ARGEN SHOCK: Mortality related to the use of Swan Ganz and to the hemodynamic pattern found in patients with AMICS.

The Swan Ganz Catheter (SGC) allows us to diagnose different types of cardiogenic shock (CS). OBJECTIVES: 1) Determine the frequency of use of SGC, 2) Analyze the clinical characteristics and mortality according to its use and 3) Analyze the prevalence, clinical characteristics and mortality according to the type of Shock. METHODS: The 114 patients (p) from the ARGEN SHOCK registry were analyzed. A "classic" pattern was defined as PCP > 15 mm Hg, CI < 2.2 L/min/ m2, SVR > 1,200 dynes × sec × cm-5. A "vasoplegic/mixed" pattern was defined when p did not meet the classic definition. CS due to right ventricle (RV) was excluded. RESULTS: SGC was used in 35 % (n:37). There were no differences in clinical characteristics according to SGC use, but those with SGC were more likely to receive dobutamine, levosimendan, and intra aortic balloon pump (IABP). Mortality was similar (59.4 % vs 61.3 %). The pattern was "classic" in 70.2 %. There were no differences in clinical characteristics according to the type of pattern or the drugs used. Mortality was 54 % in patients with the classic pattern and 73 % with the mixed/vasoplegic pattern, but the difference did not reach statistical significance (p:0.23). CONCLUSIONS: SGC is used in one third of patients with CS. Its use does not imply differences in the drugs used or in mortality. Most patients have a classic hemodynamic pattern. There are no differences in mortality or in the type of vasoactive agents used according to the CS pattern found.

Shock cardiogénico en el contexto de los síndromes coronarios agudos en Argentina: resultados del Registro ARGEN SHOCK 2 / Cardiogenic Shock in the Setting of Acute Coronary Syndromes in Argentina: Results from the ARGEN SHOCK 2 Registry

RESUMEN El shock cardiogénico (SC) es una complicación grave del infarto agudo de miocardio (IAM) y constituye una de sus principales causas de muerte. Objetivos: Conocer las características clínicas, estrategias de tratamiento, evolución intrahospitalaria y mortalidad a 30 días del SC en Argentina. Material y métodos: Se trata de un registro prospectivo, multicéntrico, de pacientes internados con SC en el contexto de los IAM con y sin elevación del segmento ST durante 14 meses (1 de agosto 2021 al 30 de septiembre 2022) en 23 centros de Argentina. Resultados: Se incluyeron 114 pacientes, edad 64 (58-73) años, 72% hombres. El 76,3% de los casos corresponden a IAM con elevación del segmento ST, 12,3% a IAM sin elevación del segmento ST, el 7% a infarto de ventrículo derecho y el 4,4% a complicaciones mecánicas. El SC estuvo presente desde el ingreso en el 66,6% de los casos. Revascularización: 91,1%, uso de inotrópicos: 98,2%, asistencia respiratoria mecánica: 59,6%, SwanGanz: 33,3%, balón de contrapulsación intraaórtico: 30,1%. La mortalidad intrahospitalaria global fue 60,5%, sin diferencias entre los IAM con o sin elevación del segmento ST, y a 30 días del 62,6%. Conclusiones: La morbimortalidad del SC es muy elevada a pesar de la alta tasa de reperfusión empleada.

ABSTRACT Background: Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI) and constitutes one of the leading causes of death. Objective: The aim of this study was to investigate the clinical characteristics, treatment strategies, hospital outcome and 30-day mortality of CS in Argentina. Methods: We conducted a prospective, and multicenter registry of patients with acute myocardial infarction (AMI) with and without ST-segment elevation complicated with CS that were hospitalized in 23 centers in Argentina for 14 months (between August 1, 2021, and September 30, 2022). Results: The cohort was made up of 114 patients; median age was 64 years (58-73) and 72% were women; 76.3% corresponded to ST-segment elevation AMI, 12.3% to non-ST-segment elevation AMI, 7% had right ventricular infarction and 4.4% had mechanical complications. In 66.6% of cases CS was present on admission. Revascularization: 91.1%, use of inotropic agents: 98.2%, mechanical ventilation: 59.6%, Swan-Ganz catheter: 33.3%, intra-aortic balloon pump: 30.1%. Overall in-hospital mortality was 60.5%, with no differences between AMI with or without ST-segment elevation, and was 62.6% at 30 days. Conclusion: Morbidity and mortality of CS are high despite the high rate of reperfusion therapy used.

Determinantes no convencionales de la salud cardiovascular de la mujer en Latinoamérica / Non-conventional Determinants of Cardiovascular Health in Latin American Women

RESUMEN Introducción: Más allá de los factores de riesgo (FR) tradicionales, hay determinantes no convencionales (DnoC) de la salud cardiovascular (CV) que operan en las mujeres como factores de riesgo adicional. Es por ello necesario explorarlos y establecer su prevalencia y vínculo con el género femenino. Objetivo: conocer la prevalencia de los DnoC socioeconómicos (SE) y psicosociales (PS) y su impacto en la salud CV de la mujer en Latinoamérica (LATAM). Material y métodos: estudio observacional, de corte transversal realizado a través de una encuesta anónima en mujeres de LATAM entre mayo y junio de 2022. Se recabaron datos sobre DnoC (SE y PS), FR convencionales y enfermedad cardiovascular (ECV). Resultados: participaron 4915 mujeres con edad media de 49 ± 13 años. El 49,6% residía en Argentina, el 55,8% en grandes ciudades, el 94,4% declaró acceso adecuado a la salud y el 89% tuvo acceso a algún nivel de educación. Si bien el 79,9% expresó tener trabajo remunerado, más de la mitad refirió percibir un salario no acorde (59,5%) y una exposición a la violencia en el ámbito laboral (26,7%). Los determinantes PS más prevalentes fueron el bajo a moderado nivel de satisfacción (68,3%), la ansiedad o irritabilidad (51,9%), el desinterés, los pensamientos negativos o la infelicidad (41,7%). El grupo de edad mayor de 45 años se asoció significativamente a más sobrepeso, obesidad, desempleo y violencia laboral. En el análisis multivariado se encontró asociación independiente con ECV para el trastorno del sueño (OR 1,7; p = 0,001), residir en una ciudad de baja densidad poblacional (OR 0,5; p <0,001), la violencia laboral (OR 1,8; p = 0,001), la ansiedad (OR 1,5; p = 0,001) y al haber padecido complicaciones del embarazo (OR 1,6; p = 0,022). Conclusión: se demostró una importante prevalencia de factores PS y SE que impactan en la salud CV de las mujeres en LATAM. Variables como la violencia laboral, la ansiedad o la irritabilidad, residir en ciudades de baja densidad poblacional, así como los trastornos del sueño y complicaciones del embarazo se asociaron de forma independiente con la ECV. Esta encuesta muestra el impacto de los DnoC SE y PS en la carga cardiometabólica (CCM) y la salud CV de las mujeres en LATAM, principalmente en aquellas mayores de 45 años.

ABSTRACT Background: Besides traditional risk factors (RF), non-conventional determinants (NCD) of cardiovascular (CV) health are additional risk factors in women. Therefore, they should be explored to establish their prevalence and association with the female gender. Objective: The aim of this study is to know the prevalence of socioeconomic (SE) and psychosocial (PS) factors as NCD in CV health in Latin American (LATAM) women. Methods: We conducted an observational, cross-sectional study using an anonymous survey distributed among LATAM women between May and June 2022. The information gathered included SE and PS NCD, traditional RF and cardiovascular disease (CVD). Results: A total of 4915 women participated; mean age was 49 ± 13 years. Most respondents (49.6%) lived in Argentina, 55.8% in large cities; 94.4% reported adequate access to healthcare services and 89% had access to some level of education. Although 79.9% had a paid job, more than half reported their salary was not commensurate (59.5%) and 26.7% reported exposure to violence at the workplace. The most prevalent PS factors were low to moderate level of satisfaction (68.3%), anxiety or irritability (51.9%), apathy, negative thoughts, or unhappiness (41.7%). Age >45 years was significantly associated with overweight, obesity, unemployment, and violence at the workplace. On multivariate analysis, sleep disorders (OR 1.7; p = 0.001), living in a city with low population density (OR 0.5; p <0.001), violence at the workplace (OR 1.8; p = 0.001), anxiety (OR 1.5; p = 0.001) and a history of pregnancy complications (OR 1.6; p = 0.022) were independently associated with CVD. Conclusion: The prevalence of PS and SE factors affecting the CV health of LATAM women was significant. Variables such as violence at the workplace, anxiety, or irritability, living in cities with low population density, sleep disorders and pregnancy complications were independently associated with CVD. This survey shows the impact of SE and PS factors as NCD on the cardiometabolic burden and CV health of women in LATAM, mainly in those > 45 years.

Dobutamine stress echocardiography can predict reversible ventricular dysfunction after acute myocardial infarction.

BACKGROUND: The aim of early treatment of acute myocardial infarction (AMI) is to achieve the rapid reperfusion of the culprit artery, which correlates with improvement in ventricular function and survival. With the widespread use of thrombolytic agents or coronary angioplasty as reperfusion strategies for AMI, it is possible to reduce the amount of myocardial necrosis. HYPOTHESIS: The assessment of residual viability with dobutamine stress echocardiography (DSE) in the infarcted area after AMI is relevant to subsequent management and prognosis. METHODS: Thirty-seven patients with AMI (mean age 59 +/- 12, 31 male, 22 with anterior AMI, 15 with inferior AMI) admitted to the coronary care unit within 3.8 +/- 1.8 h of the onset of symptoms were included. Two-dimensional echocardiography (2-D echo) study and DSE were performed at a mean of 4.7 +/- 1.8 days. Follow-up 2-D echo was performed at a mean of 25 +/- 11 days. To assess left ventricular regional systolic function, 2-D echo images were obtained at rest and during dobutamine-induced stress and were analyzed off-line according to the 13-segment model. Improvement in wall motion score (WMS) was defined by a decrease of at least two grades in the score. RESULTS: Wall motion score improved in 13 of the 37 patients after DSE (rest WMS 20.9 +/- 2.0 vs. D-WMS 17.7 +/- 2.2; p<0.001), which correlated with clinical or angiographic signs of reperfusion of the culprit vessel in all cases. Follow-up WMS evidenced a significant correlation with WMS after DSE (r = 0.91; p < 0.001). Sensitivity, specificity, and positive and negative predictive values of DSE in detecting patients whose left ventricular function (LVF) improved at 2-D echo follow-up were 72,96,92.8, and 82.7%, respectively. CONCLUSIONS: (1) Dobutamine stress echocardiography improved WMS in 35% of patients and correlated with signs of patency of the culprit vessel; (2) LVF improvement after dobutamine was predictive of late LVF recovery; (3) DSE can be a useful and safe tool for detecting reversible myocardial dysfunction after AMI.