Effects of Trimetazidine on Right Ventricular Function and Ventricular Remodeling in Patients with Pulmonary Artery Hypertension: A Randomised Controlled Trial.

BACKGROUND: Pulmonary artery hypertension (PAH) is a chronic and progressive disease. Although current therapy has improved the disease prognosis, PAH has a poor survival rate. The key feature leading to disease progression and death is right ventricular (RV) failure. METHODS AND RESULTS: We assessed the role of trimetazidine, a fatty acid beta-oxidation (FAO) inhibitor, in right ventricular function, remodeling, and functional class in PAH patients, with a placebo-controlled double-blind, case-crossover trial. Twenty-seven PAH subjects were enrolled, randomized, and assigned to trimetazidine or placebo for three months and then reallocated to the other study arm. The primary endpoint was RV morphology and function change after three months of treatment. Secondary endpoints were the change in exercise capacity assessed by a 6 min walk test after three months of treatment and the change in pro-BNP and Galectin-3 plasma levels after three months. Trimetazidine use was safe and well-tolerated. After three months of treatment, patients in the trimetazidine group showed a small but significant reduction of RV diastolic area, and a substantial increase in the 6 min walk distance (418 vs. 438 mt, p = 0.023), without significant changes in biomarkers. CONCLUSIONS: A short course of trimetazidine is safe and well-tolerated on PAH patients, and it is associated with significant increases in the 6MWT and minor but significant improvement in RV remodeling. The therapeutic potential of this drug should be evaluated in larger clinical trials.

Venoarterial Extracorporeal Membrane Oxygenation as A Bridge to Surgery in Post-Myocardial Infarction Ventricular Septal Defect with Cardiogenic Shock: Case Report

ABSTRACT We describe a 60-year-old woman with post-myocardial infarction (MI) ventricular septal defect (VSD) and cardiogenic shock who was successfully stabilized with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge therapy for the surgical closure of her VSD. This case highlights the role of VA-ECMO in the management of post-MI VSD to improve the results of surgical repair and patient survival.

Venoarterial Extracorporeal Membrane Oxygenation as A Bridge to Surgery in Post-Myocardial Infarction Ventricular Septal Defect with Cardiogenic Shock: Case Report.

We describe a 60-year-old woman with post-myocardial infarction (MI) ventricular septal defect (VSD) and cardiogenic shock who was successfully stabilized with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge therapy for the surgical closure of her VSD. This case highlights the role of VA-ECMO in the management of post-MI VSD to improve the results of surgical repair and patient survival.

COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease.

Background: Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications. Objectives: The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients. Methods: COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression. Results: Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; P < 0.0001) and were in more advanced physiological stage (P = 0.032) and NYHA functional class (P = 0.01), had lower baseline oxygen saturation (P = 0.0001), and more frequently had a history of atrial arrhythmia (P < 0.0001), previous hospitalization for heart failure (P < 0.0007), and were more likely hospitalized for COVID-19 (P < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; P = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; P = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; P < 0.0001) were independently associated with increased risk of TE/bleeding complications. Conclusions: ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants.

Cuantificación de la extrasistolía supraventricular y ventricular en el holter de 24 horas: significación pronóstica en estudios actuales / Quantification and clinical significance of supraventricular and ventricular extrasystoles in holter recordings: a review

En la actualidad existen diferencias en la interpretación y cuantificación de los extrasístoles supraventriculares y ventriculares en el Holter de ritmo cardíaco y no existe siempre una misma definición e interpretación de lo que se denomina como "escaso", "ocasional", "frecuente" o "muy frecuente". El objetivo del presente trabajo ha sido revisar las evidencias actuales y sus fundamentos en relación a la cuantificación o carga de la extrasistolía supraventricular y ventricular en un Holter de ritmo cardíaco, lo que debiera contribuir a una mayor precisión y mejor interpretación de la información cuantitativa en la práctica clínica diaria con este examen. Se revisa en la literatura el concepto de carga de extrasístoles supraventriculares y ventriculares y su relación con eventos clínicos: fibrilación auricular y accidente cerebrovascular en el caso de la extrasistolía supraventricular y mortalidad post infarto y deterioro de la función ventricular en el caso de la extrasistolía ventricular. De esta manera se cuantifica en base a la evidencia la extrasistolía supraventricular y ventricular.

Considerable differences exist in the quantification and clinical significance of both supraventricular and ventricular extrasystoles found in Holter recordings. Usually extrasystoles were classified as rare, occasional, frequent and very frequent. Current publications were analyzed regarding the frequency and clinical significance or these arrhythmias, especially in in relation to prior myocardial infarction, ventricular dysfunction, atrial fibrillation and cerebro vascular events. Tables showing limits to define the severity of supraventricular and ventricular extrasystoles are included.

COVID-19 in Adults With Congenital Heart Disease.

BACKGROUND: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. OBJECTIVES: This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. METHODS: Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. RESULTS: From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. CONCLUSIONS: COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

Poverty, quality of life and psychological wellbeing in adults with congenital heart disease in Chile.

The objective of this study was to assess the quality of life and psychological wellbeing of adults with congenital heart disease (CHD) in Chile, and to identify other associated factors. The study enrolled 68 patients aged between 18 and 72 (median 29), 35 being females. They completed a questionnaire, which included a quality of life assessment tool (the Medical Outcome Study 36-Item Short Form Health Survey), a number of psychological scales (the General Health Questionnaire, the Basic Psychological Needs Scales and the Beck Hopelessness Scale), a socioeconomic survey, and some clinical data. CHD patients reported worse scores in those scales assessing physical dimensions of quality of life (physical function (70.5), physical role functioning (64), vitality (65.3)), and general quality of life (58.6), than in emotional or social dimensions. Female gender was associated with lower scores in physical function (59.12 versus 82.66; p<0.01) and physical role functioning (53.68 versus 75; p<0.05); poverty was associated with worse results in physical function (61.92 versus 82.96; p<0.01), role physical (53.21 versus 79.63; p<0.01), vitality (60.89 versus 71.67; p<0.05), social role functioning (70.19 versus 82.87; p<0.05) and bodily pain (65.77 versus 81.2; p<0.05). Furthermore, we found that psychological scales had an association with quality of life, but clinical variables did not show significant correlations to any dimension. Poverty has an impact on the quality of life of CHD patients. This population only has a decrease in the quality of life physical dimensions, suggesting that quality of life depends on many different factors.

Cardiorespiratory fitness improves prediction of mortality of standard cardiovascular risk scores in a Latino population.

BACKGROUND: Cardiorespiratory fitness (CRF) is a powerful predictor of mortality. This study evaluated the predictive value of CRF for mortality in Chilean subjects without atherosclerotic disease compared with the Framingham, European Systematic Coronary Risk Evaluation (SCORE), and 2013 ACC/AHA risk scores and determined the incremental predictive value of CRF when added to these scores. HYPOTHESIS: CRF improves prediction of all-cause and cardiovascular disease (CVD)-related mortality of the standard international risk scores. METHODS: Cross-sectional study, which evaluated 4064 subjects between 2002 and 2016. Cardiovascular (CV) risk factors, anthropometric and biochemical parameters, and blood pressure were measured. CRF was determined by metabolic equivalents during maximum stress test. The Framingham, SCORE, and ACC/AHA risk scores were calculated for all subjects. After a median follow-up of 9 years, all-cause and CVD-related mortality were assessed. Receiver operating curves were built to determine mortality prediction for CRF, the risk scores, and CRF added to the scores. RESULTS: As of August 2016, 99 deaths were reported, 33 of which were CVD-related. All risk scores and CRF predicted CVD-related mortality, with CRF identified as the best predictor: CRF: C = 0.88 (95% CI: 0.82-0.93) vs Framingham: C = 0.68 (95% CI: 0.60-0.76), SCORE: C = 0.76 (95% CI: 0.70-0.83), and ACC/AHA: C = 0.79 (95% CI: 0.73-0.85). Predictive power of the three scores improved when CRF was added to the model, but this was only significant for the Framingham score. CONCLUSIONS: CRF is a good predictor of both, all-cause and CV mortality and a better predictor of CVD-related deaths than standard risk scores in this population.

Urinary sodium-to-potassium ratio and body mass index in relation to high blood pressure in a national health survey in Chile.

Several lifestyle and sociodemographic factors are associated with blood pressure (BP). The authors conducted a retrospective study of 4870 subjects from the National Health Survey 2009 in Chile to identify exposure factors associated with increasing BP levels. Subjects with isolated urinary excretion of sodium (n = 2873), potassium, and creatinine were included to estimate daily salt intake and urinary sodium/potassium (Na/K) ratio. Hypertension was defined according to European guidelines 2018 and American guidelines ACC/AHA 2017. Proportional odds models were developed to analyze education level, sedentarism, smoking, alcohol intake, estimated urinary Na/K ratio, estimated daily salt intake, and body mass index (BMI) as factors associated with increasing BP levels (from high-normal BP to hypertension). Logistic regression models were checked for overdispersion. Mean age and BMI of the population were 42 years old and 27 kg/m2 , respectively; 19% had low education level and 27% had hypertension according to European guidelines, whereas 47% according to ACC/AHA criteria. Mean estimated urinary Na/K ratio was 4 ± 2, and mean salt consumption was 10 ± 2 g/day. Estimated urinary Na/K ratio (OR, 1.11; 95% CI, 1.01-1.21), BMI (OR, 1.10; 95% CI, 1.07-1.13), estimated daily salt intake (OR, 1.10; 95% CI, 1.03-1.17), and alcohol intake (OR, 1.03; 95% CI, 1.01-1.05) were significantly associated with hypertension. This study highlights that a healthy diet and weight control should be important components of BP management plans, and it suggests that public policies should include close monitoring of these factors to reduce hypertension prevalence and improve its management in a Latino population.

[Five o'clock tea and the risk of metabolic syndrome]. / La ingesta de "once", en reemplazo de la cena, se asocia al riesgo de presentar síndrome metabólico.

BACKGROUND: Seventy four percent of Chileans replaced the traditional dinner for the consumption of "five o'clock tea" (5CT), a mealtime that includes bread and is simliar to western breakfast. The latter favors the intake of unhealthy foods. AIM: To study whether the consumption of "5CT", instead of dinner, could be a risk factor for the development of metabolic syndrome (MetSyn). MATERIAL AND METHODS: Anthropometric parameters, mean blood pressure, lipid profile, thyroid stimulating hormone and fasting glucose were measured in 489 subjects aged 39 ± 12 years (33% women) who attended a primary cardiovascular prevention (CV) program. A 24-hour recall and usual meal times were registered during a dietary interview. To determine the association between the consumption of "5CT" or dinner and the probability of presenting two or more components of MetSyn, we built an odds proportional model adjusted by age and sex. In addition, severity for MetSyn was calculated. RESULTS: Nineteen percent of participants had MetSyn and 39%, two or more MetSyn components. Those who consumed "5CT" instead of dinner, had 54% more probability of having 2 or more MetSyn components (Odds ratio = 1.54, confidence intervals 1.032.32, p = 0.04). Participants who included processed carbohydrates in their last meal had a higher probability of having components of MetSyn. This probability decreased among participants who ate dinner with a low proportion of refined carbohydrates. CONCLUSIONS: Subjects who eat "5CT", instead of dinner as the last meal, have a higher cardiometabolic risk and MetSyn severity.

Menores niveles circulantes del péptido vasoactivo y cardioprotector angiotensina-(1-9) en pacientes con hipertension arterial pulmonar / Lower circulating levels of angiotensin-(1-9), a vasoactive and cardio-protective peptide in patients with pulmonary artery hypertension

RESUMEN: Introducción: La vía clásica del sistema renina-angiotensina (SRA) está activado en pacientes con hipertensión arterial pulmonar (HAP). Previamente, hemos encontrado que en la disfunción ventricular post infarto al miocardio experimental la activación del eje clásico del SRA, dado por la enzima convertidora de angiotensina I (ECA) y angiotensina (Ang ) II se correlaciona negativamente con el eje paralelo del SRA dado por la ECA homóloga (ECA2) y el péptido vasoactivo y cardioprotector Ang-(1-9). Resultados preclínicos muestran la eficacia de la administración de Ang-(1-9) en el tratamiento del remodelamiento cardiovascular patológico. Hasta la fecha no existen antecedentes de los niveles circulantes de Ang-(1-9) en pacientes con hipertensión arterial pulmonar comparados con sujetos sanos. Objetivo: Determinar los niveles circulantes del péptido vasoactivo y cardiprotector Ang-(1-9) en pacientes con HAP y compararlos con sujetos sanos pareados por edad y sexo. Métodos: Estudio comparativo transversal en pacientes con HAP (grupo I, OMS) con presión de arteria pulmonar media (mPAP) ≥25 mmHg bajo tratamiento con furosemida (40%), espironolactona (53%), Acenocumarol/Warfarina (47%), Bosentan/Ambrisentan (27%), Sildenafil (80%), iloprost (7%) y digoxina (13%). Los sujetos controles correspondieron a sujetos asintomáticos sanos sin enfermedad cardiovascular, cardiopatía estructural ni pulmonar (n=14). En todos los pacientes se determinó mPAP, proBNP, resistencia vascular pulmonar (RVP, WU), presión capilar pulmonar (PCP, mmHg), gasto cardíaco (L/min), capacidad funcional por test de caminata 6 minutos (TC6M), cambio del área fraccional del ventrículo derecho VD (FAC, %). Se utilizó prueba t de Student y programa estadístico SPSS10.0. Un valor de p < 0,05 fue considerado como estadísticamente significativo. Resultados: Los pacientes ingresados al estudio mostraron: etiología de la HAP, idiopática (86,7%), VIH (13,3%), capacidad funcional I (6,2%), II (68,3) y III (25%) y promedio mPAP 51,3±1,9. Pacientes con HAP (grupo I, OMS) versus sujetos sanos mostraron disminución significativa de FAC, actividad plasmática de la ECA2 y niveles circulantes de Ang-(1-9). En la vía clásica del RAAS pacientes con HAP mostraron mayor actividad plasmática de ECA y niveles circulantes e Ag II. Correlaciones significativas se encontraron entre niveles de Ang-(1-9) y mPAP (r = -0.701, p < 0,001) y Ang-(1-9) vs FAC (r = 0.549, p < 0,01). Conclusiones: En pacientes con HAP (grupo I, OMS), los niveles circulantes de Ang-(1-9) están significativamente disminuidos y se asocian inversamente con la PAP, severidad del remodelamiento y disfunción del ventrículo derecho. El uso terapéutico de Ang-(1-9) como agente vasodilatador y cardioprotector podría ser relevante y potencialmente útil, desde una perspectiva clínica, en la HAP. Ang-(1-9) podría reducir la PAP y mejorar el remodelamiento vascular y del ventrículo derecho en la HAP. Por lo tanto, este péptido podría ser útil como blanco terapéutico en la HAP.

ABSTRACTS: Classic renin-angiotensis pathway (RAP) is activated in patients with pulmonary artery hypertension (PAH). We have previously shown that in patients with post myocardial infarction systolic dysfunction the activation of RAP mediated by angiotensin converting enzyme (ACE) and angiotensin II (Ang II) is inversely correlated with the parallel RAP axis mediated by homologous ACE (ACE2) and by the vasoactive and cardioprotective peptide Ang-(1-9). Pre clinical studies show that administration of Ang-(1-9) leads to a favorable ventricular remodelling. At present there is no information regarding levels of Ang-(1-9) in PAH patients compared to healthy subjects. Methods: 16 PAH patients (WHO group 1), with mean PA pressure > 25mmHg being treated with furosemide (40%), Bosentan/Ambrisentan (27%), Sildenafil (80%), iloprost (7%) were compared with healthy subjects (n=14). mPAP, pro BNP, pulmonary vascular resistance (Wu), pulmonary capillary pressure (PCP mmHg), cardiac output (L/min), functional capacity (6 min walking test) (6mWT), and changes in right ventricular fractional area (RV FA), were measured in all subjects. Results: In HAP subjects, the eiotology of PAH was unknown in 87%, or HIV (13%). Functional class was I (6.2 %), II (68.3%) or III (25%). Mean PAP was 51.3±1.9. Compared to healthy subjects, PAH patients had significantly lower RV FA, ACE2 and Ang-(19) levels. Also they had greater ACE plasma activity and AngII circulating levels. Significant correlations were found between Ang-(1-9) and mPAP (-0.701, p < 0,001) and between Ang-(1-9) and RV FA (r = 0.549, p < 0,01). Conclusion: group I PAH subjects, circulating levels of Ang-(1-9) are significantly lower than in healthy subjects and are inversely related to PAP, severity of ventricular remodeling and right ventricular dysfunction. The use of Ang-(1-9) as a vasodilator and cardioprotector agent could be clinically useful in PAH subjects.

La ingesta de "once", en reemplazo de la cena, se asocia al riesgo de presentar síndrome metabólico / Five o'clock tea and the risk of metabolic syndrome

Background: Seventy four percent of Chileans replaced the traditional dinner for the consumption of "five o'clock tea" (5CT), a mealtime that includes bread and is simliar to western breakfast. The latter favors the intake of unhealthy foods. Aim: To study whether the consumption of "5CT", instead of dinner, could be a risk factor for the development of metabolic syndrome (MetSyn). Material and Methods: Anthropometric parameters, mean blood pressure, lipid profile, thyroid stimulating hormone and fasting glucose were measured in 489 subjects aged 39 ± 12 years (33% women) who attended a primary cardiovascular prevention (CV) program. A 24-hour recall and usual meal times were registered during a dietary interview. To determine the association between the consumption of "5CT" or dinner and the probability of presenting two or more components of MetSyn, we built an odds proportional model adjusted by age and sex. In addition, severity for MetSyn was calculated. Results: Nineteen percent of participants had MetSyn and 39%, two or more MetSyn components. Those who consumed "5CT" instead of dinner, had 54% more probability of having 2 or more MetSyn components (Odds ratio = 1.54, confidence intervals 1.032.32, p = 0.04). Participants who included processed carbohydrates in their last meal had a higher probability of having components of MetSyn. This probability decreased among participants who ate dinner with a low proportion of refined carbohydrates. Conclusions: Subjects who eat "5CT", instead of dinner as the last meal, have a higher cardiometabolic risk and MetSyn severity.

Cintura e índice de masa corporal: los mejores predictores antropométricos en la reducción y progresión de la agregación de factores de riesgo cardiometabólicos / Waist and body mass index: The best anthropometric predictors in the reduction and progression of the aggregation of cardiometabolic risk factor

El objetivo de este estudio fue determinar el impacto de la variación de distintas mediciones antropométricas en la evolución del síndrome metabólico (SM). El estudio fue prospectivo en 178 sujetos que asistieron a un programa de salud cardiovascular entre el año 2013 y 2016. Se recolectaron datos demográficos, historia médica, factores de riesgo cardiovascular, y se midió perfil lipídico, glicemia de ayuno, presión arterial y medidas antropométricas (IMC, perímetro de cintura y cadera y % de grasa corporal). Se consideró la agregación de 2 o más componentes de síndrome metabólico (SM), excluyendo cintura y se determinó la probabilidad de reversión del SM, considerándose como la reducción desde 2 o más componentes a 1 o ninguno. El tiempo de seguimiento promedio fue de 2 años. La edad promedio fue de 40 años y 37% eran mujeres. Según los modelos de odds proporcionales, ajustados por edad, sexo y tiempo de seguimiento, aquellos sujetos con 2 o más componentes de SM triplicaron su probabilidad de revertir el SM por cada reducción de 1 Kg/m2 de IMC por año (OR IMC = 3,03; 1,74-5,28; p<0,001). En el caso de cintura, esta probabilidad aumentó en 52% por la reducción de 1 cm por año (ORcintura =1,52; 1,28-1,81; p<0,001). Finalmente una reducción de 0,01 en el índice cintura/cadera aumentó en 26% la probabilidad de revertir el SM (ORcintura/cadera =1,26; 1,06-1,491; p<0,01); sin embargo, el % de grasa corporal no tuvo un efecto significativo Los cambios en IMC y circunferencia de cintura serían los parámetros antropométricos más confiables para monitorear la evolución del SM(AU)

The objective of this study was to determine the impact of variation of different anthropometric parameters at follow-up in the evolution of the metabolic syndrome (MetS). Prospective study in 178 subjects who attended a cardiovascular health program between 2013 and 2016. Demographical data, medical history and cardiovascular (CV) risk factors (RFs) were collected. In addition, fasting lipid profile, blood glucose, blood pressure and anthropometrical parameters (BMI, WC, hip, and fat percentage) were measured. To determine the evolution of MetS, the clustering of 2 or more of the MetS components were considered, excluding WC. Odds proportional models adjusted by age, sex and time of follow-up were built to determine the probability of reverting the MetS. MetS reversion was considered as the reduction to 1 or 0 components in subjects with 2 or more. Mean follow-up time was 2 years. Mean age was 40 years old and 37% were women. According to the odds proportional models, subjects tripled their chance of reverting MetS for each 1 kg/m2 of BMI reduction (ORBMI=3.03; 1.74-5.28; p<0.001). For WC, the chance of reverting MetS increased 52% for each reduction of 1 cm of waist (ORwaist =1.52; 1.28-1.81; p<0.001). A reduction of 0.01 in the waist to hip ratio increased in 26% the chance of reverting MetS (ORwaist/hip=1.26; 1.06-1.491; p<0.01); however, fat percentage did not have a significant effect on the evolution of the MetS. BMI and WC are the most reliable anthropometrical parameters for monitoring the evolution of MetS aggregation in the out-patient clinical setting(AU)

[Evaluation the American College of Cardiology and American Heart Association Predictive score for cardiovascular diseases]. / Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago.

BACKGROUND: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. AIM: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. MATERIAL AND METHODS: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3,284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the Death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. RESULTS: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p < 0.01) and diabetes (p < 0. 01) and tended to be older (p = 0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p = 0.09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p = 0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. CONCLUSIONS: The new ACC/AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Does Good Aerobic Capacity Attenuate the Effects of Aging on Cardiovascular Risk Factors? Results from a Cross-Sectional Study in a Latino Population.

Background. High aerobic capacity is associated with low cardiovascular (CV) risk. The aim of this study was to determine the CV RF burden in subjects with aerobic capacity ≥10 METs and compare it with those having <10 METs. Methods. Cross-sectional study in 2646 subjects (mean age 48 ± 12 years). Demographics, medical history, physical activity, cardiovascular RFs, fasting lipids and blood glucose levels, blood pressure, and anthropometric measurements were collected. Aerobic capacity was determined by exercise stress test. The ACC/AHA 2013 pooled cohort equation was used to calculate CV risk. Logistic models were built to determine the probability of having ≥2 RFs versus 0-1 RF, by age and sex, according to aerobic capacity. Results. 15% of subjects had aerobic capacity < 10 METs. The ACC/AHA scores were 15% in men and 6% in women with <10 METs and 5% and 2%, respectively, in those with ≥10 METs. The probability of having ≥2 RFs increased with age in both groups; however, it was significantly higher in subjects with <10 METs (odds ratio [OR]: 2.54; 95% CI: 1.92-3.35). Conclusions. Aerobic capacity ≥ 10 METs is associated with a better CV RF profile and lower CV risk score in all age groups, regardless of gender.

Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago / Evaluation the American College of Cardiology and American Heart Association Predictive score for cardiovascular diseases

Background: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. Aim: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. Material and Methods: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3,284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the Death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. Results: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p < 0.01) and diabetes (p < 0. 01) and tended to be older (p = 0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p = 0.09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p = 0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. Conclusions: The new ACC/AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Estimated glomerular filtration rate and urine biomarkers in patients with single-ventricle Fontan circulation.

OBJECTIVES: To define whether adults with a Fontan circulation, who have lifelong venous congestion and limited cardiac output, have impaired glomerular filtration rate (GFR) or elevated urinary biomarkers of kidney injury. METHODS: We measured circulating cystatin C and creatinine (n=70) and urinary creatinine, albumin, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl glucosaminidase (NAG) (n=59) in ambulatory adult Fontan patients and 20 age-matched and sex-matched controls. Urinary biomarkers were normalised to urine creatinine concentration. Survival free from non-elective cardiovascular hospitalisation was compared by estimated GFR and urinary biomarker levels using survival analysis. RESULTS: Cystatin C GFR was lower in the Fontan group compared with controls (114.2±22.8 vs 136.3±12.8 mL/min/1.73 m2, p<0.0001); GFR<90 mL/min/1.73 m2 in 14.3% vs 0% of controls. Albumin-to-creatinine ratio (ACR), KIM-1 and NAG were elevated compared with controls; ACR=23.2 (7.6-38.3) vs 3.6 (2.5-5.7) mg/g, p<0.0001; NAG=1.8 (1.1-2.6) vs 1.1 (0.9-1.6) U/g, p=0.02; KIM-1=0.91 (0.52-1.45) vs 0.33 (0.24-0.74) ng/mg, p=0.001. Microalbuminuria, ACR>30 mg/g, was present in 33.9% of the Fontan patients but in none of the controls. Over median 707 (IQR 371-942)-day follow-up, 31.4% of patients had a clinical event. Higher KIM-1 and NAG were associated with higher risk of non-elective hospitalisation or death (HR/+1 SD=2.1, 95% CI 1.3 to 3.3, p=0.002; HR/+1 SD=1.6, 95% CI 1.05 to 2.4, p=0.03, respectively); cystatin C GFR was associated with risk of the outcome (HR/+1 SD=0.66, 95% CI 0.48 to 0.90, p=0.009) but creatinine-based GFR was not (HR/+1 SD=0.91, 95% CI 0.61 to 1.38, p=0.66). Neither ACR nor NGAL was associated with events. CONCLUSIONS: The Fontan circulation is commonly associated with reduced estimated GFR and evidence for glomerular and tubular injury. Those with lower cystatin C GFR and tubular injury are at increased risk of adverse outcomes.

Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension.

BACKGROUND: Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated. METHODS: Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. RESULTS: Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, P<.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002). CONCLUSIONS: Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.

[Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary vasodilator therapies]. / Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. AIM: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. PATIENTS AND METHODS: One hundred fifteen patients aged 43 ± 15.6 years (85% females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ± 14 mmHg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. RESULTS: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. CONCLUSIONS: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature.