Health-Related Quality of Life in Patients Under Treatment With Apixaban in Latin America.

Atrial fibrillation (AF) has a strong impact on the quality of life (QOL) of patients and anticoagulation has a lot to do with it. We evaluated the QOL of patients with nonvalvular AF who start treatment with apixaban in Latin America. QOL was analyzed through a questionnaire developed to evaluate anticoagulated patients, which was completed by them 3 months after starting treatment. We included 521 patients from Uruguay, Bolivia, Ecuador, Paraguay, and Peru. A high index of general treatment satisfaction (5.34 ± 0.46) and self-efficacy (5.11 ± 0.68) were observed; the distress index was low (1.77 ± 0.88), as was the perception of daily hassles (1.35 ± 0.49) and strain social network related to medication (1.21 ± 0.34). Patients with AF who started treatment with apixaban has good satisfaction and self-efficacy scores with low index of stress, few daily limitations and social disruptions.

Does high sensitivity troponin add prognostic value to validated risk scores to predict in-hospital mortality in patients with acute heart failure?

Troponin elevation correlates with an increased short and long-term mortality in patients with acute decompensated heart failure (AHF). However, it has not been included in the development of multiple validated predictive models of mortality. We aim to  determine whether the addition of high-sensitivity troponin T (hs-TnT) to clinical risk scores improves the prediction of in-hospital mortality in patients with AHF. A retrospective analysis of a prospective and consecutive cohort was performed. Adult patients hospitalized between 2015 and 2019 with a primary diagnosis of AHF were included. Hs-TnT was measured on admission. OPTIMIZE-HF, GWTG-HF, and ADHERE risks score were calculated for each patient. The primary endpoint was all-cause in-hospital mortality. Discrimination of isolated hs-TnT and the risk scores with and without the addition of hs-TnT were evaluated using the area under the ROC curve (AUC-ROC). A subanalysis was performed according to left ventricular ejection fraction (LVEF). Of 712 patients, 562 (79%) had hs-TnT measurement upon admission, and was elevated in 91%. In-hospital mortality was 8.7% (n = 49). The AUC-ROC was 0.70 (95% CI 0.63-0.77) for isolated hs-TnT, and 0.80 (0.74-0.87), 0.79 (0.72 -0.86) and 0.79 (0.71-0.86) for the OPTIMIZE-HF, GWTG-HF and ADHERE scores, respectively. The addition of hs-TnT to the models did not increase the AUC: 0.72 (0.66-0.79) for the OPTIMIZE-HF + hs-TnT score (difference between AUC - 0.08 p = 0.04), 0.74 (0.68-0.80) for GWTG-HF (difference between AUC-0.04, p = 0.2) and 0.7 (0.63-0.77) for ADHERE (difference between AUC - 0.085 p = 0.07). The models presented good calibration (p > 0.05). In the sub-analysis, no differences were found between risk scores with the addition of hs-TnT in the population with LVEF < 40% and ≥ 40%. Elevated hs-TnT on admission was frequent and its incorporation into the validated risk scores did not prove an incremental prognostic benefit in patients hospitalized for AHF, regardless of LVEF. Isolated hs-TnT had a modest ability to predict hospital mortality. Additional prospective studies are needed to validate these findings.

Impact of COVID-19 Pandemic Lockdown in Decompensated Heart Failure Hospitalizations.

Background and Objectives: Coronavirus disease 2019 (COVID-19) pandemic lockdown may have collaterally affected the care of patients with acute decompensated heart failure (ADHF). We aimed to evaluate the impact of lockdown pandemic on hospitalizations for ADHF. Methods: We conducted a single-center study, performing a retrospective analysis of prospectively collected data. We included consecutive adult patients with a primary diagnosis of ADHF admitted to a cardiovascular disease specialized hospital. We compared those patients admitted between March-June of 2019 (before COVID-19 [BC]) and 2020 (after COVID-19 [AC]), during mandatory lockdown. Results: A total 79 corresponding to BC period and 60 to AC period were included, representing a decrease of 25% (interquartile range [IQR], 11-33). During the BC period, 31.6% of patients were referred from other centers compared to 15% during the pandemic (p=0.02). In the AC period patients were older (median age, 81[IQR, 73-87] years vs. 77 [IQR, 64-84] years, p=0.014). The etiology of HF, cause of decompensation, left ventricular function, and laboratory parameters were similar in both periods. The use of mechanical ventilation (13.9% vs. 3.3%, p=0.03) and circulatory support (7.6% vs. 0%, p=0.02) was higher in the BC period. During the BC period, 5 emergency heart transplants were performed, and none in AC, (p=0.004). In-hospital mortality was similar in both periods (3.8% vs. 3.3%; p=0.80). Conclusions: We observed a reduction in the number of hospitalizations and referral of patients for ADHF during COVID-19 pandemic.

Isochromosome 17q, a Rare Chromosomal Abnormality in a Female Patient with Pancytopenia.

OBJECTIVES: Myelodysplastic syndromes present with a range of cytogenetic abnormalities that are used to guide diagnosis and management of the disease. Herein, we present the case of a 72-year-old female patient who presented with pancytopenia. Peripheral blood showed Hb 9.0 g/dl, neutrophils less than 1800/mm3, and platelets less than 100,000/mm3. Bone marrow showed erythroid hyperplasia, megaloblastic changes, dyserythropoiesis, multinuclearity, nuclear bridges, nuclear budding, atypical mitoses, and ring sideroblasts. Also, CD34 and CD117 as well as myeloperoxidase positive populations were present. On this basis, a diagnosis of myelodysplastic syndrome was rendered. Chromosome studies showed an abnormal female karyotype with an isochromosome 17q as well as deletion 20q in 17 of the 20 metaphase cells examined. The remaining three cells were cytogenetically normal. Molecular cytogenetic studies using a TP53-specific probe showed only one TP53 signal in 87% of the nuclei examined. An i(17q) as a sole cytogenetic aberration is rare among both MDS and myeloid malignancies in general, but is functionally similar to aberrations of 17p that lead to loss of TP53. This case provides further insight into the spectrum of cytogenetic abnormalities present in MDS.

Consenso Paraguayo de Hipertensión Arterial 2015

Este consenso fue ideado por el Director del Programa Nacional de Prevención Cardiovascular del M.S P. y B.S. (Paraguay) a raíz de que se necesitaba un documento actualizado que sirva como guía a los profesionales de la salud de todos los niveles de atención incluyendo a las diferentes especialidades, que tratan la hipertensión arterial y sus complicaciones agudas y crónicas. A través del convenio entre el Programa Nacional de Prevención Cardiovascular y la Sociedad Paraguaya de Cardiología de realizar actualizaciones de las Guías o documentos para difusión de manejo de patologías cardiovasculares y factores de riesgo asociados, se ha decidido elaborar y lanzar este material, que será utilizado como guía oficial en todo el territorio nacional. Con mesas de trabajo de varios días y la colaboración de representantes de sociedades científicas afines y asesores internacionales se ha logrado esta guía. Se presentan recomendaciones para facilitar el manejo de los pacientes con hipertensión arterial y sus complicaciones, con el propósito de disminuir la morbimortalidad cardiovascular. Han sido elaboradas según las evidencias científicas y conocimiento de expertos, con un enfoque práctico y sencillo. Todos los participantes aprobaron las decisiones finales. Los autores reconocen que la publicación y difusión de directrices serán siempre una guía práctica y que permitirá a los médicos ampliar los conocimientos con las recomendaciones propuestas, detectar precozmente el daño de órganos blancos y mejorar la calidad de vida de los pacientes hipertensos.

This consensus was conceived by the Director of the National Program of Cardiovascular Prevention of the M.S P. y B.S. (Ministry of Public Health and Social Welfare, Paraguay) because an updated document was necessary as a guide for health professional of all care levels including different specialties that treat arterial hypertension and its acute and chronic complications. Through this consensus between the National Program of Cardiovascular Prevention and the Paraguayan Cardiology Society of updating Guides or documents for the dissemination of the management of cardiovascular pathologies and associated risk factors it was decided to elaborate and launch this material that will be used as an official guide in the national territory. This guide was achieved after working tables held during several days and the collaboration of representatives of related scientific societies and international advisers. Recommendations for facilitating the management of patients with arterial hypertension and its complications are presented in order to reduce the cardiovascular morbidity and mortality. They have been elaborated according to scientific evidence and knowledge of experts with a practical and simple approach. All the participants approved the final decisions. The authors recognize that the publications and dissemination of guidelines will always be a practical guide that will allow physicians to increase their knowledge with the proposed recommendation in order to early detect the damage of target organs and improve the quality of life of the hypertensive patients.

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Coexisting chordal papillary fibroelastoma and leaflet Lambl's tumour of the mitral valve.

Cardiac papillary fibroelastoma (CPF) is a rare and histologically benign tumour. It is the most common valvular tumour and the third cardiac benign tumour, after myxoma and lipoma (less then 16% of all cardiac tumours). CPF is a surgically correctable cause of cerebrovascular and myocardial infarction, making its identification by echocardiography beneficial. We report an unusual case of double localization on both chordae and leaflet of the mitral valve.