La guía europea de dislipemia. Fortalezas y debilidades / European guidelines on dyslipidemia. Strengths and weaknesses

La guía conjunta de la Sociedad Europea de Cardiología y la European Atherosclerosis Societypara el manejo de la dislipemia incluye varios aspectos de interés clínico: la estratificación del riesgo como base de la decisión del tratamiento hipolipemiante y su intensidad; el colesterol unido a lipoproteínas de baja densidad como diana terapéutica principal; la delimitación de objetivos terapéuticos de este parámetro según el riesgo (< 70 mg/dl para los pacientes de riesgo muy alto y < 100 mg/dl para los de riesgo alto); el énfasis en las estatinas potentes y a dosis altas como tratamiento básico para alcanzar dichos objetivos, y las recomendaciones específicas en diversos escenarios de interés clínico como ancianos, mujeres, prevención secundaria, disfunción renal y otros (AU)

The joint guidelines of the European Society of Cardiology and the European Atherosclerosis Society on the management of dyslipidemia include a number of interesting clinical features: risk stratification provides the basis for selecting the type and intensity of lipid-lowering treatment; the principal therapeutic target is the low-density lipoprotein cholesterol level; the precise treatment target for this parameter depends on the level of risk (<70 mg/dl for very-high-risk patients and <100 mg/dl for high-risk patients); potent statins, given at a high dose, are the drugs of choice for achieving these goals; and particular recommendations must be followed for a number of common clinical scenarios: e.g. the elderly, women, patients with chronic kidney disease and secondary prevention (AU)

El exceso de peso es el principal determinante de la hipertrigliceridemia posprandial / Overweight is the main determinant of excessive increase of triglycerides after meals

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Implantación transfemoral directa de válvula aórtica en paciente con prótesis mitral previa / Direct transfemoral aortic valve implantation in a patient with a mechanical mitral prosthesis

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Coronary lesions quantification with dual-axis rotational coronary angiography.

BACKGROUND: Coronary angiography (CA) has been the gold standard technique for studying coronary artery disease. It is based on the analysis of bidimensional orthogonal projections that may not be optimal to estimate determinate coronary segments. Rotational angiography "Xperswing" (DARCA) is a new technique that allows the visualization of the coronary arteries from multiple views, with a single contrast injection. The aim of this study is to evaluate the coronary lesions quantification with DARCA. METHODS: Quantitative coronary analysis of significant coronary stenosis (>50%) was performed. Every lesion was measured in two different projections: the "optimal projection", obtained by DARCA and defined by the operator as the one with a better lesion qualification, and the "standard projection", corresponding to the usual projection closer to the optimal one in obliquity and angulation. Measures were performed twice and by two independent operators. Intra- and inter-observer correlation was estimated by Kappa index and variables were compared with t Student test (SPSS 14.0). RESULTS: 205 lesions in 147 patients were analyzed. Kappa coefficient intra-observer was 0.80 and 0.86 respectively with an inter-observer correlation index of 0.72. Lesion length and maximal diameter of the vessel were significantly greater in the group of RA. In the segments analysis, calculated length was longer for the first diagonal branch, first marginal obtuse artery, middle circumflex, middle and distal RCA and posterior descending artery, with greater reference diameters for proximal LAD and distal RCA. There were no significant differences for coronary stenosis grade. CONCLUSIONS: RA XperSwing provides a better visualization of coronary arteries improving lesions characterization, with longer measured lesions length and greater vessel diameters, especially in coronary segments with more angulation.

Estratificación del riesgo cardiovascular: importancia y aplicaciones / Cardiovascular risk assessment: relevance and usefulness

En las nuevas «Guías para el manejo de las dislipemias» de la Sociedad Europea de Cardiología se destaca la importancia clínica de calcular el riesgo cardiovascular total individual como base de las decisiones de tratamiento preventivo ulteriores. El baremo aconsejado es el SCORE modificado con la inclusión del colesterol unido a lipoproteínas de alta densidad, con el que los sujetos asintomáticos se catalogan en riesgo muy alto (> 10%), alto (5-10%), moderado (1-5%) o bajo (< 1%) de fallecer por una causa cardiovascular en los siguientes 10 años. Algunos marcadores o factores de riesgo complementarios (otros parámetros lipídicos y analíticos, técnicas de imagen como la ecografía carotídea, el calcio coronario o el índice tobillo/ brazo) se consideran útiles para afinar la cuantificación del riesgo de los sujetos en la categoría intermedia (AU)

The latest guidelines on the management of dyslipidemia produced by the European Society of Cardiology (ESC) emphasize that preventative treatment should be based on an assessment of the individual’s total cardiovascular risk. The recommended assessment tool is the modified SCORE (Systematic Coronary Risk Evaluation) risk chart, which takes high-density lipoprotein cholesterol into account. The chart classifies asymptomatic patients according to their risk of dying from cardiovascular disease in the next 10 years: very high (>10%), high (5-10%), moderate (1-5%) or low (<1%). The use of additional complementary risk markers or risk factors (e.g. other lipid or laboratory parameters, the results of imaging techniques such as carotid ultrasonography, the coronary calcium score or the ankle-brachial index) are considered useful for refining risk assessment in intermediate-risk patient (AU)

Red de Chiari y fibrilación auricular paroxística / Chiari's network and paroxysmal atrial fibrillation

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Indicaciones actuales del tratamiento trombolítico en el infarto agudo de miocardio / Current indications for thrombolytic treatment of acute myocardial infarction

La trombolisis es menos eficaz que la intervención coronaria percutánea primaria, pero debe utilizarse cuando esta no es factible. La administración prehospitalaria reduce los retrasos y aumenta el beneficio de la trombolisis; el tratamiento fibrinolítico practicado menos de 2 h tras el comienzo del infarto tiene resultados similares a la revascularización mecánica. La «angioplastia facilitada» (administración de fibrinolíticos previa a la angioplastia primaria) no se considera indicada; sí lo están la angioplastia de rescate ante el fracaso del fibrinolítico y la revascularización diferida en cualquier caso. Las guías de práctica clínica detallan las indicaciones, los intervalos temporales, las contraindicaciones y las dosis recomendadas de los trombolíticos para utilizarlos correctamente y obtener su máximo beneficio (AU)

Although thrombolysis is less effective than primary percutaneous coronary intervention, it has to be used when the latter is not feasible. Prehospital administration reduces the treatment delay and increases the benefit of thrombolysis. Use of fibrinolytic therapy within the first 2 hours after the onset of an infarct gives results comparable to mechanical revascularization. At present, there are no indications for facilitated angioplasty (i.e. the administration of fibrinolytics prior to primary angioplasty). However, rescue angioplasty may be carried out when thrombolysis fails and deferred revascularization should be performed whenever possible. Clinical practice guidelines describe the indications, contraindications and the recommended doses for thrombolytics. These ensure that the drugs are used correctly and provide the maximum clinical benefit (AU)

Concordancia entre la determinación de triglicéridos en sangre capilar y por el método tradicional / Measurement of triglycerides in capillary blood: validation against whole blood measurement

Fundamentos y objetivo: La hipertrigliceridemia es un factor de riesgo cardiovascular independiente, que forma parte del síndrome metabólico y del síndrome dismetabólico posprandial. La determinación de los triglicéridos (TG) en sangre capilar sin duda facilitaría el diagnóstico de esas alteraciones. El objetivo del presente estudio fue analizar la concordancia entre los valores de TG medidos en sangre total y capilar (Accutrend® GCT Roche Diagnostics). Pacientes y método: Se incluyó a 50 voluntarios sin enfermedad cardiovascular, en quienes se determinaron simultáneamente los TG en sangre capilar y por venopunción. Resultados: Se observaron valores más altos en la determinación capilar (116,5mg/dl frente a 86,0mg/dl; p<0,001) y una correlación excelente entre ambas determinaciones (r=0,95; p<0,001). Conclusiones: En esta muestra de pacientes consecutivos no seleccionados demostramos que la medición capilar de TG se correlaciona excelentemente con la medición en sangre y que existen diferencias relevantes en las determinaciones entre ambos sexos. Se proponen ecuaciones de regresión para la estimación de los valores de TG en sangre a partir de una determinación capilar: varones: TG capilar X 0,837; mujeres: TG capilar X 0,698 (AU)

Background and objective: Elevated plasma triglycerides (TG) are an independent cardiovascular risk factor and a part of metabolic and postprandial syndromes. Capillary analysis of TG would facilitate the recognition of those abnormalities. The aim of the present study was to assess the concordance between TG values measured in capillary (Accutrend® GCT Roche Diagnostics) and total blood. Patients and methods: Total blood and capillary TG were analyzed in 50 subjects without cardiovascular disease. Results: Mean capillary TG were higher than total blood TG (116.5mg/dl vs 86.0mg/dl; P<.001); a good correlation between both methods was obtained (r=0.95; P<.001). Conclusions: in this cohort of consecutive unselected subjects we found that capillary TG measurement correlates well with total blood analysis and that there are significant differences between men and women. We propose regression equations to estimate blood TG from capillary measurements: men: capillary TG X 0,837; women: capillary TG X 0,698 (AU)

[Measurement of triglycerides in capillary blood: validation against whole blood measurement]. / Concordancia entre la determinación de triglicéridos en sangre capilar y por el método tradicional.

BACKGROUND AND OBJECTIVE: Elevated plasma triglycerides (TG) are an independent cardiovascular risk factor and a part of metabolic and postprandial syndromes. Capillary analysis of TG would facilitate the recognition of those abnormalities. The aim of the present study was to assess the concordance between TG values measured in capillary (Accutrend GCT Roche Diagnostics) and total blood. PATIENTS AND METHODS: Total blood and capillary TG were analyzed in 50 subjects without cardiovascular disease. RESULTS: Mean capillary TG were higher than total blood TG (116.5mg/dl vs 86.0mg/dl; P<.001); a good correlation between both methods was obtained (r=0.95; P<.001). CONCLUSIONS: in this cohort of consecutive unselected subjects we found that capillary TG measurement correlates well with total blood analysis and that there are significant differences between men and women. We propose regression equations to estimate blood TG from capillary measurements: men: capillary TG X 0,837; women: capillary TG X 0,698.

[Obesity, metabolic syndrome and diabetes: cardiovascular implications and therapy]. / Obesidad, síndrome metabólico y diabetes: implicaciones cardiovasculares y actuación terapéutica.

Obesity, metabolic syndrome and type-2 diabetes mellitus are three interrelated conditions that share a number of pathophysiological mechanisms and that are frequently observed to lead, in succession, to cardiovascular complications. The fact that their prevalence is increasing alarmingly should prompt all healthcare professionals urgently to implement measures to prevent these complications. The most effective, though also the least adopted, are those related to lifestyle modification. Drug treatment targeted at controlling risk factors (e.g., hypertension, dyslipidemia, and thrombophilia), metabolic abnormalities, and excess weight is also necessary.

Obesidad, síndrome metabólico y diabetes: implicaciones cardiovasculares y actuación terapéutica / Obesity, Metabolic Syndrome and Diabetes: Cardiovascular Implications and Therapy

Obesidad, síndrome metabólico y diabetes mellitus tipo2 son tres enfermedades interrelacionadas que compartenmecanismos de aparición y evolución y con frecuenciase van combinando sucesivamente y ocasionan complicaciones cardiovasculares. Su prevalencia crecealarmantemente y debería impeler a los profesionales dela salud y a los gestores a implantar medidas urgentespara prevenir la aparición de complicaciones. Las máseficaces, aunque menos practicadas, son las relacionadascon el estilo de vida. También son necesarios tratamientos farmacológicos destinados al control de los factores de riesgo (hipertensión, dislipemias, trombofilia), las alteraciones metabólicas y el propio exceso de peso

Obesity, metabolic syndrome and type-2 diabetesmellitus are three interrelated conditions that share anumber of pathophysiological mechanisms and that arefrequently observed to lead, in succession, tocardiovascular complications. The fact that theirprevalence is increasing alarmingly should prompt allhealthcare professionals urgently to implement measuresto prevent these complications. The most effective,though also the least adopted, are those related tolifestyle modification. Drug treatment targeted atcontrolling risk factors (e.g., hypertension, dyslipidemia, and thrombophilia), metabolic abnormalities, and excess weight is also necessary

Electrocardiograma preoperatorio: ¿rutina inútil o herramienta esencial? / The preoperative electrocardiogram: meaningless routine or essential tool?

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