of age, non-diabetic, without a history of stroke and with a low representation of subjects with a history of coronary artery disease (16%). A group with intensive anti-hypertensive therapy (pressure achieved 121.5 mmHg) achieved a significantly lower cardiovascular risk as compared with a group with standard therapy (pressure achieved 134.6 mmHg). The Guide proposes immediate pharmacological therapy in diabetic hypertensive patients, in those with stage 3 chronic kidney disease or with persistent albuminuria, and in patients with atherosclerotic disease. The Guideline does not include the management of isolated systolic hypertension of the elderly and did not consider studies that show an increased risk when pressure is reduced below 130/80 mmHg in patients with coronary disease, peripheral vascular disease, diabetes mellitus or chronic renal failure. The new classification of hypertension would increase the number of hypertensive patients in our country by more than one million, would increase the risk associated with diastolic pressure reductions in older adults and ignores the evidence indicating a risk associated with reductions below 130/80 mmHg in patients with diabetes, with chronic renal failure or with atherosclerotic disease. Therefore, it is advisable to maintain a threshold of 140/90 mmHg and perform a careful and gradual management of blood pressure in the latter group of hypertensive patients.

Hemodynamic changes during heart displacement in aorta no-touch off-pump coronary artery bypass surgery: a pilot study

Abstract Objective: To evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB). Methods: Prospective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated. Results: There was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively). Conclusion: Heart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.

Valoración del daño corporal en cardiopatía isquémica, basado en las guías de valoración del deterioro permanente de la academia americana de medicina / Assessment of body damage in ischemic heart disease, based on the guidelines for assessing the permanent deterioration of the American Academy of Medicine

ResumenEn este artículo se describirán los elementos básicos necesarios que deben tomarse en cuenta cuando se está valorando médico legalmente a una persona con cardiopatía isquémica, tanto en la historia clínica, examen físico y los estudios complementarios. Además se dará una explicación breve sobre el uso de tabla de enfermedad coronaria para la asignación de porcentaje basado en las Guías de Valoración del Deterioro Permanente de la Academia Americana de Medicina y con ello brindarle al médico forense las herramientas necesarias para asignar de forma objetiva un porcentaje de pérdida de la capacidad funcional por los efectos de la cardiopatía de origen isquémico.

AbstractIn this article will be described the necessary basic elements to be taken into account when using a forensic medical approach to diagnose a person with ischemic heart disease, both in clinical history, physical examination and complementary studies. In addition, is a brief explanation of how to use the table of coronary heart disease for the allocation of a percentage based on the Guidelines for Evaluation of Permanent Impairment of the American Academy of Medicine and thereby provide to the medical examiner the necessary tools to assign subjectively the percentage of loss of functional capacity by the effects of ischemic heart disease.

Doenças Psiquiátricas e o Sistema Cardiovascular: Interação Cérebro e Coração / Psychiatric Disorders and Cardiovascular System: Heart-Brain Interaction

Depressão e ansiedade são transtornos psiquiátricos que frequentemente coexistem com a doença arterialcoronariana (DAC) e outras doenças cardiovasculares (DCV). Tanto os sintomas depressivos como a ansiedadesão atualmente reconhecidos como fatores de risco para DAC e DCV, além de apresentarem processosfisiopatológicos complexos que parecem influenciar negativamente no prognóstico dos pacientes com essascomorbidades. Dentre estes, destacam-se a hipercortisolemia, a hiperatividade simpática, as anormalidadesplaquetárias complexas, a ativação imunológica levando à resposta inflamatória, os fatores genéticos comuns e a associação com comportamentos que predispõem à doença cardiovascular. Estratégias de tratamento da depressão, como o uso de inibidores seletivos de recaptação de serotonina (ISRS), têm o potencial de contribuir para a redução do risco de eventos coronarianos agudos. Clinicamente, instrumentos e protocolos para o rastreio e avaliação da depressão e ansiedade buscam atuar nos efeitos negativos desses transtornos sobre a qualidade de vida e a saúde cardiovascular...

Depression and anxiety are psychiatric disorders that often coexist with coronary artery disease (CAD) and other cardiovascular diseases (CVD). Both depressive symptoms and anxiety are currently recognized as risk factors for CAD and CVD, and presente complex pathophysiological processes that seem to adversely influence the prognosis of patients with these comorbidities. Thesesymptoms include hypercortisolism, sympathetic hyperactivity, complex platelet abnormalities, immune activation leading to inflammatory response, common genetic factors and association with behaviors that predispose to cardiovascular disease. Strategies for treating depression such as using selective serotonin reuptake inhibitors (SSRI), have the potential to contribute to reducing the risk of acute coronary events. From a clinical perspective, instruments and protocols for screening and evaluating depression and anxiety are intended to counteract the negative effects of these disorders on the quality of life and cardiovascular health...

Enfermedad renal crónica en hemodiálisis: concentración de enzimas cardíacas en ausencia de evidencia de cardiopatía isquémica aguda / Chronic Kidney Disease in hemodialysis: cardiac enzymes concentrations without evidence of acute coronary disease

Se trata de un estudio observacional, analítico y prospectivo cuyo objetivo es analizar la concentración de enzimas cardíacas en pacientes con enfermedad renal crónica en hemodiálisis sin evidencia clínica de cardiopatía isquémica aguda, hospitalizados en el Servicio de Medicina Interna del Hospital Universitario de Caracas, Venezuela durante el período 2014-2015. Métodos: Se tomó muestra de suero a 48 pacientes con enfermedad renal crónica en hemodiálisis sin evidencia de cardiopatía isquémica aguda, y se midieron las concentraciones de creatin quinasa (CK), creatin quinasa fracción MB (CK-MB) y Troponina I (Tn-I) antes y después de la diálisis. Resultados: la mediana de los valores obtenidos de CK fue 42 prediálisis y 38 postdiálisis (p = 0,434), CK-MB: 10 pre y postdiálisis (p = 0,629), con respecto a troponina I, la mediana fue 0,00 pre y postdiálisis (p = 0,586). Se obtuvo valores dentro de límites normales de CK en 91,1% pre y 93,3% postdiálisis, CKMB 93,3% prediálisis y postdiálisis y Troponina I en 97,67% pre y 95,35% postdiálisis. Conclusiones: no se evidenciaron cambios significativos en las concentraciones de CK, CK-MB y Troponina I tanto pre como postdiálisis, encontrándose dentro de la normalidad en más de 90% de los casos. No se encontró relación entre concentración Troponina I, CK y CK-MB según edad, sexo, factores de riesgo cardiovasculares (diabetes mellitus e hipertensión arterial) y tiempo de hemodiálisis. Cualquiera de las enzimas puede tener utilidad clínica, siendo de preferencia las más cardioespecíficas, individualizando cada caso según su clínica y sus valores basales de enzimas cardíacas(AU)

This is an observational, analytical prospective study aimed to analyze cardiac enzymes concentrations in chronic kidney disease patients in hemodialysis without evidence of acute coronary disease at Internal Medicine Service of Hospital Universitario de Caracas, Venezuela during 2014-2015. Methods: serum samples were taken in 46 patients' with chronic kidney disease in hemodialysis without evidence of acute coronary disease and creatin kinase (CK), creatin kinase fraction MB (CK-MB) and Troponin I (Tn-I) were measured before and after hemodialysis. Results: was 42 predialysis and 38 postdialysis (p = 0.434), CK-MB 10 predialysis and post-dialysis (p = 0.629) the median value of troponin I, was 0.00 before and after dialysis (p = 0.586). It was obtained values within normal range of CK in 91.1% and 93.3% pre and post-dialysis, CK-MB in 93.3% predialysis and postdialysis and Troponin I in 97.67% pre and 95.35 % postdialysis. Conclusions: No significant changes were found in concentrations of CK, CK-MB and Troponin I bothpre and post-dialysis, with normal values in over 90% of cases. No relationship between concentration of Troponin I, CK and CK-MB and age, sex, cardiovascular risk factors (diabetes and hypertension) or time in hemodialysis were found. Any of the enzymes may have clinical utility, being the cardiospecific ones preferably, individualizing each case based on clinical and baseline cardiac enzymes(AU)

Caracterización de pacientes en posoperatorio de revascularización miocárdica según eventos clínicos de cuidado de enfermería / Characterization of patients in postoperative period of myocardial revascularization according to clinical nursing care events", "_e": "n

Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.

Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.

Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease

Remote ischemic preconditioning (RIPre) can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG) surgery were assigned randomly to a RIPre group (n=20) or coronary heart disease (CHD) group (n=20). Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD), CD34+ monocyte count, and endothelial nitric oxide synthase (eNOS expression). Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, P<0.05) and significantly reduced troponin after CABG surgery (0.72±0.31 and 1.64±0.19, P<0.05). RIPre activated STAT-3 and increased CD34+ endothelial progenitor cell counts found in arteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.

Resposta vascular após implante de stents liberadores de biolimus A9 compolímero bioabsorvível e stents liberadores de everolimus com polímero durável. Resultados da análise de tomografia de coerência óptica do estudo randomizado BIOACTIVE / Vascular response after implantation of biolimus A9-eluting stent with bioabsorbable polymer and everolimus-eluting stents with durable polymer. Results of the optical coherence tomography analysis of the BIOACTIVE randomized trial

No estudo BIOACTIVE, avaliamos as respostas vasculares após implante do stent eluidor de biolimus A9 (SEB; BioMatrix®) e o stent eluidor de everolimus (SEE; XIENCE V®). Apresentamos a análise detomografia de coerência óptica (OCT) 6 meses pós-intervenção. Métodos: Os pacientes foram randomizados para tratamento com SEB (n = 22) ou SEE (n = 18). O desfecho primário foi a frequência de hastes não cobertas e mal apostas pela OCT. Resultados: A OCT foi realizada em 26 pacientes (SEB: n = 15; SEE: n = 11) e foram analisadas 749 imagens tomográficas e 7.725 hastes de stent. SEB e SEE apresentaram áreas luminais e dos stents semelhantes.A área de hiperplasia neointimal, a espessura neointimal e o porcentual de obstrução intra-stent (8,44 ± 5,10% vs. 9,21 ± 6,36%; p = 0,74) foram similares. As taxas de hastes não cobertas (SEB: 2,10 ± 3,60% vs. SEE: 2,46 ± 2,15%; p = 0,77) e mal apostas (SEB: 0,48 ± 1,48% vs. SEE 0,44 ± 1,05%; p = 0,94) foram baixas e semelhantes. A frequência de frames com sinais compatíveis com infiltrado inflamatório peri-haste foi baixa e similar entre SEB (15,53 ± 20,77%) e SEE (11,70 ± 27,51%; p = 0,68).Conclusões: Stents farmacológicos de segunda geração SEB e SEE se mostraram igualmente eficientes emsuprimir a formação neointimal aos 6 meses, com respostas vasculares favoráveis. A frequência de framescom sinais de infiltrado peri-haste por paciente foi baixa, e menor do que a historicamente observada comos stents farmacológicos de primeira geração...

In BIOACTIVE study, we evaluated vascular responses after the implant of biolimus A9-eluting stent (BES; BioMatrixTM) and the everolimus-eluting stent (EES; XIENCE VTM). In this study, we present the optical coherence tomography analysis (OCT) 6 months post-intervention. Methods: Patients were randomized to treatment with BES (n = 22) or EES (n = 18). The primary outcome was the frequency of non-covered, poorly positioned struts by OCT.Results: OCT was performed in 26 patients (BES: n = 15; EES: n = 11) and 749 tomographic images and 7,725stent struts were analyzed. BES and EES showed similar luminal and stent areas. Neointimal hyperplasia area, neointimal thickness and the percentage of in-stent obstruction (8.44 ± 5.10% vs. 9.21 ± 6.36%; p = 0.74) were similar. The rates of not covered struts (BES: 2.10 ± 3.60% vs. ESS: 2.46 ± 2.15%, p = 0.77) and poorly positioned struts (BES: 0.48 ± 1.48% vs. EES 0.44 ± 1.05%, p = 0.94) were similarly low. The frequency of frames with signs consistent with peri-strut inflammatory infiltrate was low and similar between BES (15.53 ± 20.77%) and EES (11.70 ± 27.51%; p = 0.68). Conclusions: The second-generation drug-eluting stents BES and EES were equally effective at suppressing the neointimal formation after 6 months, with favorable vascular responses. The frequency of frameswith peri-strut infiltrate signals per patient was low, and lower than that observed historically with firstgenerationdrug-eluting stents...

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations. .

Nitroprusiato: una droga confiable para la estimación de la reserva de flujo fraccional coronario / Nitroprusside: a reliable drug for fractional flow reserve assessment

La angiografía coronaria permanece como "gold standard" para el diagnóstico y toma de decisiones en la enfermedad coronaria. Sin embargo, la significación de lesiones con estenosis de 50-70 por ciento es difícil. La medición de la reserva de flujo fraccional (FFR) es una herramienta útil para dilucidar esta interrogante. Generalmente se usa adenosina (A) en bolo intracoronario para inducir máxima vasodilatación y hay poca evidencia para drogas alternativas con este objeto. En este estudio evaluamos el uso de nitroprusiato (N) como droga alternativa. Métodos y Resultados: Se efectuó un estudio clínico aleatorizado. A (120 ug IC) y posteriormente N (50 ug IC), o vice-versa, se usaron para evaluar cada lesión. Se evaluaron 60 lesiones en 44 pacientes (24 hombres) de 63.5 +/- 9.6 años, con masa corporal 28.95 +/- 3.32 kg/m2. Las lesiones se localizaron en arteria descendente anterior en 46.7 por ciento, coronaria derecha en 26.7 por ciento, circunfleja en 11.7 por ciento y 13.9 por ciento en las otras arterias. La estenosis coronaria promedio evaluada por angiografía cuantitativa fue 49.5 por ciento (95 por ciento CI: 46.5 - 52.5 por ciento). La presión arterial media (PAM) basal fue similar en ambos grupos (pre - A: 106.5 +/- 18.2 mmHg, pre - N: 105.6 +/- 18.8 mmHg, NS) o después de A, pero se observó un descenso transitorio después de NP (descenso promedio de 12.5 mmHg, 95 por ciento CI: 9.2 a15.7 mmHg, 2p < 0.001). Este efecto estaba asociado a la hiperemia prolongada lograda con N. (duración de hiperemia con N: 39.2 +/- 8.7 s., y con A of 15.3 +/- 3.2 s. 2p < 0.001). Hubo excelente correlación entre los resultados de A y de N respecto de FFR (r 0.986)...

Abstract: Coronary angiography remains the gold standard for diagnosing coronary artery disease and making therapeutic decisions. However the significance of intermediate lesions (between 50-70%) is difficult to evaluate. Fractional flow reserve (FFR) measurement is an important tool for the evaluation of these lesions. To achieve maximum vasodilatation, Intracoronary (IC) bolus or a continuous intravenous infusion of (A) is usually used. There is very little data for an alternative drug. The aim of this study was to evaluate Sodium nitroprusside (N) 50 IC bolus as an alternative to A for to determine FFR.Method and Results: A multicentric, randomized clinical trial was conducted. A, (120 IC) and subsequently N (50 IC) or vice versa was used for every lesion. 60 coronary lesions were evaluated in 44 patients (24 men and 20 women), mean age 63.5 ± 9.6 years and BMI 28.95 ± 3.32 kg/m2. The lesions were located in the left anterior descending artery in 46.7% of patients, the right coronary in 26.7%, the circumflex in 11.7% and others in 13.9%. Mean coronary artery stenosis as assessed by quantitative coronary angiography (QCA) was 49.5% (95% CI: 46.5 - 52.5%).The mean arterial pressure (MAP) was similar in groups at baseline.(pre - A: 106.5 ± 18.2 mmHg, pre - N: 105.6 ± 18.8 mmHg, NS), or after A, but there was a transient decrease in MAP when N was administered (average decline of MAP: 12.5 mmHg, (95% CI: 9.2 to 15.7 mmHg, 2p < 0.001). This effect was due to the prolonged hypere-mia time achieved with the drug (hyperemia duration with nitroprusside 39.2 ± 8.7 sec. and with adenosine of 15.3 ± 3.2 sec. 2p < 0.001). We could demonstrate an excellent correlation between IC nitroprusside and IC adenosine with regard to FFR measurement, (correlation coefficient = 0.986, p < 0.001)...

Enfermedad arterial coronaria e indicaciones para revascularización coronaria / Coronary artery disease and indications for coronary revascularization

La enfermedad coronaria es una de las principales causas de morbimortalidad en países en desarrollo, donde es vital un adecuado diagnóstico y manejo debido a que ignorar esta enfermedad en etapas tempranas aumenta los costos. Por tanto, esta revisión bibliográfica pretende definir los conceptos de enfermedad coronaria, diagnóstico, estratificación de riesgo y estrategias de manejo donde se destaca la importancia que ha adquirido el manejo médico óptimo, sin perder de vista el rol que juega los métodos invasivos de revascularización, según lo que han determinado nuevas guías con indicaciones adecuadas para la revascularización tomando en cuenta: la presentación clínica (ej: angina estable, síndrome coronario agudo), severidad de la angina, extensión de la isquemia en evaluaciones no invasivas con la presencia o ausencia de otros factores pronósticos, terapia farmacológica amplia y extensión de la enfermedad anatómica.

Acurácia dos escores GRACE e TIMI na predição da gravidade angiográfica da síndrome coronariana aguda / Accuracy of the GRACE and TIMI scores in predicting the angiographic severity of acute coronary syndrome

FUNDAMENTO: A acurácia dos escores GRACE e TIMI em predizer a extensão da doença coronariana em pacientes com síndromes coronarianas agudas sem supradesnivelamento do segmento ST (SCA) não está estabelecida. OBJETIVO: Testar a hipótese de que os escores de risco GRACE e TIMI predizem satisfatoriamente a extensão da doença coronariana, em pacientes com SCA submetidos a coronariografia. MÉTODOS: Indivíduos admitidos com critérios objetivos de SCA e que realizaram coronariografia durante o internamento foram consecutivamente analisados. A doença coronariana angiográfica foi descrita de três formas: quantificação da extensão da doença coronariana pelo escore de Gensini; presença de qualquer obstrução coronariana (> 70% ou > 50% quando tronco de coronária esquerda); presença de doença severa (triarterial ou tronco de coronária esquerda). RESULTADOS: Em 112 pacientes avaliados, observou-se correlação positiva do escore de Gensini com os escores GRACE (p = 0,017) e TIMI (p = 0,02), porém essa associação foi de fraca magnitude (r = 0,23 e r = 0,27; respectivamente). O escore GRACE não foi capaz de predizer doença coronariana obstrutiva (área abaixo da curva ROC = 0,57; 95%IC = 0,46 - 0,69), nem doença coronariana severa (ROC = 0,59; 95%IC = 0,48 -0,70). O Escore TIMI se mostrou modesto preditor em relação à presença de doença coronariana (ROC = 0,65; 95%IC = 0,55 - 0,76) e presença de doença severa (ROC = 0,66; 95%IC = 0,56 - 0,76). CONCLUSÃO: (1) Existe associação positiva entre o valor dos escores TIMI ou GRACE e a extensão da doença coronária em pacientes com SCA; (2) No entanto, o grau dessa associação não é suficiente para que esses escores sejam preditores acurados dos resultados da coronariografia.

BACKGROUND: The accuracy of the GRACE and TIMI scores in predicting coronary disease extension in patients with non-ST-elevation acute coronary syndromes (ACS) has not been established. OBJECTIVE: To assess the hypothesis that the GRACE and TIMI risk scores satisfactorily predict coronary disease extension in patients withnon-ST-elevation ACS undergoing coronary angiography. METHODS: Individuals meeting the objective criteria for ACS and undergoing coronary angiography during hospitalization were consecutively assessed. Angiographic coronary disease was described as follows: quantification of coronary disease extension by using Gensini score; presence of any coronary artery obstruction (> 70% or > 50% when affecting left main coronary artery); and presence of severe disease (three-vessel disease or affecting the left main coronary artery). RESULTS: Of 112 patients assessed, a positive correlation of the Gensini score was observed with the GRACE (p = 0.017) and TIMI (p = 0.02) scores, but that association was weak (r = 0.23 and r = 0.27; respectively). The GRACE score could predict neither obstructive coronary disease (area under the ROC curve = 0.57; 95% CI = 0.46 - 0.69), nor severe coronary disease (ROC = 0.59; 95% CI = 0.48 - 0.70). The TIMI score proved to be a modest predictor of coronary disease (ROC = 0.65; 95% CI = 0.55 - 0.76) and of severe coronary disease (ROC = 0.66; 95% CI = 0.56 - 0.76). CONCLUSION: (1) There is a positive association between the values of the TIMI or GRACE scores and the extension of coronary artery disease in patients with ACS; (2) however, the degree of that association is not sufficient to make those scores accurate predictors of coronary angiography results.

Changes of left ventricular myocardial collagen fibers and osteopontin expression in hypertrophic cardiomyopathy / 法医学杂志

OBJECTIVE@#To investigate the changes of collagen fibers and the expression of osteopontin in the left ventricle in cases of hypertrophic cardiomyopathy (HCM), along with the significance of their potential forensic application.@*METHODS@#Fifteen cases of HCM, 15 cases of coronary heart disease with cardiac hypertrophy and 20 cases of traffic accidents were selected as HCM group, coronary heart disease group and control group, respectively. Collagen volume fraction and osteopontin expression were observed and compared by HE staining, Masson trichrome staining and immunohistochemistry methods. Imaging and statistical methods were used for quantitative analysis.@*RESULTS@#Collagen volume fraction in left ventricle of HCM and coronary heart disease were significantly higher than that in the control group (P < 0.05), which was not significantly different between the HCM group and the coronary heart disease group. The integral light density value of osteopontin in left ventricular cardiomyocytes of the HCM group and the coronary heart disease group were significantly higher than that of the control group (P< 0.05), and the value of the HCM group was also significantly higher than that of coronary heart disease group (P < 0.05).@*CONCLUSION@#The increased contents of collagen fibers and the overexpression of osteopontin may play an important role in myocardial fibrosis, and they can be used as markers in aid of diagnosing sudden death due to HCM.