Efficacy of radiation attenuating caps in reducing radiation doses received at the cerebral level in interventional physicians: a systematic review.

Background.Anecdotal reports are appearing in the scientific literature about cases of brain tumors in interventional physicians who are exposed to ionizing radiation. In response to this alarm, several designs of leaded caps have been made commercially available. However, the results reported on their efficacy are discordant.Objective.To synthesize, by means of a systematic review of the literature, the capacity of decreasing radiation levels conferred by radiation attenuating devices (RADs) at the cerebral level of interventional physicians.Methodology.A systematic review was performed including the following databases: MEDLINE, SCOPUS, EBSCO, Science Direct, Cochrane Controlled Trials Register (CENTRAL), WOS, WHO International Clinical Trials Register, Scielo and Google Scholar, considering original studies that evaluated the efficacy of RAD in experimental or clinical contexts from January 1990 to May 2023. Data selection and extraction were performed in triplicate, with a fourth author resolving discrepancies.Results.Twenty articles were included in the review from a total of 373 studies initially selected from the databases. From these, twelve studies were performed under clinical conditions encompassing 3801 fluoroscopically guided procedures, ten studies were performed under experimental conditions with phantoms, with a total of 88 procedures, four studies were performed using numerical calculations with a total of 63 procedures. The attenuation and effectiveness of provided by the caps analyzed in the present review varying from 12.3% to 99.9%, and 4.9% to 91% respectively.Conclusion.RAD were found to potentially provide radiation protection, but a high heterogeneity in the shielding afforded was found. This indicates the need for local assessment of cap efficiency according to the practice.

Case Report: Sustained ventricular arrhythmia in a child supported by a Berlin heart EXCOR ventricular assist device.

Mechanical circulatory support is an established therapy to support failing hearts as a bridge to transplantation. Although tolerated overall, arrhythmias may occur after ventricular assist device implantation and can complicate patient management. We report on an infant with dilated cardiomyopathy who developed ventricular tachycardia followed by recalcitrant ventricular fibrillation, refractory to comprehensive medical therapy post Berlin Heart EXCOR® (BHE) implant.

Etiología y evolución de la anemia en pacientes sometidos a cirugía cardiovascular / Etiology and evolution of anemia in patients submitted to cardiovascular surgery

Resumen Objetivo: El objetivo del presente estudio es evaluar en nuestro medio la prevalencia de anemia en el preoperatorio de la cirugía cardiovascular, su incidencia postoperatoria y su evolución durante el primer mes. Métodos: Se realizó un estudio de cohorte prospectivo en el que se incluyeron todos los pacientes sometidos a cirugía cardiovascular central intervenidos durante el periodo del 01/09/2021 al 01/09/2022 en un hospital universitario. Se realizó seguimiento clínico y de laboratorio previo a la cirugía, al quinto y al día treinta del postoperatorio. Se comparó a los grupos con y sin anemia preoperatoria. Resultados: La prevalencia de anemia en el preoperatorio fue del 32.1%. La incidencia de anemia en el postoperatorio fue del 96% en el grupo de pacientes sin anemia previa. Al mes de la cirugía un 73 y un 90% de los pacientes, con y sin anemia preoperatoria respectivamente, persistían anémicos. Los pacientes con anemia preoperatoria tuvieron una menor recuperación de sus valores de hemoglobina al mes. Se observó una tendencia a mayor mortalidad y una mayor necesidad de derivación a centros de rehabilitación postegreso hospitalario en aquellos con anemia preoperatoria. Conclusiones: En este trabajo se evidenció una alta prevalencia e incidencia de anemia en el perioperatorio de las cirugías cardiovasculares. Así como su subtratamiento y elevada persistencia durante el mes posterior a la cirugía.

Abstract Objective: The aim of this study is to evaluate the prevalence of anemia in the preoperative period of cardiovascular surgery, its postoperative incidence and its evolution during the first month in our setting. Methods: A prospective cohort study was carried out in which all patients undergoing central cardiovascular surgery operated during the period 09/01/2021-09/01/2022 in a university hospital were included. Clinical and laboratory follow-up was carried out prior to surgery, on the fifth and on the 30th postoperative day. Groups with and without preoperative anemia were compared. Results: The prevalence of anemia in the preoperative period was 32.1%. The incidence of anemia in the postoperative period was 96% in the group of patients without previous anemia. One month after surgery, 73 and 90% of the patients, with and without preoperative anemia, respectively, remained anemic. Patients with preoperative anemia had less recovery of their hemoglobin values at one month. A trend towards higher mortality and a greater need for referral to post-hospital discharge rehabilitation centers was observed in those with preoperative anemia. Conclusions: In this work, a high prevalence and incidence of anemia in the perioperative period of cardiovascular surgeries was evidenced. As well as its subtreatment and high persistence during the month after surgery.

Medical staff dose estimation during pediatric cardiac interventional procedures.

The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.

[Characteristics of cardiologist training in Latin America: a survey of the Interamerican Society of Cardiology]. / Características de la formación de los cardiólogos en América Latina: una encuesta de la Sociedad Interamericana de Cardiología.

Objectives: Describe the characteristics of the different cardiology medical residencies in Latin America. Method: Cross-sectional study that aims to evaluate the characteristics of cardiology residencies in Spanish-speaking countries of Latin America, through self-administered electronic surveys. Results: Three hundred seven residents of 147 residences were surveyed. Mean age was 31 years and 63% were male. Ninety eight percent carry out their training in the capital city. The average total training time is 4.8 years. Forty four percent complete their residency in internal medicine prior to starting cardiology, and 10% have no prior training. In cardiology training is 3 years in most countries. Fifty four percent present academic activities every day and 16% only once or less, consisting of theoretical classes (93%), clinical cases (85%), bibliographic workshops (69%), and writing scientific papers (68%). Supervision is carried out by the chief resident (45%), resident coordinator (44%), resident instructor (27%) or the department head (54%), while 2.6% do not present supervision. The main rotations were echocardiography (99%), hemodynamics (96%), coronary unit (93%), and electrophysiology (92%). Residents highlighted the need to improve academic activities (23%) and scientific production (12%). Conclusions: There are important differences in the academic and practical training between the residences of the different countries of America.

Objetivos: Describir las características de las diferentes residencias médicas de cardiología de Latinoamérica. Método: Estudio de corte transversal que tiene como objetivo evaluar las características de las residencias de cardiología en países hispanohablantes de América Latina, mediante encuestas electrónicas autoadministradas. Resultados: Se encuestó a 307 residentes de 147 residencias. La mediana de edad fue 31 años y el 63% era de sexo masculino. El 98% realiza su formación en la ciudad capital. El tiempo de formación total promedio es de 4.8 años. El 44% realiza la residencia completa en medicina interna previo al inicio de cardiología, y el 10% no tiene formación previa. En cardiología la formación es de tres años en la mayoría de los países. El 54% presenta actividades académicas todos los días y el 16% solo una vez o menos, consistente en clases teóricas (93%), casos clínicos (85%), ateneos bibliográficos (69%) y redacción de trabajos científicos (68%). La supervisión es realizada por el jefe de residentes (45%), coordinador de residentes (44%), instructor de residentes (27%) o el jefe de servicio (54%), mientras que el 2.6% no presenta supervisión. Las rotaciones principales fueron ecocardiografía (99%), hemodinamia (96%), unidad coronaria (93%) y electrofisiología (92%). El 23% resaltó la necesidad de mejorar las actividades académicas y 12% la producción científica. Conclusiones: Existen importantes diferencias en la formación académica y práctica entre las residencias de los diferentes países de América.

Mortality, Hospitalization, and Cardiac Interventions in Patients With Atrial Fibrillation Aged <65 Years.

BACKGROUND: The risk factor (RF) burden, clinical course, and long-term outcome among patients with atrial fibrillation (AF) aged <65 years is unclear. METHODS: Adult (n=67 221; mean age, 72.4±12.3 years; and 45% women) patients with AF evaluated at the University of Pittsburgh Medical Center between January 2010 and December 2019 were studied. Hospital system-wide electronic health records and administrative data were utilized to ascertain RFs, comorbidities, and subsequent hospitalization and cardiac interventions. The association of AF with all-cause mortality among those aged <65 years was analyzed using an internal contemporary cohort of patients without AF (n=918 073). RESULTS: Nearly one-quarter (n=17 335) of the cohort was aged <65 years (32% women) with considerable cardiovascular RFs (current smoker, 16%; mean body mass index, 33.0±8.3; hypertension, 55%; diabetes, 21%; heart failure, 20%; coronary artery disease, 19%; and prior ischemic stroke, 6%) and comorbidity burden (chronic obstructive pulmonary disease, 11%; obstructive sleep apnea, 18%; and chronic kidney disease, 1.3%). Over mean follow-up of >5 years, 2084 (6.7%, <50 years; 13%, 50-65 years) patients died. The proportion of patients with >1 hospitalization for myocardial infarction, heart failure, and stroke was 1.3%, 4.8%, and 1.1% for those aged <50 years and 2.2%, 7.4%, and 1.1% for the 50- to 65-year subgroup, respectively. Multiple cardiac and noncardiac RFs were associated with increased mortality in younger patients with AF with heart failure and hypertension demonstrating significant age-related interaction (P=0.007 and P=0.013, respectively). Patients with AF aged <65 years experienced significantly worse survival compared with comorbidity-adjusted patients without AF (men aged <50 years and hazard ratio, 1.5 [95% CI, 1.24-1.79]; 50-65 years and hazard ratio, 1.3 [95% CI, 1.26-1.43]; women aged <50 years and hazard ratio, 2.4 [95% CI, 1.82-3.16]; 50-65 years and hazard ratio, 1.7 [95% CI, 1.6-1.92]). CONCLUSIONS: Patients with AF aged <65 years have significant comorbidity burden and considerable long-term mortality. They are also at a significantly increased risk of hospitalization for heart failure, stroke, and myocardial infarction. These patients warrant an aggressive focus on RF and comorbidity evaluation and management.

Effects of telerehabilitation on cardiac remodeling and hemodynamics parameters in hypertensive older adults: A randomized controlled trial.

OBJECTIVE: This study aimed to assess the effects of telerehabilitation with multimodal exercise on cardiac remodeling and blood pressure in hypertensive older adults. METHODS: Thirty-two hypertensive older adults (66.7 ± 5.33 years; 29.5 ± 4.22 Kg/m2; 24 female) were randomized into either a telerehabilitation or a control group. Echocardiographic parameters and blood pressure were assessed before and after the 16-week intervention. The exercise program was supervised, individualized, and offered 3×/week via videoconference. RESULTS: Blood pressure significantly decreased after telerehabilitation when compared to the control group, presenting a large effect size. The moderate effect size in relative and posterior wall thickness (g = 0.63; g = 0.61), shortening fraction (g = 0.54), and ejection fraction (g = 0.68). CONCLUSION: As a preliminary study, telerehabilitation is favorable to promote a moderate clinical improvement of some cardiac morphofunctional parameters and reduce blood pressure in hypertensive older adults.

Academic and professional profile of cardiology fellowship graduates of National Institute of Cardiology Ignacio Chávez from 2000 to 2015.

BACKGROUND: The Ignacio Chávez National Institute of Cardiology (NIC) has positioned itself as an international benchmark in cardiovascular medical education, standing out for its high academic standards and human quality. OBJECTIVE: This study aims to identify the employment and academic profile of cardiology fellowship graduates from the National Institute of Cardiology of Mexico (NIC). METHODS: A cross-sectional and retrospective study was conducted, involving 473 graduates from the period 2000-2015. Data was collected through an electronic survey. RESULTS: A total of 221 graduates agreed to participate, accounting for 46.7% of the total number of graduates. Among the participants, 85.2% were male. The majority of graduates (82.4%) held Mexican nationality, while the remaining individuals represented various Latin-American nationalities. Following the completion of the cardiology fellowship, 89% of graduates pursued further postgraduate degrees. Within this group, 95.4% completed at least one additional fellowship, while 4.6% pursued a master's or PhD program. The most popular fellowship program chosen was Interventional Cardiology. On average, NIC graduates dedicate 10.8 hours per day to their work, with 6.4 hours dedicated to cardiology and 4.3 hours to their other postgraduate degree. Those employed in both public and private health systems allocate 6.1 hours and 5.2 hours per day, respectively. Additionally, 75% of graduates are involved in teaching activities. Currently, 84% of graduates are employed in Mexico. CONCLUSION: The majority of NIC graduates are physicians who further their academic training by pursuing additional postgraduate programs. They work longer hours per day compared to the general Mexican population, with a significant focus on clinical cardiology. Graduates actively seek opportunities to share their expertise through various academic activities.

ANTECEDENTES: El Instituto Nacional de Cardiología Ignacio Chávez (INC) se ha posicionado como un referente internacional en la educación médica cardiológica, destacándose por su alto nivel académico y calidad humana. OBJETIVO: El objetivo de este estudio fue identificar el perfil laboral y académico actual de los egresados del Instituto Nacional de Cardiología Ignacio Chávez (INC). MÉTODOS: Se llevó a cabo un estudio transversal y retrospectivo que incluyó a 473 egresados del INC graduados entre 2000 y 2015. Se utilizó una encuesta electrónica para recopilar los datos. RESULTADOS: Un total de 221 egresados aceptaron participar en el estudio, lo que representa el 46.7% del total de egresados. El 85.2% de los participantes son hombres. La mayoría de los egresados son de nacionalidad mexicana (82.4%), mientras que el resto se distribuye en varios países de Latinoamérica. El 89% de los egresados completó otro posgrado después de cardiología. De este grupo, el 95.4% realizó al menos una alta especialidad, mientras que el 4.6% obtuvo una maestría o doctorado. La especialidad más comúnmente elegida fue Cardiología Intervencionista. Los egresados del INC trabajan en promedio 10.8 horas al día, de las cuales 6.4 horas se dedican a la cardiología clínica y 4.3 horas al otro posgrado. Aquellos que trabajan en el sector público y privado dedican 6.1 horas y 5.2 horas al día, respectivamente. Además, el 75% de los egresados desempeña actividades de enseñanza. El 84% de los egresados trabajan en México. CONCLUSIÓN: En su mayoría, los egresados del INC son médicos especialistas que continúan su formación académica a través de la realización de otros posgrados. Trabajan más horas al día en comparación con el resto de la población mexicana, y dedican la mayor parte de su tiempo al ejercicio de la cardiología clínica. También buscan transmitir sus conocimientos a través de actividades académicas y de enseñanza.

Perfil académico y profesional de los egresados de la especialidad de Cardiología de 2000 a 2015 en el Instituto Nacional de Cardiología Ignacio Chávez / Academic and professional profile of cardiology fellowship graduates of National Institute of Cardiology Ignacio Chávez from 2000 to 2015

Resumen Antecedentes: El Instituto Nacional de Cardiología Ignacio Chávez (INC) se ha posicionado como un referente internacional en la educación médica cardiológica, destacándose por su alto nivel académico y calidad humana. Objetivo: El objetivo de este estudio fue identificar el perfil laboral y académico actual de los egresados del Instituto Nacional de Cardiología Ignacio Chávez (INC). Métodos: Se llevó a cabo un estudio transversal y retrospectivo que incluyó a 473 egresados del INC graduados entre 2000 y 2015. Se utilizó una encuesta electrónica para recopilar los datos. Resultados: Un total de 221 egresados aceptaron participar en el estudio, lo que representa el 46.7% del total de egresados. El 85.2% de los participantes son hombres. La mayoría de los egresados son de nacionalidad mexicana (82.4%), mientras que el resto se distribuye en varios países de Latinoamérica. El 89% de los egresados completó otro posgrado después de cardiología. De este grupo, el 95.4% realizó al menos una alta especialidad, mientras que el 4.6% obtuvo una maestría o doctorado. La especialidad más comúnmente elegida fue Cardiología Intervencionista. Los egresados del INC trabajan en promedio 10.8 horas al día, de las cuales 6.4 horas se dedican a la cardiología clínica y 4.3 horas al otro posgrado. Aquellos que trabajan en el sector público y privado dedican 6.1 horas y 5.2 horas al día, respectivamente. Además, el 75% de los egresados desempeña actividades de enseñanza. El 84% de los egresados trabajan en México. Conclusión: En su mayoría, los egresados del INC son médicos especialistas que continúan su formación académica a través de la realización de otros posgrados. Trabajan más horas al día en comparación con el resto de la población mexicana, y dedican la mayor parte de su tiempo al ejercicio de la cardiología clínica. También buscan transmitir sus conocimientos a través de actividades académicas y de enseñanza.

Abstract Background: The Ignacio Chávez National Institute of Cardiology (NIC) has positioned itself as an international benchmark in cardiovascular medical education, standing out for its high academic standards and human quality. Objective: This study aims to identify the employment and academic profile of cardiology fellowship graduates from the National Institute of Cardiology of Mexico (NIC). Methods: A cross-sectional and retrospective study was conducted, involving 473 graduates from the period 2000-2015. Data was collected through an electronic survey. Results: A total of 221 graduates agreed to participate, accounting for 46.7% of the total number of graduates. Among the participants, 85.2% were male. The majority of graduates (82.4%) held Mexican nationality, while the remaining individuals represented various Latin-American nationalities. Following the completion of the cardiology fellowship, 89% of graduates pursued further postgraduate degrees. Within this group, 95.4% completed at least one additional fellowship, while 4.6% pursued a master's or PhD program. The most popular fellowship program chosen was Interventional Cardiology. On average, NIC graduates dedicate 10.8 hours per day to their work, with 6.4 hours dedicated to cardiology and 4.3 hours to their other postgraduate degree. Those employed in both public and private health systems allocate 6.1 hours and 5.2 hours per day, respectively. Additionally, 75% of graduates are involved in teaching activities. Currently, 84% of graduates are employed in Mexico. Conclusion: The majority of NIC graduates are physicians who further their academic training by pursuing additional postgraduate programs. They work longer hours per day compared to the general Mexican population, with a significant focus on clinical cardiology. Graduates actively seek opportunities to share their expertise through various academic activities.

[Etiology and evolution of anemia in patients submitted to cardiovascular surgery]. / Etiología y evolución de la anemia en pacientes sometidos a cirugía cardiovascular.

Introduction: Anemia is associated with increased mortality in patients undergoing major surgeries. Objective: The aim of this study is to evaluate the prevalence of anemia in the preoperative period of cardiovascular surgery, its postoperative incidence and its evolution during the first month in our setting. Methods: A prospective cohort study was carried out in which all patients undergoing central cardiovascular surgery operated during the period 09/01/2021-09/01/2022 in a university hospital were included. Clinical and laboratory follow-up was carried out prior to surgery, on the fifth and on the 30th postoperative day. Groups with and without preoperative anemia were compared. Results: The prevalence of anemia in the preoperative period was 32.1%. The incidence of anemia in the postoperative period was 96% in the group of patients without previous anemia. One month after surgery, 73 and 90% of the patients, with and without preoperative anemia, respectively, remained anemic. Patients with preoperative anemia had less recovery of their hemoglobin values at one month. A trend towards higher mortality and a greater need for referral to post-hospital discharge rehabilitation centers was observed in those with preoperative anemia. Conclusions: In this work, a high prevalence and incidence of anemia in the perioperative period of cardiovascular surgeries was evidenced. As well as its subtreatment and high persistence during the month after surgery.

Introducción: La anemia se asocia a un aumento de la mortalidad en pacientes sometidos a cirugías mayores. Objetivo: El objetivo del presente estudio es evaluar en nuestro medio la prevalencia de anemia en el preoperatorio de la cirugía cardiovascular, su incidencia postoperatoria y su evolución durante el primer mes. Métodos: Se realizó un estudio de cohorte prospectivo en el que se incluyeron todos los pacientes sometidos a cirugía cardiovascular central intervenidos durante el periodo del 01/09/2021 al 01/09/2022 en un hospital universitario. Se realizó seguimiento clínico y de laboratorio previo a la cirugía, al quinto y al día treinta del postoperatorio. Se comparó a los grupos con y sin anemia preoperatoria. Resultados: La prevalencia de anemia en el preoperatorio fue del 32.1%. La incidencia de anemia en el postoperatorio fue del 96% en el grupo de pacientes sin anemia previa. Al mes de la cirugía un 73 y un 90% de los pacientes, con y sin anemia preoperatoria respectivamente, persistían anémicos. Los pacientes con anemia preoperatoria tuvieron una menor recuperación de sus valores de hemoglobina al mes. Se observó una tendencia a mayor mortalidad y una mayor necesidad de derivación a centros de rehabilitación postegreso hospitalario en aquellos con anemia preoperatoria. Conclusiones: En este trabajo se evidenció una alta prevalencia e incidencia de anemia en el perioperatorio de las cirugías cardiovasculares. Así como su subtratamiento y elevada persistencia durante el mes posterior a la cirugía.

An Approach to Establishing Diagnostic Reference Levels in Interventional Pediatric Cardiology from Different Regions of Brazil.

Diagnostic reference levels (DRLs) are a pivotal strategy to be implemented since pediatric interventional cardiology procedures are increasing. This work aimed to propose an initial set of Brazilian DRLs for pediatric interventional diagnostic and therapeutic (D&T) procedures. A retrospective study was carried out in four Brazilian states, distributed across the three regions of the country. Data were collected from pediatric patients undergoing cardiac interventional procedures (CIPs), including their age and anthropometric characteristics, and at least four parameters (number of images, exposure time, air kerma-area product-PKA, and cumulative air kerma). Data from 279 patients undergoing CIPs were gathered (147 diagnostic and 132 therapeutic procedures). There were no significant differences in exposure time and the number of images between the D&T procedures. A wide range of PKA was observed when the therapeutic procedures were compared to diagnostics for all age groups. There were significant differences between the D&T procedures, whether grouping data by patient weight or age. In terms of cumulative air kerma, it was noted that no value exceeded the level to trigger a monitoring process for patients. This study shows that it is possible to adopt them as the first proposal to establish national DRLs considering pediatric patient groups.

Factors Associated with Growth in a Cohort of Children with Complex Biventricular Congenital Heart Disease.

OBJECTIVES: To evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, as well as to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics. STUDY DESIGN: A single-institution retrospective cohort study was performed in children born February 1999 to March 2009 with complex congenital heart disease who underwent biventricular repair before age 4 years, defined by Risk Adjustment in Congenital Heart Surgery-1 category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 years were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations. RESULTS: Compared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI before adolescence (-0.539; 95% CI -1.02, -0.054; P = .029). In addition, other clinical and perioperative characteristics had significant associations with growth, including low birth weight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder. CONCLUSIONS: Early childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.

Right Atrial Enlargement on Electrocardiogram in Previously Healthy Young Patients.

OBJECTIVES: To assess whether right atrial enlargement (RAE) on electrocardiogram (ECG) correlates with true RAE on echocardiogram in previously healthy young patients and to understand which patients with RAE on ECG may warrant additional testing. STUDY DESIGN: A single-center, retrospective review of previously healthy young patients with (1) ECGs that were read as RAE by a pediatric cardiologist and (2) echocardiograms obtained within 90 days of the ECG. ECGs were reviewed to confirm RAE and determine which leads met criteria. The echocardiograms were then reviewed and RA measurements with z scores obtained. A z score >2 was considered positive for RAE on echocardiogram. RESULTS: In total, 162 patients with median age 10.8 years were included in the study. A total of 23 patients had true RAE on echocardiogram, giving a positive predictive value (PPV) of 14%. In patients <1 year of age, the PPV increased to 35%. In patients older than 1 year, the PPV was low at 7%. Patients with true RAE were more likely to meet criteria for RAE in the anterior precordial leads (V1-V3) (48% vs 5%, P < .001) and meet criteria for right ventricular hypertrophy (22% vs 6%, P = .023). CONCLUSION: Our findings show that RAE on ECG has a low PPV for RAE on echocardiogram in previously healthy young patients. The highest yield for RAE on echocardiogram was observed in patients who were <1 year of age, had RAE in the anterior precordial leads, or displayed right ventricular hypertrophy on ECG.

Factors associated with medication non-adherence among patients with heart failure / Fatores associados à não adesão ao tratamento farmacológico de pacientes com insuficiência cardíaca / Factores asociados a la no adhesión al tratamiento farmacológico de pacientes con insuficiencia cardíaca

Abstract Objective: to identify the factors contributing to medication non-adherence among patients with heart failure. Method: cross-sectional and analytical study using the Medida de Adesão ao Tratamento [Treatment Adherence Measure] scale to assess medication non-adherence. Independent variables were collected using the European Heart Failure Self-care Behavior Scale and an instrument developed by the authors based on a previous study. Statistical tests were implemented to analyze data with p≤0.05 statistical significance. Results: the sample comprised 340 patients, with 9.4% considered non-adherent. The multiple analysis results showed that one unit increase in an individual's self-care score led to an 8% increase in the prevalence of non-adherence; patients with a family income above three times the minimum wage presented a prevalence of non-adherence equal to 3.5% of the prevalence of those with up to one times the minimum wage; individuals consuming alcohol or with depression presented 3.49 and 3.69 times higher prevalence of non-adherence, respectively, than individuals not presenting such history. Conclusion: medication non-adherence was associated with self-care, family income, depression, and alcohol consumption.

Resumo Objetivo: identificar os fatores que contribuem para a não adesão ao tratamento farmacológico de pacientes com insuficiência cardíaca. Método: estudo transversal e analítico que utilizou a escala de Medida de Adesão ao Tratamento para avaliar a não adesão ao tratamento farmacológico. Variáveis independentes foram coletadas utilizando-se a European Heart Failure Self-care Behavior Scale e um instrumento elaborado pelos autores, baseado em estudo anterior. Foram utilizados testes estatísticos para análise dos dados, sendo considerados significativos os valores de p≤0,05. Resultados: a amostra foi composta por 340 pacientes. Desses, 9,4% foram classificados como não aderentes. Os resultados da análise múltipla mostraram que o aumento de uma unidade no escore de autocuidado leva a um aumento de 8% na prevalência de não adesão do indivíduo; pacientes com renda familiar superior a três salários mínimos têm prevalência de não adesão ao tratamento igual a 3,5% da prevalência entre aqueles com até um salário mínimo; indivíduos que ingerem bebida alcoólica e sofrem de depressão têm prevalências de não adesão 3,49 e 3,69 vezes maiores, respectivamente, do que aqueles que não têm tais antecedentes. Conclusão: a não adesão ao tratamento farmacológico relacionou-se com comportamento de autocuidado, renda familiar, depressão e ingestão de bebida alcoólica.

Resumen Objetivo: identificar los factores que contribuyen para la no adhesión al tratamiento farmacológico de pacientes con insuficiencia cardíaca. Método: estudio transversal y analítico que utilizó la escala de Medida de Adhesión al Tratamiento para evaluar la no adhesión al tratamiento farmacológico. Las variables independientes fueron recolectadas utilizando la European Heart Failure Self-care Behavior Scale y un instrumento elaborado por los autores, basado en estudio anterior. Fueron utilizadas pruebas estadísticas para el análisis de los datos, siendo considerados significativos los valores de p≤0,05. Resultados: la muestra estuvo compuesta por 340 pacientes; de esos, 9,4% fueron clasificados como no adherentes. Los resultados del análisis múltiple mostraron que el aumento de una unidad en el puntaje de autocuidado lleva a un aumento de 8% en la prevalencia de la no adhesión del individuo; pacientes con renta familiar superior a tres salarios mínimos tienen prevalencia de no adhesión al tratamiento igual a 3,5% de aquellos que reciben hasta un salario mínimo; individuos que ingieren bebida alcohólica y sufren de depresión, tienen prevalencias de no adhesión de 3,49 y 3,69 veces mayores, respectivamente, que aquellos que no tienen esos antecedentes. Conclusión: la no adhesión al tratamiento farmacológico se relacionó con comportamientos de autocuidado, renta familiar, depresión e ingestión de bebida alcohólica.

Computer-Interpreted Electrocardiograms: Impact on Cardiology Practice

Abstract In the realm of modern cardiology, the integration of computer-interpreted electrocardiograms (CI-ECGs) has marked the beginning of a new era of diagnostic precision and efficiency. Contemporary electrocardiogram (ECG) integration systems, applying algorithms and artificial intelligence, have modernized the interpretation of heart rhythms and cardiac morphology. Due to their ability to rapidly analyze and interpret ECG recordings CI-ECGs have already profoundly impacted clinical practice. This review explores the evolution of computer interpreted ECG technology, evaluates the pros and cons of current automatic reporting systems, analyzes the growing role of artificial intelligence on ECG interpretation technologies, and discusses emerging applications that may have transformative effects on patient outcomes. Emphasis is placed on the role of ECGs in the automatic diagnosis of occlusion myocardial infarctions (OMI). AI models enhance accuracy and efficiency in ECG interpretation, offering insights into cardiac function and aiding timely detection of concerning patterns for accurate clinical diagnoses. The shift to AI-driven diagnostics has emphasized the importance of data in the realm of cardiology by improving patient care. The integration of novel AI models in ECG analysis has created a promising future for ECG diagnostics through a synergistic fusion of feature-based machine learning models, deep learning approaches, and clinical acumen. Overall, CI-ECGs have transformed cardiology practice, offering rapid, accurate, and standardized analyses. These systems reduce interpretation time significantly, allowing for quick identification of abnormalities. However, sole reliance on automated interpretations may overlook nuanced findings, risking diagnostic errors. Therefore, a balanced approach in integrating automated analysis with clinical judgment is necessary.

Analysis of the patient care flow in hemodynamics supported by lean thinking / Análisis del flujo de la atención provista a pacientes de un servicio de hemodinámica sustentado en la filosofía lean / Análise do fluxo do atendimento de pacientes em hemodinâmica sustentado no pensamento lean

ABSTRACT Objective: to analyze the patient care flow in a Hemodynamics service grounded on Lean Thinking based on Value Stream Mapping. Method: an exploratory-descriptive case study carried out in the Hemodynamics service of a public university hospital from southern Brazil. Data collection was conducted through participant observation with twelve members of the multiprofessional team and interviews with five participants from May 2021 to February 2022. The analysis was based on the Lean framework and on the stages foreseen in Value Stream Mapping. Results: the Value Stream Map of the current situation of the service was prepared, identifying suppliers and customers of the process and their requirements. A total of 61 problems related to unmet requirements were listed, of which 12 were prioritized in order to promote improvement planning. Conclusion: with Value Stream Mapping it was possible to establish improvement priorities that exert impacts on operational performance of the service. It was identified that improvements related to standardization of the activities minimize waste from failures and waiting times, which were the most prevalent in the service, among others observed.

RESUMEN Objetivo: analizar el flujo de la atención provista a los pacientes en un servicio de Hemodinámica, sustentado en la filosofía Lean sobre la base del Mapa de Flujo de Valor. Método: estudio de casos, exploratorio y descriptivo, realizado en el servicio de Hemodinámica de un hospital público universitario del sur de Brasil. Los datos se recolectaron por medio de observación participante con doce integrantes del equipo multiprofesional y de entrevistas con cinco participantes entre mayo de 2021 y febrero de 2022. El análisis se sustentó en el referencial Lean y en las etapas previstas en el Mapa de Flujo de Valor. Resultados: se elaboró el Mapa de Flujo de Valor correspondiente a la situación actual del servicio, con la debida identificación de proveedores y clientes del proceso y sus requisitos. Se elaboró una lista con 61 problemas relacionados a requisitos no cumplidos, 12 de los cuales 12 fueron priorizados con el fin de promover la planificación de mejoras. Conclusión: con el Mapa de Flujo de Valor fue posible establecer prioridades de mejora que ejercieron un impacto sobre el desempeño operativo del servicio. Se identificó que las mejoras relacionadas con la estandarización de las actividades minimizan los desperdicios por fallas y esperas, que fueron los más prevalentes en el servicio, entre otros observados.

RESUMO Objetivo: analisar o fluxo do atendimento de pacientes em um serviço de hemodinâmica sustentado no pensamento Lean com base no Mapa de Fluxo de Valor. Método: estudo de caso, exploratório-descritivo, realizado no serviço de hemodinâmica de um hospital público universitário do sul do Brasil. A coleta de dados ocorreu por meio de observação participante com doze integrantes da equipe multiprofissional e entrevistas com cinco participantes no período de maio de 2021 a fevereiro de 2022. A análise sustentou-se no referencial Lean e nas etapas previstas no Mapa de Fluxo de Valor. Resultados: elaborou-se o Mapa de Fluxo de Valor da situação atual do serviço, identificando-se fornecedores e clientes do processo e seus requisitos. Elencaram-se 61 problemas relacionados a requisitos não atendidos, dos quais 12 foram priorizados, a fim de promover o planejamento de melhorias. Conclusão: com o Mapa de Fluxo de Valor foi possível estabelecer prioridades de melhoria que impactam no desempenho operacional do serviço. Identificou-se que melhorias relacionadas à padronização das atividades minimizam os desperdícios de falha e espera, que foram os mais prevalentes no serviço, entre outros observados.

Forty years of a Postgraduate Program in Cardiology at a Brazilian public university: indicators of its graduates

ABSTRACT Purpose: To evaluate the profile of graduates of the Postgraduate Program (PGP) in Cardiology of a public federal university, according to sociodemographic factors and professional trajectory. Methods: The variables were collected from databases from the observed institution and digital platforms. The analysis of differences between the various levels of degrees was carried out in three cohorts: the entire historical series (graduates from 1978-2021), the first 20 years (1978-1997) and the second 20 years (1998-2018). Results: The results demonstrated that most students from the PGP completed a PhD and are men over 30 years old, they came from public universities and the Southeast region. In the first 20 years, significant differences were observed in the distribution of masters and doctors working professionally at the institution analyzed, as well as in the age of the students. In the 20 years of the second half, there were differences between masters and PhD working professionally in the institution itself, as they came from private universities, they are women and PhD. Conclusions: The changes in the profile of masters and PhD that graduated from this PGP in cardiology reflect transformations that occurred in the job market and academy over the decades.

Contribution of informal caregivers to self-care in individuals with heart failure / Contribución de cuidadores informales para el autocuidado de personas con insuficiencia cardíaca / Contribuição de cuidadores informais para o autocuidado de pessoas com insuficiência cardíaca

ABSTRACT Objectives: to evaluate the contribution of informal caregivers to the self-care of individuals with heart failure. Methods: a cross-sectional study was conducted with 87 caregivers from March to October 2022 in the city of João Pessoa/PB. The caregivers' contribution was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index instrument. Scores ≥ 70 points indicate adequate contribution. Data were analyzed using descriptive statistics and Spearman's correlation. Results: the sample consisted of 81.6% female caregivers. Median scores obtained for the self-care contribution scales were: 63.3 for maintenance; 55.5 for management; and 66.6 for confidence. Caregivers never or rarely recommended monitoring body weight, regular physical exercise, extra use of diuretics, and fluid restriction. Conclusions: informal caregivers showed inadequate contribution in the areas of maintenance, management, and confidence in self-care of individuals with heart failure.

RESUMEN Objetivos: evaluar la contribución de cuidadores informales para el autocuidado de personas con insuficiencia cardíaca. Métodos: estudio transversal, realizado con 87 cuidadores, de marzo a octubre de 2022, en la ciudad João Pessoa/PB. La contribución del cuidador fue evaluada mediante el instrumento Caregiver Contribution to Self-Care of Heart Failure Index. Escores ≥ 70 puntos indican contribución adecuada. Los datos fueron analizados mediante estadística descriptiva y correlación de Spearman. Resultados: son del sexo femenino 81,6% de la muestra. La mediana de los escores obtenidos para las escalas de contribución para el autocuidado fueron: 63,3 para manutención; 55,5 para manejo; y 66,6 para confianza. Los cuidadores nunca o raramente recomendaban el monitoreo del peso corporal, la práctica regular de ejercicios físicos, el uso extra de diuréticos y la restricción de líquidos. Conclusiones: los cuidadores informales presentaron contribución inadecuada en los quesitos manutención, manejo y confianza del autocuidado de personas con insuficiencia cardíaca.

RESUMO Objetivos: avaliar a contribuição de cuidadores informais para o autocuidado de pessoas com insuficiência cardíaca. Métodos: estudo transversal, realizado com 87 cuidadores, de março a outubro de 2022, na cidade João Pessoa/PB. A contribuição do cuidador foi avaliada por meio do instrumento Caregiver Contribution to Self-Care of Heart Failure Index. Escores ≥ 70 pontos indicam contribuição adequada. Os dados foram analisados por meio de estatística descritiva e correlação de Spearman. Resultados: eram do sexo feminino 81,6% da amostra. A mediana dos escores obtidos para as escalas de contribuição para o autocuidado foram: 63,3 para manutenção; 55,5 para manejo; e 66,6 para confiança. Os cuidadores nunca ou raramente recomendavam o monitoramento do peso corporal, a prática regular de exercícios físicos, o uso extra de diuréticos e a restrição de líquidos. Conclusões: os cuidadores informais apresentaram contribuição inadequada nos quesitos manutenção, manejo e confiança do autocuidado de pessoas com insuficiência cardíaca.

[Self-perception of smoking cessation skills among Cardiology residents in Argentina]. / Autopercepción de las habilidades para la cesación del tabaquismo entre los residentes de cardiología en Argentina.

Objective: To evaluate the self-perception of cardiology residents in Argentina regarding their abilities to help their patients stop smoking, as well as their opinions about their knowledge and skills in this area. Materials and methods: A cross-sectional study was carried out using secondary data from a study carried out in five Latin American countries and Spain, focusing on the information provided by cardiology residents in Argentina. Discrete variables were expressed as median and interquartile range, and categorical variables were expressed as percentages, and were analyzed using the chi-square test or Fisher's exact test, depending on the relative frequency of the expected values. Results: 447 residents participated; 87.5% routinely provided brief advice to quit smoking, and 11.6% used validated questionnaires to assess the degree of addiction. Furthermore, 32.1% stated that they prescribed pharmacological treatment, but 53.1% were only familiar with a single drug. When asked about their self-perception of getting their patients to stop smoking, the median response was 5 (scale from 1 to 10); only 13.7% responded with a score of 8 or more. Conclusions: The present study suggests that cardiology residents in Argentina recognize the importance of carrying out smoking cessation interventions, but a high proportion of them do not feel qualified to do so.