Physicians' perceptions on the impact of COVID-19 in coronary artery disease diagnostic imaging and treatment: A Latin America survey. For the Society of Cardiovascular Imaging of the Inter-American Society of Cardiology.

Background: Services during the pandemic were severely restricted, public reluctance to seek medical assistance rose, with a reduction of diagnostic and therapeutic modalities use in coronary artery disease (CAD). However, information about perceived barriers of care among cardiologists is limited. We aim to explore these barriers diagnostic and treatment modalities of CAD in Latin America during the pandemic. Methods: An anonymous Google form 12 closed-questions survey was conducted between November 2020 to January 2021. Latin American cardiologists members of the Imaging Society (SISIAC) of the Inter-American Society of Cardiology (SIAC) were reached by email and social media. Results: Differences were found in relation to patients' perceived reluctance to undergo testing, particularly in South America and inpatient care (p < 0.05). Respondents' perceived barriers in the use of CV tests were higher in South America (p < 0.05) and related to public practice (p < 0.01). Barriers to the treatment of myocardial infarction were present in all regions (p < 0.05), and follow-up was influenced by COVID-19 in both public and private practices (p = 0.01). Conclusions:  Regardless of treatment and diagnostic approach (invasive or non-invasive) followed, according to physicians' perception, the pandemic significantly impacted the clinical management of CAD in the Latin American population, similar to the global situation.

Intramyocardial Dissecting Hematoma: A Mechanical Complication Needing Surgical Therapy?

Intramyocardial dissecting hematoma is a form of cardiac rupture caused by myocardial infarction, percutaneous coronary intervention, or trauma. It is a cavity between myocardial fibers caused by partial rupture of the ventricular wall. Therapeutic management, including the timing for surgical approach, has not been standardized. We present a case series describing 4 patients. (Level of Difficulty: Intermediate.).

[Body image adaptation in health personnel during COVID-19]. / Adaptación de la imagen corporal en personal de salud durante la COVID-19.

Background: Everything that has contact with the body is also integrated as part of the individual's body image; Personal Protective Equipment (PPE) could be integrated into body image. Objective: To describe the characteristics of the drawing of the human figure as a projective tool of body image in health personnel. Material and methods: A retrospective longitudinal descriptive study was carried out, which consisted of the compilation and analysis of the drawing tests of the human figure performed on health personnel in the contingency of COVID-19. A descriptive analysis of the qualitative variables and an inferential analysis with McNemar's test were carried out to compare proportions between groups. Results: 147 drawings in the previous context and their respective drawings in context during the contingency were included. When comparing both groups, in the pandemic context an increase in distortions or omissions was observed (p = 0.013), mainly located in the hands and arms (p < 0.001). Also, traces suggestive of isolation (p = 0.039), drawings with poor definition of the eyes (p = 0.69), inclusion of PPE (p < 0.001), and omission of the nose (p = 0.011) and mouth (p < 0.001) were observed). Conclusions: The increase in distortions or omissions may be related to reconstructing the social part. Six months after the start of the contingency, 40% of the health personnel had already incorporated the PPE into their projective drawing of body image.

Introducción: : todo lo que tiene contacto con el cuerpo también se integra como parte de la imagen corporal del individuo; el equipo de protección personal (EPP) podría integrarse a la imagen corporal. Objetivo: describir las características del dibujo de la figura humana como herramienta proyectiva de la imagen corporal en el personal de salud. Material y métodos: se realizó un estudio descriptivo longitudinal retrospectivo, que consistió en la recopilación y análisis de los test de dibujo de la figura humana realizado al personal de salud en la contingencia por COVID-19. Se realizó un análisis descriptivo de las variables cualitativas y un análisis inferencial con prueba de McNemar para comparar proporciones entre grupos. Resultados: se incluyeron 147 dibujos en contexto previo y sus respectivos dibujos en contexto durante la contingencia. Al comparar ambos grupos, en el contexto pandémico se observó un incremento en las distorsiones u omisiones (p = 0.013), principalmente localizadas en manos y brazos (p < 0.001). También, se observaron trazos sugerentes de aislamiento (p = 0.039), dibujos con poca definición de los ojos (p = 0.69), inclusión del EPP (p < 0.001) y omisión de nariz (p = 0.011) y boca (p < 0.001). Conclusiones: el incremento en las distorsiones u omisiones puede estar relacionado con la reconstrucción de la parte social. Seis meses posteriores al inicio de la contingencia, el 40% del personal de salud ya había incorporado el EPP a su dibujo proyectivo de imagen corporal.

Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry.

AIMS: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. METHODS AND RESULTS: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73-3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39-2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12-0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20-0.41; p < 0.001). CONCLUSION: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Cancer and Infective Endocarditis: Characteristics and Prognostic Impact.

Background: The interplay between cancer and IE has become of increasing interest. This study sought to assess the prevalence, baseline characteristics, management, and outcomes of IE cancer patients in the ESC EORP EURO-ENDO registry. Methods: Three thousand and eighty-five patients with IE were identified based on the ESC 2015 criteria. Three hundred and fifty-nine (11.6%) IE cancer patients were compared to 2,726 (88.4%) cancer-free IE patients. Results: In cancer patients, IE was mostly community-acquired (74.8%). The most frequently identified microorganisms were S. aureus (25.4%) and Enterococci (23.8%). The most frequent complications were acute renal failure (25.9%), embolic events (21.7%) and congestive heart failure (18.1%). Theoretical indication for cardiac surgery was not significantly different between groups (65.5 vs. 69.8%, P = 0.091), but was effectively less performed when indicated in IE patients with cancer (65.5 vs. 75.0%, P = 0.002). Compared to cancer-free IE patients, in-hospital and 1-year mortality occurred in 23.4 vs. 16.1%, P = 0.006, and 18.0 vs. 10.2%; P < 0.001, respectively. In IE cancer patients, predictors of mortality by multivariate analysis were creatinine > 2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). Conclusions: Cancer in IE patients is common and associated with a worse outcome. This large, observational cohort provides new insights concerning the contemporary profile, management, and clinical outcomes of IE cancer patients across a wide range of countries.

Taquicardia ventricular monomorfa sostenida secundaria a lipoma intramiocárdica / Sustained monomorphic ventricular tachycardia secondary to intramyocardial lipoma

[RESUMEN]. Introducción: A pesar de ser extremadamente raros, los tumores cardíacos conforman un importante desafío diagnóstico de la práctica cardiooncológica. Los lipomas son la segunda neoplasia primaria benigna en orden de frecuencia, representan entre un 8 a 12% de los tumores cardíacos primarios benignos en adultos. Materiales, métodos: Presentamos un caso clínico de una paciente estudiada y diagnosticada en nuestra institución. Descripción: Se presenta a una paciente de 21 años, de género femenino, sin factores de riesgo cardiovasculares, que fue referida a nuestra institución con diagnóstico de lipoma cardíaco. Su presentación inicial incluyó taquicardia ventricular sostenida con descompensación hemodinámica, que respondió favorablemente a la cardioversión eléctrica. Tras su ingreso, se llevaron a cabo estudios diagnósticos adicionales para obtener una caracterización más precisa de la masa y facilitar la toma de decisiones terapéuticas. El ecocardiograma transtorácico reveló la presencia de una masa en el septum interventricular basal, con extensión a la pared inferior de ambos ventrículos. La resonancia cardíaca posterior confirmó la naturaleza lipídica de la masa, que se presentaba de manera homogénea, con lí- mites definidos, sin realce en ninguna fase del contraste endovenoso y encapsulada, sin afectar estructuras adyacentes. La ausencia de realce precoz y tardío permitió descartar la vascularización y la presencia de tejido fibroso, respectivamente, consolidando así el diagnóstico de lipoma. Después de una evaluación exhaustiva por el equipo cardiovascular de nuestro hospital, se decidió de manera conjunta no proceder con una intervención quirúrgica debido a la ubicación anatómica del tumor y al elevado riesgo de morbimortalidad asociado. La alternativa consensuada fue la implantación de un cardiodesfibrilador, considerando el historial de arritmia severa y el riesgo de recurrencia en esta paciente. Conclusión: Se presenta un caso infrecuente de tumor cardíaco, que genera grandes desafíos diagnósticos y terapéuticos. Se optó por un tratamiento conservador con el propósito de prevenir la recurrencia de eventos arrítmicos.

[ABSTRACT]. Introduction: Despite being extremely rare, cardiac tumors pose a significant diagnostic challenge in cardio-oncology practice. Lipomas rank as the second most common primary benign neoplasm, accounting for 8 to 12% of primary benign cardiac tumors in adults. Materials and Methods: We present a clinical case of a patient studied and diagnosed at our institution. Description: A 21-year-old female patient, without cardiovascular risk factors, was referred to our institution with a diagnosis of cardiac lipoma. Her initial presentation included sustained ventricular tachycardia with hemodynamic decompensation, successfully managed with electrical cardioversion. Following admission, additional diagnostic studies were conducted to achieve a more precise characterization of the mass and guide therapeutic decision-making. Transthoracic echocardiography revealed a mass in the basal interventricular septum, extending to the inferior wall of both ventricles. Subsequent cardiac resonance confirmed the lipid nature of the mass, presenting homogeneously with well-defined borders, no enhancement in any phase of intravenous contrast, encapsulated, and without involvement of adjacent structures. The absence of early and late enhancement ruled out tumor vascularization and fibrous tissue, respectively, confirming the diagnosis of a lipoma. Following a comprehensive evaluation by our hospital's cardiovascular team, a joint decision was made to refrain from surgical intervention due to the anatomical location of the tumor and the associated high risk of morbidity and mortality. The consensus alternative was the implantation of a cardioverter-defibrillator, considering the patient's history of severe arrhythmia and the risk of recurrence. Conclusion: An infrequent case of cardiac tumor, that is associated with diagnostic and therapeutic challenges, is described. A conservative treatment was chosen aiming to prevent the recurrence of arrhythmic events.

Estudio preliminar de correlación fenotipo-genotipo en miocardiopatías de pacientes derivados a un centro de alta complejidad del conurbano bonaerense / A Preliminary Study of the Phenotype-Genotype Correlation in Cardiomyopathies in Patients Referred to a Tertiary Healthcare Center in the Suburbs of Buenos Aires

RESUMEN Introducción : Las miocardiopatías se definen como un trastorno del miocardio en el que el músculo cardíaco es estructural y funcionalmente anormal, en ausencia de enfermedad arterial coronaria, hipertensión arterial (HTA), enfermedad valvular y enfermedad cardíaca congénita. Estas enfermedades son relativamente frecuentes, y suponen una importante causa de morbimortalidad a nivel global. Aunque el estudio genético se recomienda para el cribado familiar, la falta de datos robustos sobre asociaciones genotipo-fenotipo específicas ha reducido su impacto en el manejo clínico. Objetivos : El objetivo de este estudio es analizar la frecuencia de mutaciones en una población de pacientes con miocardiopatía derivados a un centro de alta complejidad y el análisis de la correlación genotipo-fenotipo en las mutaciones identificadas. Material y métodos: Se estudiaron en forma prospectiva 102 pacientes con sospecha de miocardiopatía hipertrófica (MCH) familiar, de los cuales 70 constituían casos índices, de una cohorte ambispectiva de pacientes con miocardiopatías controladas en un hos pital público de alta complejidad de tercer nivel de atención de la provincia de Buenos Aires, desde enero 2012 al 30 agosto 2022. Resultados : De 102 pacientes 83 fueron considerados afectados. De eelos, 31 eran MCH y 52 fenocopias, sin diferencia en el pronóstico. Se realizó estudio genético en 77 pacientes, de los cuales 57 presentaron mutaciones reconocibles, en el 80% de los casos coincidentes con un Score de Mayo ≥3. Se detectaron 28 variantes de significado incierto. Conclusiones : Se comprobó que realizar estudio molecular guiado por el Score de Mayo permitió obtener un alto grado de probabilidad de detectar mutaciones. Se evidenció la importancia del estudio molecular debido a la existencia de solapamiento fenotípico y genotípico de las miocardiopatías. El conocimiento de la variante genética causal actualmente no afecta el manejo clínico de la mayoría de los pacientes con MCH, pero es de ayuda ante un pequeño grupo de genes que tienen opciones de tratamiento.

ABSTRACT Background : Cardiomyopathies are defined as a disorder of the myocardium in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension (HT), valvular heart disease and congenital heart disease. These diseases are relatively common and a major cause of morbidity and mortality worldwide. Although genetic testing is recommended for family screening, lack of solid data on specific genotype-phenotype associations has reduced its impact on clinical management. Objectives : This study aims to analyze the frequency of mutations in a population of patients with cardiomyopathy referred to a tertiary healthcare center and to analyze the genotype-phenotype correlation of the identified mutations. Methods : We prospectively included 102 patients with suspected familial hypertrophic cardiomyopathy (HCM), 70 of which were index cases, from an ambispective cohort of patients with cardiomyopathies treated in a tertiary healthcare public hos pital in the province of Buenos Aires, from January 2012 to August 30, 2022. Results : Of 102 patients, 83 were considered affected. Of these, 31 were HCM and 52 were phenocopies, with no difference in prognosis. A genetic study was carried out in 77 patients, of whom 57 presented recognizable mutations, in 80% of the cases coinciding with a Mayo Score ≥3. Twenty-eight variants of uncertain significance were detected. Conclusions : It was confirmed that molecular testing guided by the Mayo Score provided high probability of detecting mutations. Molecular testing proved to be important due to the phenotypic and genotypic overlap in cardiomyopathies. Understanding the causative genetic variant, nowadays, does not affect the clinical management of most HCM patients, but is helpful in a small group of genes with treatment options.

Adaptación de la imagen corporal en personal de salud durante la COVID-19 / Body image adaptation in health personnel during COVID-19

Introducción: todo lo que tiene contacto con el cuerpo también se integra como parte de la imagen corporal del individuo; el equipo de protección personal (EPP) podría integrarse a la imagen corporal. Objetivo: describir las características del dibujo de la figura humana como herramienta proyectiva de la imagen corporal en el personal de salud. Material y métodos: se realizó un estudio descriptivo longitudinal retrospectivo, que consistió en la recopilación y análisis de los test de dibujo de la figura humana realizado al personal de salud en la contingencia por COVID-19. Se realizó un análisis descriptivo de las variables cualitativas y un análisis inferencial con prueba de McNemar para comparar proporciones entre grupos. Resultados: se incluyeron 147 dibujos en contexto previo y sus respectivos dibujos en contexto durante la contingencia. Al comparar ambos grupos, en el contexto pandémico se observó un incremento en las distorsiones u omisiones (p = 0.013), principalmente localizadas en manos y brazos (p < 0.001). También, se observaron trazos sugerentes de aislamiento (p = 0.039), dibujos con poca definición de los ojos (p = 0.69), inclusión del EPP (p < 0.001) y omisión de nariz (p = 0.011) y boca (p < 0.001). Conclusiones: el incremento en las distorsiones u omisiones puede estar relacionado con la reconstrucción de la parte social. Seis meses posteriores al inicio de la contingencia, el 40% del personal de salud ya había incorporado el EPP a su dibujo proyectivo de imagen corporal.

Background: Everything that has contact with the body is also integrated as part of the individual's body image; Personal Protective Equipment (PPE) could be integrated into body image. Objective: To describe the characteristics of the drawing of the human figure as a projective tool of body image in health personnel. Material and methods: A retrospective longitudinal descriptive study was carried out, which consisted of the compilation and analysis of the drawing tests of the human figure performed on health personnel in the contingency of COVID-19. A descriptive analysis of the qualitative variables and an inferential analysis with McNemar's test were carried out to compare proportions between groups. Results: 147 drawings in the previous context and their respective drawings in context during the contingency were included. When comparing both groups, in the pandemic context an increase in distortions or omissions was observed (p = 0.013), mainly located in the hands and arms (p < 0.001). Also, traces suggestive of isolation (p = 0.039), drawings with poor definition of the eyes (p = 0.69), inclusion of PPE (p < 0.001), and omission of the nose (p = 0.011) and mouth (p < 0.001) were observed). Conclusions: The increase in distortions or omissions maybe related to reconstructing the social part. Six months after the start of the contingency, 40% of the health personnel had already incorporated the PPE into their projective drawing of body image.

Valor pronóstico del ecocardiograma con strain bidimensional por Speckle Tracking en pacientes con amiloidosis asociada a transtiretina / Prognosis value of the echocardiogram with bidimensional strain by speckle tracking in patients with amyloidosis associated with transthyretin

[RESUMEN]: La amiloidosis cardíaca asociada a transtiretina (ATTR) es una cardiomiopatía infiltrativa caracterizada por el depósito de fibrillas en el miocardio, asociada a un mal pronóstico, incluye dos subtipos: hereditaria (ATTRh) y natural. La mutación Val30Met es la más frecuente a nivel mundial. El diagnóstico es desafiante, se basa en un alto grado de sospecha clínica, una combinación de técnicas de imagen y en algunos casos una biopsia endomiocárdica. Las nuevas técnicas ecocardiográficas han aportado avances en el diagnóstico gracias a su mejor sensibilidad en comparación con parámetros clásicos. OBJETIVO: Evaluar si el deterioro del strain (deformación) longitudinal global (SLG) del ventrículo izquierdo (VI) evaluada por ecocardiografía en pacientes con ATTRh Val30Met, se asocia a eventos cardiovasculares adversos. METODOLOGÍA: Estudio prospectivo de Cohorte. Se evaluaron en total 53 pacientes con amiloidosis tratados en el Hospital "El Cruce" de Florencio Varela desde junio de 2014 y se incluyeron 26 pacientes con la mutación Val30Met, entre marzo y noviembre del 2019 que cumplían con los criterios de inclusión. RESULTADOS: Se observaron eventos (requerimiento de marcapaso, desarrollo de insuficiencia cardíaca y muerte) en el 53.8 % de los pacientes, de los cuales 71,4 % eran hombres (OR: 0,30 (IC95: 0,05-1,54), p=0.13). De los 5 pacientes con amiloidosis de inicio tardío (>60 años) el 100 % presentó eventos (p 0,03). En el análisis univariado, las variables que mostraron asociación con eventos fueron: edad de inicio de los síntomas (p= <0.001), edad de diagnóstico (p=0.004), inicio temprano (p= 0.02), bajo peso (p= 0.004), disnea (p= <0.001), presencia de HVI (p=0.005), disfunción diastólica (p=0.007), dilatación de la AI (p=0.003) y el SLG promedio (p= 0.003). CONCLUSIONES: La FEY (fracción de eyección) del VI se mantiene normal hasta etapas avanzadas, por lo que se considera inadecuada para la correcta valoración de estos pacientes siendo necesarios métodos alternativos que aumenten la sensibilidad en el período preclínico. El punto de corte de SLG-14.4 ± 4.5% discriminó la evolución a eventos cardiovasculares adversos.

[ABSTRACT]: Transthyretin-associated cardiac amyloidosis (ATTR) is an infi ltrative cardiomyopathy characterized by the deposition of fi brils in the myocardium, associated with a poor prognosis, it includes two subtypes: hereditary (hATTR) and natural. The Val30Met mutation is the most frequent worldwide. The diagnosis is challenging, based on a high degree of clinical suspicion, a combination of imaging techniques, and in some cases an endomyocardial biopsy. The new echocardiographic techniques have brought advances in diagnosis thanks to their better sensitivity compared to classical parameters. OBJECTIVE: To assess whether the deterioration of the global longitudinal strain (deformation) of the left ventricle (LV) evaluated by echocardiography in patients with hATTR Val30Met is associated with adverse cardiovascular events. METHODS: Prospective cohort study. A total of 53 patients with amyloidosis treated at the Hospital "El Cruce" in Florencio Varela since June 2014 were evaluated, 26 patients with the Val30Met mutation were included, between March and November 2019, who met the inclusion criteria. RESULTS: Of the 5 patients with late-onset amyloidosis (> 60 years), 100% had events (p 0.03). Events (requirement for a pacemaker, development of heart failure and death) were observed in 53.8% of the patients, of which 71.4% were men (OR: 0.30 (CI95: 0.05-1.54), p = 0.13). In the univariate analysis, the variables that showed an association with events were: age of onset of symptoms (p = <0.001), age of diagnosis (p = 0.004), early onset (p = 0.02), underweight (p = 0.004), dyspnea (p = <0.001), presence of LVH (p = 0.005), diastolic dysfunction (p = 0.007), LA dilation (p = 0.003) and mean GLS (p = 0.003). CONCLUSIONS: The LV EF (ejection fraction) remains normal until advanced stages, which is why it is considered inadequate for the correct evaluation of these patients, and alternative methods are necessary to increase sensitivity in the preclinical period. The cut-off point of GLS-14.4 ± 4.5% discriminated the evolution to adverse cardiovascular events.

Resistencia a la heparina en pacientes con síndrome respiratorio agudo grave coronavirus tipo 2: a propósito de un caso / Heparin resistance in patients with severe acute respiratory syndrome coronavirus type 2: a case report

[RESUMEN]: Los pacientes con Covid 19 causado por el virus del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) desarrollan coagulopatía sobre todo en los casos graves, lo que conlleva un alto riesgo de presentar eventos trombóticos. En estos pacientes, el uso de terapia anticoagulante con heparina no fraccionada (HNF) resulta en ocasiones de difícil manejo. Como sabemos, su utilización debe controlarse mediante el tiempo de tromboplastina parcial activada (APTT), con un valor referencial de 1.5 a 2.5 del valor basal. Debido a la respuesta inflamatoria severa provocada por SARS-CoV-2 hay un aumento en la síntesis de fibrinógeno y/o Factor VIII (FVIII), que puede producir la ausencia de prolongación del APTT a pesar de dosis altas de HNF, fenómeno conocido como resistencia bioquímica a la heparina. Además, en pacientes con Covid 19 se ha descrito disminución de los valores de antitrombina (AT), aunque dentro del rango hemostático, respecto a un grupo control. Se describirá el caso de un paciente internado en nuestra institución, con diagnóstico de Covid 19 grave y resistencia bioquímica a la heparina, lo que resultó en un difícil manejo de la anticoagulación.

[ABSTRACT]: Patients with Covid 19, caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) can develop a coagulopathic state, mostly in severe cases, with a high risk of thrombotic complications. In these patients, the use of anticoagulant therapy with unfractioned heparin (UFH) can be challenging. UFH must be controlled by the activated partial thromboplastin time (aPTT), with a referetial value of 1.5 ­ 2.0 times the baseline value. SARS-CoV-2 produces a severe infl ammatory response which causes an elevation in fi brinogen and Factor VIII (FVIII) liver synthesis. This can interfere with the aPTT, not being able to raise it to therapeutically desired ranges in spite of high doses of UFH, a phenomenon known as heparin laboratory resistance. In Covid 19 patients, a lower level of antithrombin (AT) synthesis with respect to a control group has also been described, although witihn the hemostatic range. We will describe a case report from our hospital, with a diagnosis of severe Covid 19 and heparin laboratory resistance, which led to diffi culties in the anticoagulation therapy management.

Hematoma intramiocárdico disecante tras el IAM / Intramyocardial dissecting hematoma after AMI

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[Association between biochemical markers and left ventricular dysfunction in the ST-elevation acute myocardial infarction]. / Asociación entre marcadores bioquímicos y disfunción ventricular izquierda en infarto con elevación del segmento ST.

OBJECTIVE: The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with ST-elevation acute myocardial infarction. METHODS: With an observational and prospective design we included patients with less than 24h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. RESULTS: A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P=.005), peak creatine-phosphokinase-MB (P=.01), leukocyte count (P=.001) and glucose (P=.033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P=.01) and peak creatine-phosphokinase-MB (P=.02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. CONCLUSION: B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction.

Asociación entre marcadores bioquímicos y disfunción ventricular izquierda en infarto con elevación del segmento ST / Association between biochemical markers and left ventricular dysfunction in the ST-elevation acute myocardial infarction

Resumen Objetivo: La asociación entre marcadores serológicos y fracción de expulsión en el infarto no ha sido completamente estudiada. Nuestro objetivo es estudiar la asociación existente entre marcadores bioquímicos y disfunción ventricular izquierda en el infarto agudo de miocardio con elevación del segmento ST. Métodos: Con un diseño observacional, prospectivo, incluimos a pacientes con infarto con elevación ST en las primeras 24 h. Se analizaron al ingreso: recuento de leucocitos, glucemia, péptido natriurético tipo B y troponina T, y creatinfosfocinasa total y fracción MB al ingreso y en forma seriada. Estos parámetros se correlacionaron con la fracción de expulsión estimada por ecocardiograma. Resultados: Se incluyeron 108 pacientes. Mediana de fracción de expulsión 48% (intervalo intercuartílico 41-57). En el análisis de regresión lineal simple, el péptido natriurético tipo B (p = 0.005), el pico de creatinfosfocinasa fracción MB (p = 0.01), el recuento leucocitario (p = 0.001) y la glucemia (p = 0.033) se asociaron inversa y significativamente con la fracción de expulsión. No mostraron asociación los otros parámetros. En el análisis de regresión lineal múltiple, solo el péptido natriurético tipo B (p = 0.01) y el pico de creatinfosfocinasa fracción MB (p = 0.02) presentaron correlación significativa con la fracción de expulsión. Ambos parámetros se asociaron significativamente con una fracción de expulsión < 50%, de manera independiente a otras variables clínicas. Conclusiones: En la etapa aguda del infarto con elevación ST, el péptido natriurético tipo B y la creatinfosfocinasa fracción MB se asociaron significativamente con la disfunción ventricular izquierda independientemente de la presencia de otros marcadores bioquímicos y variables clínicas determinantes de disfunción ventricular.

Objective: The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with ST-elevation acute myocardial infarction. Methods: With an observational and prospective design we included patients with less than 24 h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. Results: A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P = .005), peak creatine-phosphokinase-MB (P = .01), leukocyte count (P = .001) and glucose (P = .033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P = .01) and peak creatine-phosphokinase-MB (P = .02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. Conclusion: B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction.

Comentarios sobre la infección por influenza a H1N1 desde la perspectiva de la terapia intensiva de adultos / Comments on H1N1 influenza infection from the perspective of the adult intensive care

El objetivo del presente fue caracterizar el comportamiento de esta nueva afección en el ámbito de terapia intensiva. Se incluyeron pacientes que ingresaron a la terapia intensiva del hospital y se recorre el tratamiento realizado.