[Epidemiological characteristics of heart transplant recipients in Peru 2010-2020]. / Características epidemiológicas de receptores de trasplante cardiaco en el Perú, 2010-2020.

Objective: To evaluate the epidemiological, clinical, surgical, pathological characteristics and outcomes in the follow-up of heart transplant recipients at the National Cardiovascular Institute during 2010-2020. Material and Methods: A retrospective descriptive study was performed by reviewing the medical records of patients undergoing heart transplantation at a national referral center, describing the clinical, surgical, laboratory, pathology characteristics and survival of patients up to 10 years of follow-up. Results: Eighty-six patients were transplanted in 10 years, the median age was 41 years (RIQ 28-56), being predominantly male (66.3%). The three leading causes of indication for heart transplantation were: dilated cardiomyopathy (48.9%), ischemic heart disease (17.4%), and myocarditis (6.9%). Total ischemia time was 160 minutes (RIQ 129.7-233.5). Survival at one, five, and ten years was 84.8%, 73.6%, and 65.7% respectively. The main cause of death was non-cardiac: infectious (39.1%) and of unknown origin (26%). Conclusions: The main etiology of heart failure in heart transplant recipients in Peru in recent years was nonischemic dilated cardiomyopathy. We observed that the survival rate was similar to that of international registries; however, the rate of mortality due to infectious causes and death of unknown origin is high, which poses a challenge in the management of post-transplant patients.

[Incessant focal atrial tachycardia as a cause of cardiomyopathy. About a case]. / Taquicardia atrial focal incesante como causa de cardiomiopatía. A propósito de un caso.

Focal atrial tachycardia is a rare type of supraventricular tachyarrhythmia, generally present in young people, and is a rare cause of tachycardiomyopathy (10%). We present a clinical case of tachycardiomyopathy in a 30-year-old man, without comorbidities, who was diagnosed with incessant focal atrial tachycardia, refractory to medical therapy, and electrical cardioversion. Successful endocardial ablation was performed, and in outpatient follow-up at 6 months, he showed a recovery of the left ventricular ejection fraction and reduction of the left chambers to normal ranges, with progressive decrease of dyspnea.

[Cardiac Amyloidosis: Experience in a National Reference Cardiovascular Institute]. / Amiloidosis Cardíaca: Experiencia en un Instituto Cardiovascular de Referencia Nacional.

Objectives: To determine the clinical, imaging and laboratory characteristics and one year after diagnosis survival of patients with cardiac amyloidosis in a national reference hospital. Materials and methods: Case series study. We evaluated the clinical characteristics, complementary examinations and survival of patients with cardiac amyloidosis diagnosed, treated and followed up in the Clinical Cardiology service of the National Cardiovascular Institute - INCOR EsSalud in Lima, Peru. Results: We found eight patients with diagnosis of cardiac amyloidosis. The median age was 64.5 years and 75% were male. The etiology of cases was unspecified cardiac amyloidosis (25%), transthyretin cardiac amyloidosis (37.5%), and light chain cardiac amyloidosis (37.5%). Symptomatic heart failure (NYHA II-III) was the most common initial presentation symptom (87.5%). The most frequent extracardiac manifestations were: sensory-motor neuropathy (62.5%), musculoskeletal (37.5%), nephropathy (25%), bilateral carpal tunnel syndrome (25%), monoclonal gammopathies (25%) and refractory pleural effusion (25 %). Survival at one year was 75% and the cause of the 2 deaths was sudden death. Conclusions: In this study of cardiac amyloidosis at a specialized center, the most frequent clinical manifestations were heart failure and sensory-motor neuropathy. Mortality was 25% per year, and in all cases as sudden death.

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI).

OBJECTIVES: The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. METHODS: Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. RESULTS: Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction <40% after infarction (Group 1). Age>75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age>75 years, and the absence of electrocardiographic signs of reperfusion. CONCLUSIONS: Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI) / Insuficiencia cardiaca complicando el infarto de miocardio. Un reporte de Peruvian Registry of ST-elevation Myocardial Infarction (PERSTEMI)

Abstract Objectives: The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. Methods: Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. Results: Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction <40% after infarction (Group 1). Age > 75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age > 75 years, and the absence of electrocardiographic signs of reperfusion. Conclusions: Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Resumen Objetivos: Se desea saber la incidencia, los factores asociados y la mortalidad a 30 días de los pacientes con insuficiencia cardiaca (IC) postinfarto de miocardio con elevación del segmento ST (IMCEST) en Perú. Métodos: Estudio observacional, de cohortes, multicéntrico a nivel nacional, de pacientes enrolados en el registro peruano de IMCEST, excluyendo los pacientes con antecedente de IC. Se compararon las características epidemiológicas, tratamiento y evolución a 30 días de los pacientes con (grupo 1) y sin (grupo 2) IC postinfarto. Resultados: De 388 pacientes se encontró un 48.7% con síntomas de IC o fracción de eyección de ventrículo izquierdo < 40% postinfarto (grupo 1). La edad > 75 años, el infarto de pared anterior y la ausencia de signos electrocardiográficos de reperfusión fueron los factores relacionados a mayor incidencia de IC. La mortalidad intrahospitalaria en el grupo 1 fue del 20.6% y los factores independientes relacionados a mayor mortalidad fueron la edad > 75 años y la ausencia de signos electrocardiográficos de reperfusión. Conclusiones: La IC complica casi al 50% de pacientes con IMCEST y está asociada a mayor mortalidad intrahospitalaria y a 30 días. La edad > 75 años y la ausencia de ondas T negativas en el electrocardiograma posreperfusión son factores independientes de mayor incidencia de IC y de mortalidad a 30 días.

Impacto del intervencionismo percutaneo en lesiones complejas en el INCOR - EsSalud (imleco) / Impact of the interventionism percutaneo in complex injuries in the INCOR - EsSalud (imleco)

Objetivos: Evaluar la asociación entre la complejidad de las lesiones y los resultados angiogrßficos, eventos clínicos adversos al mes, a los 6 meses y al a±o. Métodos: Se revisaron retrospectivamente las historias clínicas de 154 pacientes que fueron sometidos a intervencionismo percutßneo coronario en el Instituto Nacional del Corazón- Hospital Guillermo Almenara Irigoyen, entre octubre del 2001 a setiembre del 2002. Se trataron 156 lesiones, de las cuales 91 eran lesiones complejas (definida como la lesión que muestra trombo, calcificación, lesión ostial, bifurcación, aneurisma, oclusión crónica o lesión en puente safeno) y 65 no complejas. Se analizaron variables clínicas, angiogrßficas y resultados de eventos adversos en el seguimiento. Resultados: La edad media de los pacientes fue de 61,7±10,2 a±os, el 83,8 por ciento correspondía al sexo masculino, 63,6 por ciento eran hipertensos y 18,8 por ciento diabéticos. El intervencionismo en lesiones complejas estuvo relacionado con mayor tasa de complicaciones periprocedimiento como fenómeno de no reflujo (71,4 por ciento, p< 0,000), compromiso de brazo colateral (39,6 por ciento, p< 0,000), disección (8,8 por ciento, p< 0,014), embolización distal ( 7,7 por ciento, p<0,02), y eventos adversos al mes de muerte (p< 0,08), muerte/IM (p<0,05), cirugía (p<0,014), muerte/IM/RM( p<0,01), muerte/IM/RM/H (p<0,004), a los 6 meses muerte(p<0,02), muerte/IM (p<0,009), muerte/IM/RM, muerte/IM/RM/H (p< 0,000) y al a±o muerte. Cirugía, muerte/IM, muerte/IM/RM y muerte/IM/RM/H (p<0,01). Conclusiones: Los pacientes con lesiones complejas presentaron una mayor tasa significativa de complicaciones periprocedimiento y eventos adversos (muerte, cirugía, Muerte/infarto, muerte/infarto/revascularización ymuerte/infarto/revascularización/rehospitalización) al mes, a los 6 meses y al a±o.

OBJECTIVES: To evaluate association between coronary lesion complexity and angiographic results, clinical events at first, sixth and twelveth month. METHODS: We retrospectively reviewed clinical charts of 154 patients who underwent coronary percutaneous intervention at the Instituto Nacional del Corazón (INCOR) - National Hospital Guillermo Almenara Irigoyen, between October 2001 and September 2002. 156 lesiones were treated, 91 of them were complex ones (defined as a lesion with thrombus, calcified, ostial lesion, bifurcation, with aneurysm, closed cronically or lesion of a vein graft) and 65 non complex lesions. Clinical, angiographic and clinical events during the foolw up were analyzed. RESULTS: Mean age was 61.7±10.2 years old, 83.8 percent were male, 63.6 per cent had hypertension and 18.8 per cent were diabetic. Intervention in complex lesions was associated with higher rate of periprocedure complications as non reflow phenomenon(71.4 per cent pï0.000), side branch compromise (39.6 per cent pï0.000), dissection (8.8 per cent pï0.014), distal embolisation (7.7 per cent pï0.02) and adverse clinical events at one month of death (pï0.08), death/MI (pï0.05), CABG (pï0.014), death/MI/CABG (pï0.01), death/MI/CABG/hospitalization (pï0.004), at six months death (pï 0.02), death/MI (pï0.009), death/MI/CABG, death/MI,CABG/ hospitalization (pï0.000 ) and death at a year as CABG/death/ MI, death/I/CABG and death/MI,CABG/hospitalization (pï0.01). CONCLUSIONS: Patients with complex lesions showed higher rate of periprocedure complications and adverse cinical events (death, CABG, death/MI, death/MI/CABG and death/MI,CABG/hospitalization) at one, 6 and 12 months.