Trastornos inespecíficos de la repolarización ventricular: un lobo con piel de oveja / Nonspecific ventricular repolarization abnormalities: A wolf in sheep's clothing

El término trastornos inespecíficos de la repolarización ventricular se refiere a un conjunto de alteraciones menores del segmento ST y/o la onda T. Durante mucho tiempo han sido de escaso interés clínico al no traducir diagnósticos específicos. De forma extrema, se ha aseverado que constituyen hallazgos electrocardiográficos benignos. Su presencia se ha reportado en diversos estados patológicos cardiovasculares y no cardiovasculares. Sin embargo, con frecuencia se identifica en personas asintomáticas aparentemente sanas. Un creciente número de estudios demuestran su importancia como predictores de morbimortalidad cardiovascular, expandiendo su espectro hacia la prevención cardiovascular. A la luz de las evidencias científicas acumuladas se impone un cambio en la visión tradicional que se ha tenido con los trastornos inespecíficos de la repolarización ventricular. (AU)

The term nonspecific ventricular repolarization abnormalities refers to a set of minor alterations of the ST segment and/or the T wave. For a long time, they have been of little clinical interest as they do not translate into specific diagnoses. It has even been asserted that they constitute benign electrocardiographic findings. Their presence has been reported in various cardiovascular and non-cardiovascular diseases. However, it is frequently identified in apparently healthy asymptomatic people. A growing number of studies demonstrate their importance as predictors of cardiovascular morbidity and mortality, expanding their spectrum towards cardiovascular prevention. In light of the body of scientific evidence, it is imperative that the traditional view of nonspecific ventricular repolarization abnormalities changes. (AU)

Respuesta al ECG de junio de 2020 / Response to ECG, June 2020

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Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy?

BACKGROUND: Diastolic dysfunction is considered the first marker of diabetic cardiomyopathy. However, preclinical systolic alteration was also recently described by strain, but its association with diastolic dysfunction has never been investigated. METHODS: One hundred fourteen patients with type 2 diabetes mellitus (DM) with controlled blood pressure and without overt heart disease were prospectively enrolled and compared with 88 age-matched controls. All subjects underwent comprehensive echocardiography, including diastolic evaluation according to current recommendations and speckle-tracking imaging. The prevalence of diastolic dysfunction, the determinants of diastolic parameters, and the association between preclinical systolic and diastolic dysfunctions were studied. RESULTS: Diastolic parameters were altered in patients compared with controls, with lower E/A ratios, longer mitral deceleration and isovolumic relaxation times, and higher E/e' ratio. Diastolic dysfunction occurred in 47% of patients with DM (33% and 14% with grade I and II diastolic dysfunction, respectively) and systolic alteration (longitudinal strain ≥ -18%) in 32% of patients. Whereas longitudinal systolic strain was independently associated with DM and gender, diastolic parameters were influenced by many factors, including age, rate-pressure product, history of hypertension, and body mass index. Systolic alteration occurred in 28% of patients with DM with normal diastolic function and in 35% with diastolic dysfunction. CONCLUSIONS: Diastolic dysfunction diagnosed according to current recommendations is frequent in patients with DM but is also influenced by other factors. Systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy.

Sleep apnea and ventricular arrhythmias: Clinical outcome, electrophysiologic characteristics, and follow-up after catheter ablation.

BACKGROUND AND OBJECTIVES: Sleep apnea is highly prevalent in patients with heart disease. However, the association between sleep apnea and ventricular arrhythmias is unclear. The aim of this study was to examine the relationship between sleep apnea and electrophysiologic characteristics and clinical outcome after catheter ablation in patients having ventricular arrhythmias. METHODS AND RESULTS: Forty-four patients with ventricular tachycardia (VT) or premature ventricular complexes (PVCs) without structural heart diseases (57% men; mean age: 55 + or - 15 years) underwent a sleep study. Subjects with an apnea-hypopnea index (AHI) > or = 10/h were considered to have sleep apnea. Electrophysiologic studies were performed on all patients, and 35 patients underwent catheter ablation therapy. Seventeen patients (39%) had sleep apnea with an average AHI of 27 + or - 17/h. Electrophysiologic characteristics of ventricular arrhythmias showed that sites of VT/PVCs origin in the pulmonary artery and the aortic sinus of Valsalva were detected in 27% and 20% patients with sleep apnea, which was a relatively higher rate than that in patients without sleep apnea (8% and 0%, respectively). Successful catheter ablation was achieved in 11 patients (85%) with sleep apnea and 17 (77%) without sleep apnea. During a mean follow-up period of 13.5 + or - 7.3 months after catheter ablation, 5 patients (45%) with sleep apnea and 1 patient (6%) without sleep apnea experienced recurrent VT/PVCs. Comparing the outcome between the two groups, the VT/PVCs recurrence rate was significantly higher in patients with sleep apnea than in those without sleep apnea (p=0.02). CONCLUSIONS: Ventricular arrhythmia patients with sleep apnea have a high recurrence of arrhythmias after successful catheter ablation. Patients with ventricular arrhythmias should be systematically assessed for sleep apnea owing to the potential detrimental effects of sleep apnea in the follow-up period.

Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases.

In biology, classification systems are used to promote understanding and systematic discussion through the use of logical groups and hierarchies. In clinical medicine, similar principles are used to standardise the nomenclature of disease. For more than three decades, heart muscle diseases have been classified into primary or idiopathic myocardial diseases (cardiomyopathies) and secondary disorders that have similar morphological appearances, but which are caused by an identifiable pathology such as coronary artery disease or myocardial infiltration (specific heart muscle diseases). In this document, The European Society of Cardiology Working Group on Myocardial and Pericardial Diseases presents an update of the existing classification scheme. The aim is to help clinicians look beyond generic diagnostic labels in order to reach more specific diagnoses.

Ressonância magnética cardiovascular no diagnóstico da insuficiência cardíaca / Cardiovascular magnetic resonance in the diagnosis of heart failure

A ressonância magnética cardiovascular é um método diagnóstico cuja importância vem crescendo na avaliação de pacientes com insuficiência cardíaca. A ressonância magnética cardiovascular permite avaliação anatômica, funcional, de fluxos, caracterização tecidual, e pesquisa de isquemia e viabilidade miocárdica, auxiliando na investigação da etiologia, no planejamento terapêutico e na definição do prognóstico em pacientes com insuficiência cardíaca. Dentre as várias técnicas utilizadas, destaca-se...

[Nonischemic ventricular arrhythmias: classification, clinical manifestations, diagnosis, and treatment].

Clinico-electrocardiographical and electrophysiological features of noncoronarygenic ventricular arrhythmias are presented. Characteristics of localization of arrhythmogenic focus in various parts of left and right ventricular myocardium, in interventricular septum, and in immediate vicinity of each of 4 valves are discussed. Spectrum of necessary diagnostic measures is delineated, and assessment of efficacy of drug therapy is given. Characteristics of technique of endocardial mapping of noncoronarygenic ventricular heart rhythm disturbances are presented. Indications to radiofrequency catheter ablation, physical characteristics of radiofrequency intervention, effectiveness of catheter methods of treatment in dependence of localization of arrhythmogenic focus and spectrum of possible complications of the procedure are also discussed.

Quality of care for Medicare patients hospitalized with heart failure in rural Georgia.

BACKGROUND: It is not known whether quality of care for congestive heart failure (CHF) at rural hospitals is similar to that in larger, urban hospitals. METHODS: We reviewed hospital charts for 310 Medicare patients hospitalized with CHF at six hospitals in rural Georgia. RESULTS: Of the 310 patients, 101 (33%) had left ventricular systolic dysfunction, and 60 (19%) had preserved systolic function. Information on left ventricular function was not available for 48% (range, 29% to 87% across the six hospitals). Among patients with systolic dysfunction, 77% were prescribed an angiotensin converting enzyme (ACE) inhibitor at discharge, and 73% were prescribed digoxin. However, the mean daily ACE inhibitor dose was only 48% of the recommended target dose. Only 30% of all patients with atrial fibrillation were prescribed warfarin. CONCLUSIONS: Overall quality of care for CHF at rural hospitals appears similar to that in other settings, though many patients may not receive evaluation of ventricular function.