Consequences of COVID-19 pandemic on myocardial infarction reperfusion therapy and prognosis.

Background The coronavirus disease (COVID-19) pandemic affected the prompt diagnosis and treatment of Acute myocardial infarction (AMI). AIM: To characterize the clinical profile of patients with AMI during the COVID-19 pandemic, comparing them with a historical cohort. MATERIAL AND METHODS: A case-control study of 96 patients with AMI transferred to a high-volume percutaneous coronary intervention (PCI) hospital between March and July 2020, and a historical cohort of 269 patients transferred during the same period in 2019. RESULTS: When comparing patients transferred during the pandemic with those of the historical cohort, the former were younger (63 ± 12 vs 68 ± 12 years, p < 0.01), had a higher frequency of hypertension (66 vs 45%, p < 0.01) and of smoking (40% vs 25%, p < 0.01). Also, during COVID-19 outbreak a higher proportion of patients had ST-elevation AMI consulting > 12 hours from the onset of symptoms (44 vs 0%, p < 0.01), a higher median door-to-device time (4 vs 3 hours, p < 0.01), a higher use of primary percutaneous coronary intervention (97 vs 71%, p < 0.01), and higher frequencies of cardiogenic shock (20 vs 4%, p < 0.01) and mechanical complications (10% vs 2%, p < 0.01). Patients during COVID pandemic had a higher thirty-day overall (20 vs 1.4%, p < 0.01) and cardiovascular mortality (13 vs 1%, p < 0.01). During the outbreak, 40% of patients had positive COVID-19 status, which was a predictor for thirty-day overall mortality (Risk ratio 2.90; 95% confidence intervals 1.14-7.36). CONCLUSIONS: During the pandemic patients with AMI exhibited delays in consultations and treatment, higher morbidity, and increased mortality. COVID-19 positivity was associated to worse thirty-day overall survival.

El infarto oculto: las claves para el diagnóstico precoz de infarto posterior / True posterior infarction diagnosis: report of three cases

Acute Coronary Syndrome with ST segment elevation requires rapid reperfusion, which is why the timely identification of these conditions, based on the patient's symptoms and the correct interpretation of the EKG, is essential for therapeutic decisions. We report three patients with True Posterior Infarction and their difficult EKG diagnosis. The classic 12-lead EKG method is often not capable of supporting the diagnosis, so we recommend the use of posterior leads and mirror images observing inverted V1-V2-V3 leads on the classic EKG.

Consequences of COVID-19 pandemic on myocardial infarction reperfusion therapy and prognosis / Consecuencias de la pandemia COVID-19 en la reperfusión y pronóstico del infarto de miocardio

ABSTRACT Background The coronavirus disease (COVID-19) pandemic affected the prompt diagnosis and treatment of Acute myocardial infarction (AMI). Aim: To characterize the clinical profile of patients with AMI during the COVID-19 pandemic, comparing them with a historical cohort. Material and Methods: A case-control study of 96 patients with AMI transferred to a high-volume percutaneous coronary intervention (PCI) hospital between March and July 2020, and a historical cohort of 269 patients transferred during the same period in 2019. Results: When comparing patients transferred during the pandemic with those of the historical cohort, the former were younger (63 ± 12 vs 68 ± 12 years, p 12 hours from the onset of symptoms (44 vs 0%, p < 0.01), a higher median door-to-device time (4 vs 3 hours, p < 0.01), a higher use of primary percutaneous coronary intervention (97 vs 71%, p < 0.01), and higher frequencies of cardiogenic shock (20 vs 4%, p < 0.01) and mechanical complications (10% vs 2%, p < 0.01). Patients during COVID pandemic had a higher thirty-day overall (20 vs 1.4%, p < 0.01) and cardiovascular mortality (13 vs 1%, p < 0.01). During the outbreak, 40% of patients had positive COVID-19 status, which was a predictor for thirty-day overall mortality (Risk ratio 2.90; 95% confidence intervals 1.14-7.36). Conclusions: During the pandemic patients with AMI exhibited delays in consultations and treatment, higher morbidity, and increased mortality. COVID-19 positivity was associated to worse thirty-day overall survival.

Antecedentes: La pandemia COVID-19 afectó el tratamiento oportuno del infarto agudo de miocardio (IAM). Objetivo: Caracterizar el perfil clínico de pacientes con IAM durante la pandemia COVID-19 y compararlos con una cohorte histórica. Pacientes y Métodos: Estudio caso-control de 96 pacientes con IAM transferidos a un hospital de alto volumen de intervención coronaria percutánea (ICP) entre marzo julio de 2020 y una cohorte histórica de 269 pacientes transferidos en el mismo período de 2019 (n = 269). Resultados: Al comparar los pacientes transferidos durante pandemia y la cohorte histórica, los primeros eran más jóvenes (63 ± 12 y 68 ± 12 años respectivamente, p 12 h desde iniciados síntomas de IAM con elevación ST (44,4 y 0% respectivamente, p < 0,01), una mediana de tiempo puerta-guía mayor (4 y 3 horas respectivamente, p < 0,01), un mayor uso de ICP primaria (97 y 71% respectivamente, p < 0,01), mayor frecuencia de shock cardiogénico (19,8 y 4,1% respectivamente, p < 0.01) y complicaciones mecánicas (10,4 y 1,7% respectivamente, p < 0,01). A treinta días, los primeros tuvieron mayor mortalidad general (19,8 y 1,4% respectivamente p < 0.01) y cardiovascular (12,5 y 1,4% respectivamente, p < 0,01). Durante la pandemia, 40% de los pacientes presentó positividad para COVID-19, siendo un factor predictivo de mortalidad general (razón de riesgo 2,90; intervalos de confianza 95% 1,14-7,36). Conclusiones: Durante la pandemia, hubo retrasos en tiempos de consulta y tratamiento y mayor morbimortalidad del IAM. La positividad de COVID-19 se asoció a peor sobrevida general a treinta días.

[True posterior infarction diagnosis. Report of three cases]. / El infarto oculto. Las claves para el diagnóstico precoz de infarto posterior.

Acute Coronary Syndrome with ST segment elevation requires rapid reperfusion, which is why the timely identification of these conditions, based on the patient's symptoms and the correct interpretation of the EKG, is essential for therapeutic decisions. We report three patients with True Posterior Infarction and their difficult EKG diagnosis. The classic 12-lead EKG method is often not capable of supporting the diagnosis, so we recommend the use of posterior leads and mirror images observing inverted V1-V2-V3 leads on the classic EKG.

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.

Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico

Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. Material and Methods: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. Results: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. Conclusions: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

[Recurrent hypoxemia secondary to a patent foramen ovale. Report of one case]. / Hipoxemia recurrente y formen oval permeable. Unidad diagnóstica fácilmente inadvertida. Caso clínico.

Patent foramen ovale (PFO) is a prevalent congenital septal atrial defect usually without pathological significance. In certain pathogenic situations, PFO can trigger episodes of recurrent hypoxemia, a specific condition known as platipnea-orthodeoxia syndrome (POS). We report a 73 years old female presenting with dyspnea and low arterial oxygen saturation. On admission the patient had a hemoglobin saturation of 81% and an arterial oxygen partial pressure of 50 mmHg. After breathing 100% a 17% arterial-venous shunt was found (normal: less than 12%). A transesophageal echocardiogram and a cardiac catheterization showed the presence of a PFO. A percutaneous closure was performed.

Hipoxemia recurrente y formen oval permeable. Unidad diagnóstica fácilmente inadvertida. Caso clínico / Recurrent hypoxemia secondary to a patent foramen ovale. Report of one case

Patent foramen ovale (PFO) is a prevalent congenital septal atrial defect usually without pathological significance. In certain pathogenic situations, PFO can trigger episodes of recurrent hypoxemia, a specific condition known as platipnea-orthodeoxia syndrome (POS). We report a 73 years old female presenting with dyspnea and low arterial oxygen saturation. On admission the patient had a hemoglobin saturation of 81% and an arterial oxygen partial pressure of 50 mmHg. After breathing 100% a 17% arterial-venous shunt was found (normal: less than 12%). A transesophageal echocardiogram and a cardiac catheterization showed the presence of a PFO. A percutaneous closure was performed.

[Myocardial infarction with non-obstructive coronary artery disease. Diagnostic value of intravascular imaging and cardiac resonance]. / Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico.

BACKGROUND: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. AIM: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. MATERIAL AND METHODS: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. RESULTS: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. CONCLUSIONS: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

Experiencia inicial del implante percutáneo de válvula aórtica en el Instituto Nacional del Tórax: Experience in 26 patients / Transcatheter aortic valve implantation

Background: Aortic valve stenosis (AS) is the most common valvular disease. Its surgical indication is undisputed in symptomatic severe AS, however, 30% of patients are at high surgical risk or inoperable. Transcatheter Valve Implantation (TAVI) is an alternative for this group of patients. Aim: To describe the clinical outcomes of TAVI in a group of patients treated at the Instituto Nacional del Tórax, Santiago, Chile. Patients and Methods: Prospective study including all patients referred for TAVI due to their high surgical risk or being inoperable. All-cause mortality, secondary stroke, permanent pacemaker implantation, vascular complications, prosthetic and periprosthetic regurgitation, Karnosfky test and Functional Capacity (FC) were assessed as endpoints. Results: We evaluated 26 patients with a mean age of 82 years (74% women) in whom 27 procedures were done. The mean Society of Thoracic Surgeons score was 8.8%. Overall mortality at 30 days, one and two years was 11.1, 18.5 and 29.6% respectively. Karnofsky score increased significantly from 62.3% at baseline to 83.9; 88.6 and 88.8% at six months, one and two years, respectively. Prior to the procedure, FC was 3.1 ± 0.6, decreasing significantly to 1.2; 1.3 and 1 at six months, one and two years of follow up. Conclusions: TAVI is an effective alternative treatment for patients with severe symptomatic AS and high surgical risk.

[Transcatheter aortic valve implantation.Experience in 26 patients]. / Experiencia inicial del implante percutáneo de válvula aórtica en el Instituto Nacional del Tórax.

BACKGROUND: Aortic valve stenosis (AS) is the most common valvular disease. Its surgical indication is undisputed in symptomatic severe AS, however, 30% of patients are at high surgical risk or inoperable. Transcatheter Valve Implantation (TAVI) is an alternative for this group of patients. AIM: To describe the clinical outcomes of TAVI in a group of patients treated at the Instituto Nacional del Tórax, Santiago, Chile. PATIENTS AND METHODS: Prospective study including all patients referred for TAVI due to their high surgical risk or being inoperable. All-cause mortality, secondary stroke, permanent pacemaker implantation, vascular complications, prosthetic and periprosthetic regurgitation, Karnosfky test and Functional Capacity (FC) were assessed as endpoints. RESULTS: We evaluated 26 patients with a mean age of 82 years (74% women) in whom 27 procedures were done. The mean Society of Thoracic Surgeons score was 8.8%. Overall mortality at 30 days, one and two years was 11.1, 18.5 and 29.6% respectively. Karnofsky score increased significantly from 62.3% at baseline to 83.9; 88.6 and 88.8% at six months, one and two years, respectively. Prior to the procedure, FC was 3.1 ± 0.6, decreasing significantly to 1.2; 1.3 and 1 at six months, one and two years of follow up. CONCLUSIONS: TAVI is an effective alternative treatment for patients with severe symptomatic AS and high surgical risk.

'Mother-in-child' thrombectomy technique: a novel and effective approach to decrease intracoronary thrombus burden in acute myocardial infarction.

BACKGROUND: The presence of large thrombus burden in patients presenting with acute myocardial infarction (AMI) is common and associated with poor prognosis. This study aimed to describe the feasibility and safety of the novel 'mother-in-child' thrombectomy (MCT) technique in patients presenting with AMI and large thrombus burden undergoing percutaneous coronary intervention (PCI). METHODS: We studied 13 patients presenting with AMI who underwent PCI with persistent large intracoronary thrombus after standard thrombectomy. The procedure was performed using a 5F 'Heartrail II-ST01' catheter (Terumo Medical) into a 6F guiding system. Angiographic assessment of thrombus burden and coronary flow was obtained at baseline, immediately after thrombectomy and at the end of the procedure. RESULTS: The mean age was 55.9±13.0 years and involved mostly males (76.9%). All patients underwent PCI via radial approach. Following MCT Thrombolysis In Myocardial Infarction (TIMI) flow improved by 2 or more degrees in 11 patients (84.5%), while visible angiographic thrombus was reduced in 11 patients (84.5%). In the final angiogram, normal TIMI flow was restored in 11 patients (84.5%), with normal myocardial 'blush' in 7 patients (53.8%) and total clearance of a visible thrombus in 7 patients (53.8%). Overall, 6 patients received thrombectomy as 'stand-alone' procedure. All patients were discharged alive after a mean of 5.6±2 days. CONCLUSION: This initial report suggests that significant reduction in thrombus burden and improvement of the coronary flow can be safely achieved in patients presenting with AMI and large thrombus burden by using the novel MCT technique.

Seguridad de la angioplastía coronaria ambulatoria por vía transradial: experiencia de un centro / Safety of trans-radial ambulatory coronary angioplasty: a single center experience

Introducción: El número creciente de intervenciones coronarias ha generado una demanda mayor de camas hospitalarias. Se ha reportado que luego de un periodo postintervención de 4 a 6 horas no se observan complicaciones asociadas a la angioplastía coronaria (AC). Objetivo: Evaluar la seguridad del alta precoz luego de la angioplastía coronaria. Material y métodos: Se analizaron los pacientes (pts) sometidos a AC y dados de alta luego de una observación de 4 horas, en el período comprendido entre Enero 2004 y Agosto 2010. Se analizaron las variables clínicas y angiografías. Se consideraron criterios de seguridad: infarto y/o trombosis del stent, complicaciones hemorrágicas y mortalidad hasta los 30 días. Resultados: Se realizó AC ambulatoria a 414 pacientes con una edad de 63.17 +/- 10.4 años. 80 por ciento fueron hombres. El 53 por ciento fueron portadores de enfermedad de 2 y 3 vasos. La AC fue exitosa en el 95.9 por ciento de casos. El 49 por ciento de las lesiones tratadas fueron de complejidad mayor (tipo B2 y C). Se analizaron los índices de seguridad en tres periodos: 4 a 24 horas, 24 horas a 7 dias y de 7 días a 30 días, observándose solo 3 hemorragias menores en el período más precoz y ningún sangramiento mayor, nueva revascularización, infarto agudo del miocardio, accidente cerebrovascular, ni mortalidad en ninguno de los tiempos analizados. Conclusión: El alta precoz luego de la AC por vía radial es un procedimiento seguro independiente de la complejidad de la anatomía coronaria.

The increasing number of percutaneous coronary angioplasty (PTCA) procedures poses a strain on the availability of hospital. There is evidence that no complications of PTCA are observed 4 o 6 hr after the procedure. Aim: To evaluate the safety of early discharge after PTCA Methods: Patients submitted to PTCA from January to August 2010 who were discharged after a 4 hr observation period had their clinical and angiographic characteristics assessed. Infarction, stent thrombosis and 30 day mortality were determined. Results: 414 patients were included. Mean age was 63.2 years (SD 10.4), 80 percent of them males. 53 per cent had 2 or 3 vessel disease. PTCA was successful in 95.9 percent of cases. 49 per cent of coronary artery lesions were type B2 or C. 3 minor bleeding episodes occurred before 24 hr after the procedure. No major bleedings, new revascularization, acute myocardial infarction, stroke were seen up to 30 days post procedure. There was no mortality. Conclusion: Early discharge after trans-radial artery PTCA is safe even for treatment of complex coronary artery lesions.

Oxidative stress in pericardial fluid and plasma and its association with ventricular function.

UNLABELLED: There are no studies evaluating oxidative stress markers both in pericardial fluid and plasma and whether they correlate with cardiac function indexes. The purpose of the study was to investigate whether oxidative stress markers in pericardial fluid and plasma are associated with left ventricular function. METHODS AND RESULTS: Twenty-eight consecutive patients (class I or II NYHA) scheduled for myocardial revascularization, valve replacement, valve repair or closure of atrial septal defect. Plasma and pericardial fluid were collected and malondialdehyde, catalase, superoxide dismutase and glutathione peroxidase were determined. Left ventricular ejection fraction, left ventricular end diastolic diameter and left ventricular end systolic diameter were determined as echocardiographic indexes of ventricular function. We found that oxidative stress determined by a simple malondialdehyde (MDA) assay, correlated in plasma and pericardial fluid, and this parameter was associated with left ventricular end systolic diameter. CONCLUSION: Plasma and pericardial fluid malondialdehyde levels can be used as an early marker of ventricular dysfunction.

Oral rapamycin to prevent human coronary stent restenosis: a pilot study.

BACKGROUND: Recent human trials with rapamycin-eluting stents have shown very low restenosis rates. However, the high costs of these devices preclude their use in routine angioplasty, especially when considering multiple stenting. We evaluated whether orally administered rapamycin inhibits in-stent neointimal growth in patients with unstable angina. METHODS: We enrolled 15 patients successfully treated with the implantation of a single stent in a single de novo lesion in native coronary arteries. Correct stent expansion and apposition were corroborated with intravascular ultrasound scanning in all patients. Patients received aspirin, clopidogrel, and atorvastatin for 6 months. Rapamycin was administered in a loading dose of 5 mg, followed by 2 mg/day for 4 weeks. RESULTS: The reference diameter was 3.4 +/- 0.4 mm, lesion length was 11.2 +/- 2 mm, lesion type B1 was 36%, and lesion type B2 was 64%. After the procedure, in-stent minimal lumen diameter and diameter stenosis (DS) were 3.3 +/- 0.4 mm and 0.3% +/- 7.5%, respectively. At 10 days, plasma levels of rapamycin were 7.95 +/- 2.6 ng/mL. At 6 months, angiographic determinations demonstrated an in-stent minimal lumen diameter of 2 +/- 1 mm, an in-stent DS of 41.3% +/- 28.0%, and an in-stent late loss of 1.4 +/- 1.1 mm. Binary restenosis (>50% DS) was present in 6 of 15 patients (40%). Target lesion revascularization (coronary artery bypass grafting) was performed in 2 of 15 patients (13.3%). There were no serious adverse events during the 6-month period of follow-up, but 1 patient had severe heartburn caused by esophagitis, and another patient had herpes zoster at the end of the protocol. CONCLUSIONS: Oral rapamycin was well tolerated, but did not suppress in-stent neointimal growth in this small group of patients.

Desbalance autonómico y procoagulación debido a contaminación atmosférica en Santiago: un estudio prospectivo / Autonomic imbalance and procoagulation due to Santiago’s atmospheric pollution: a prospective study

La contaminación atmosférica (CA) está asociada a aumento de morbilidad cardiovascular a través de mecanismos poco conocidos. Postulamos que la CA por partículas finas se asocia a disminución de la variabilidad de la frecuencia cardíaca (VFC) y a aumento de parámetros procoagulantes. Métodos: Cohorte prospectiva de 6 meses de duración en Santiago (n=88; edad 57±1 años; 44 pts.s con enfermedad coronaria y 44 controles pareados por edad, sexo y comuna de residencia). En cada sujeto se realizó Holter de arritmias de 24 hrs y se determinó proteína C reactiva, viscosidad plasmática, hematocrito y recuento de plaquetas durante un episodio de aumento de la CA y 6 meses después. Se obtuvieron los niveles diarios contemporáneos de partículas PM 2,5 y se analizaron sus efectos sobre la VFC y sobre los parámetros circulantes utilizando modelos aditivos generalizados con ajuste por condiciones meteorológicas, condición caso/control, edad, sexo, índice de masa corporal, colesterol total y HDL, presión arterial sistólica y diastólica, creatinina y uso de aspirina o de betabloqueadores. Resultados: Las concentraciones elevadas de partículas PM 2,5 en el aire los días previos a la medición se asociaron en forma independiente y significativa (p<0,05) con aumento de la FC y disminución en la desviación standard de los intervalos RR normales (SDNN). Se observó además una asociación independiente y significativa (p<0,05) con aumento de la viscosidad plasmática, hematocrito, VHS y del recuento de plaquetas. Conclusiones: Los resultados muestran que la CA por partículas pequeñas disminuye la VFC y aumenta parámetros circulantes de procoagulación, que podrían ser mecanismos que expliquen un aumento de la morbimortalidad cardiovascular debido a CA.

Predicción del diámetro del tronco de la coronaria izquierda a partir del diámetro de sus ramas / Diameter of left main coronary artery by estimating the diameter of its branches

Una de las limitaciones del análisis angiográfico de las coronarias es la determinación de la magnitud de las lesiones del tronco común. Una situación especialmente compleja se presenta frente a la coexistencia de tronco corto y una lesión difusa de este mismo vaso. En esta situación es muy difícil definir el grado de estenosis, en ausencia de un lumen sano con el cual comparar. El propósito de este trabajo fue validar angiográficamente formas que permitieran predecir el diámetro del tronco común a partir de sus ramas. Con este fin elaboramos una fórmula partiendo de la hipótesis de que el área del tronco es igual a la suma del área de la descendente anterior (DA) y de la circunfleja (C), corregida por un factor de progresión distal del área. La expresión matemática de esta suposición, despejando el diámetro calculado del tronco (DTc), es la siguiente: DTc=2*rad.DA+rad.C+FC.(FC=factor de progresión de área). Comparamos esta fórmula con otra derivada del postulado de que el cubo del diámetro de un vaso es igual a la suma del cubo de sus ramas (DTc=d3 DA + d3 Cx). Evaluamos estas fórmulas midiendo los diámetros de estos vasos en 27 coronariografías definidas previamente como libres de enfermedad coronaria. Se efectuó análisis de regresión y correlación entre el diámetro calculado del tronco (DTc) y el medido según la fórmula (DTm). La ecuación de regresión fue: DTc=1.04 DTm+0.01 mm; Error St Estim.= 0.81; r= 0.92; p<0.0001, para la fórmula basada en la igualdad de las áreas de sección, siendo el FC despreciable por su pequeña magnitud. Para la Fórmula basada en la igualdad de los volúmenes la ecuación de regresión fue:DTc=0.92 DTm+0.03 mm; Error St Estim. +0.73;r= 0.92; p<0.0001. En conclusión, hemos validado fórmulas capaces de predecir el diámetro del tronco a partir de los diámetros de DA y C., siendo de esperar aproximadamente un 10% de variación en la predicción, probablemente por error de medición