Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic.

Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.

La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.

Barriers to Early Diagnosis and Treatment of Familial Hypercholesterolemia: Current Perspectives on Improving Patient Care.

Familial hypercholesterolemia (FH) is a frequent disorder associated with premature atherosclerotic cardiovascular disease. Different clinical diagnosis criteria are available, and cost of genetic testing has been reduced in the last years; however, most cases are not diagnosed worldwide. Patients with FH are at high cardiovascular risk and the risk can be reduced with lifelong lifestyle and pharmacological treatment. Statins and ezetimibe are available as generic drugs in most countries reducing the cost of treatment. However, the use of high-intensity statins combined with ezetimibe and PCSK9 inhibitors, if necessary, is low for different reasons that contribute to a high number of patients not reaching LDL-C targets according to guidelines. On the other hand, cardiovascular risk varies greatly in families with FH; therefore, risk stratification strategies including cardiovascular imaging is another element to consider for improving care and management of FH. There are numerous barriers depending on the awareness, knowledge, perception of risk, management and care of patients living with FH that impact in the diagnosis and treatment of the disorder. In this contemporary review, we analyze different barriers in the diagnosis and care of patients to improve patients' care and prevention of atherosclerotic cardiovascular disease and describe recent advances and strategies to improve the gaps in the care of FH, including global collaboration and advocacy.

Telemedicina como instrumento de consulta cardiológica durante la pandemia COVID-19 / Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic

Resumen La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.

Abstract Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.

Familial Hypercholesterolaemia Diagnosis and Management.

Familial hypercholesterolaemia is the most common monogenic disorder associated with premature coronary artery disease. Mutations are most frequently found in the LDL receptor gene. Clinical criteria can be used to make the diagnosis; however, genetic testing will confirm the disorder and is very useful for cascade screening. Early identification and adequate treatment can improve prognosis, reducing negative clinical cardiovascular outcomes. Patients with familial hypercholesterolaemia are considered at high cardiovascular risk and the treatment target is LDL cholesterol <2.6 mmol/l or at least a 50 % reduction in LDL cholesterol. Patients require intensive treatment with statins and ezetimibe and/or colesevelam. Recently, proprotein convertase subtilisin/kexin type 9 inhibitors have been approved for the management of familial hypercholesterolaemia on top of statins.

Fusión de ecocardiografía 2D/3D-fluoroscopia: nueva herramienta en el intervencionismo cardiaco / Fusion of 2 D and 3 D echocardiography with fluoroscopy: a new tool in cardiac interventionism

Resumen La evolución en el intervencionismo estructural percutáneo ha generado un desarrollo paralelo en las técnicas de imagen avanzada. Teniendo en cuenta que este tipo de procedimientos requiere un entendimiento total de la anatomía cardiaca y con el fin de garantizar los mejores resultados y seguridad para el paciente durante procedimientos complejos, se desarrolló un software capaz de fusionar la fluoroscopia y la ecocardiografía 3 D en una sola imagen. La tecnología del Echonavigator® integra dos técnicas de imágenes dinámicas de un corazón en movimiento; el adecuado co-registro y visualización de fluoroscopia y ecocardiografía transesofágica 2D/3D es la clave en la obtención de resultados óptimos. La fusión de dos imágenes dinámicas en tiempo real es una herramienta factible y segura en los procedimientos de intervencionismo estructural del corazón; los estudios iniciales han logrado disminuir el tiempo de realización de los procedimientos y las dosis de radiación al paciente. El futuro es prometedor y su progresiva expansión de uso teniendo en cuenta su reciente aparición, aportará más datos en el crecimiento de esta tecnología.

Abstract The evolution of percutaneous structural interventionism has led to the simultaneous development of advanced imaging techniques. Taking into account that these types of procedures require a full understanding of cardiac anatomy, and with the aim of ensuring the best results and patient safety during complex procedures, a software program was developed that was capable of fusing and 3D-echocardiography into a single image. The Echonavigator® technology combines two dynamic imaging techniques of a heart in movement. The appropriate co-recording and visualising of fluoroscopy and 2D/3D transoesophageal echocardiography is essential for obtaining optimal results. The fusion of two images in real-time is a feasible and safe tool in structural heart interventionist procedures. Initial studies have managed to decrease the time of performing the procedures, as well as the dose of radiation to the patient. The future is promising, and its gradual expansion of use, taking into account its recent appearance, will provide more data on the growth of this technology.

Clinical and molecular aspects of familial hypercholesterolemia in Ibero-American countries.

BACKGROUND: There is little information about familial hypercholesterolemia (FH) epidemiology and care in Ibero-American countries. The Ibero-American FH network aims at reducing the gap on diagnosis and treatment of this disease in the region. OBJECTIVE: To describe clinical, molecular, and organizational characteristics of FH diagnosis in Argentina, Brazil, Chile, Colombia, Mexico, Portugal, Spain, and Uruguay. METHODS: Descriptive analysis of country data related to FH cascade screening, molecular diagnosis, clinical practice guidelines, and patient organization presence in Ibero-America. RESULTS: From a conservative estimation of an FH prevalence of 1 of 500 individuals, there should be 1.2 million heterozygous FH individuals in Ibero-America and roughly 27,400 were diagnosed so far. Only Spain, Brazil, Portugal, and Uruguay have active cascade screening programs. The prevalence of cardiovascular disease ranged from 10% to 42% in member countries, and the highest molecular identification rates are seen in Spain, 8.3%, followed by Portugal, 3.8%, and Uruguay with 2.5%. In the 3 countries with more FH patients identified (Spain, Portugal, and Brazil) between 10 and 15 mutations are responsible for 30% to 47% of all FH cases. Spain and Portugal share 5 of the 10 most common mutations (4 in low density lipoprotein receptor [LDLR] and the APOB3527). Spain and Spanish-speaking Latin American countries share 6 of the most common LDLR mutations and the APOB3527. LDL apheresis is available only in Spain and Portugal and not all countries have specific FH diagnostic and treatment guidelines as well as patient organizations. CONCLUSIONS: Ibero-American countries share similar mutations and gaps in FH care.