Central American and Caribbean Consensus Document for the Optimal Management of Oral Anticoagulation in Patients with Non-Valvular Atrial Fibrillation Endorsed by the Central American and Caribbean Society of Arterial Hypertension and Cardiovascular Prevention.

Atrial fibrillation (AF) is the most common arrhythmia in adults. Prevention of the ischaemic risk with oral anticoagulants (OACs) is widely recommended, and current clinical guidelines recommend direct oral anticoagulants (DOACs) as preference therapy for stroke prevention. However, there are currently no clinical practice guidelines or recommendation documents on the optimal management of OACs in patients with AF that specifically address and adapt to the Central American and Caribbean context. The aim of this Delphi-like study is to respond to doubts that may arise in the management of OACs in patients with non-valvular AF in this geographical area. A consensus project was performed on the basis of a systematic review of the literature, a recommended ADOLOPMENT-like approach, and the application of a two-round Delphi survey. In the first round, 31 recommendations were evaluated and 30 reached consensus, of which, 10 unanimously agreed. The study assessed expert opinions in a wide variety of contextualized recommendations for the optimal management of DOACs in patients with non-valvular atrial fibrillation (NVAF). There is a broad consensus on the clinical practice guideline (CPG) statements used related to anticoagulation indication, patient follow-up, anticoagulation therapy complications, COVID-19 management and prevention, and cardiac interventions.

Cardiovascular toxicity of checkpoint inhibitors: review of associated toxicity and design of the Spanish Immunotherapy Registry of Cardiovascular Toxicity.

Immune checkpoint inhibitors (ICI) have changed the prognosis of many tumors. However, concerning associated cardiotoxicity has been reported. Little is known about the real-life incidence-specific surveillance protocols or the translational correlation between the underlying mechanisms and the clinical presentation of ICI-induced cardiotoxicity. The lack of data from prospective studies led us to review the current knowledge and to present the creation of the Spanish Immunotherapy Registry of Cardiovascular Toxicity (SIR-CVT), a prospective registry of patients receiving ICI that aims to examine the role of hsa-miR-Chr8:96, (a specific serum biomarker of myocarditis) in the early diagnosis of ICI-induced myocarditis. An exhaustive prospective cardiac imaging study will be performed before and during the first 12 months of treatment. The correlation between clinical, imaging, and immunologic parameters may improve our understanding of ICI-induced cardiotoxicity and enable simpler surveillance protocols. We assess ICI-induced cardiovascular toxicity and describe the rationale of the SIR-CVT.

Clinical applicability of B-type natriuretic peptide in patients with suspected heart failure in primary care in Spain: the PANAMA study.

AIM: To assess the predictive value of B-type natriuretic peptide (BNP) in the diagnosis of heart failure (HF) in a primary-care setting in Spain. METHODS: PANAMA was a multicenter and cross-sectional study. Patients ≥18 years of age with a clinical diagnosis of HF (Framingham criteria) were consecutively included in the study by primary-care investigators. BNP determination and an echocardiogram were performed in every patient. The cut-off point of BNP for the criterion of exclusion of HF was considered as <100 pg/ml, as suggested by European guidelines. Sensitivity, specificity, positive-predictive value and negative-predictive value were calculated. RESULTS: A total of 72 patients (mean age: 75.1 ± 8.7 years; 74.6% women) were included. The most frequent associated risk factors were hypertension (75.6%) and dyslipidemia (54.3%). The most common major and minor criteria of HF according to Framingham criteria were radiographic cardiomegaly (90.2%) and dyspnea on ordinary exertion (100%), respectively. BNP median was 49 pg/ml (33.3 pg/ml in those with a doubtful diagnosis of HF and 83.3 pg/ml in those with a likely diagnosis of HF). Approximately 60% of patients exhibited diastolic dysfunction. Concerning accuracy parameters comparing BNP >100 pg/ml with echocardiogram, sensitivity was 25%, the specificity 80.8%, and the positive- and negative-predictive values were 68.8 and 38.9%, respectively. CONCLUSION: In patients attended by general practitioners, BNP >100 pg/ml may be a useful diagnostic tool with a high specificity for the diagnosis of HF.