Blood flow effects in a patient with a thoracic aortic endovascular prosthesis.

This work analyzes hemodynamic phenomena within the aorta of two elderly patients and their impact on blood flow behavior, particularly affected by an endovascular prosthesis in one of them (Patient II). Computational Fluid Dynamics (CFD) was utilized for this study, involving measurements of velocity, pressure, and wall shear stress (WSS) at various time points during the third cardiac cycle, at specific positions within two cross sections of the thoracic aorta. The first cross-section (Cross-Section 1, CS1) is located before the initial fluid bifurcation, just before the right subclavian artery. The second cross-section (Cross-Section 2, CS2) is situated immediately after the left subclavian artery. The results reveal that, under regular aortic geometries, velocity and pressure magnitudes follow the principles of fluid dynamics, displaying variations. However, in Patient II, an endoprosthesis near the CS2 and the proximal border of the endoprosthesis significantly disrupts fluid behavior owing to the pulsatile flow. The cross-sectional areas of Patient I are smaller than those of Patient II, leading to higher flow magnitudes. Although in CS1 of Patient I, there is considerable variability in velocity magnitudes, they exhibit a more uniform and predictable transition. In contrast, CS2 of Patient II, where magnitude variation is also high, displays irregular fluid behavior due to the endoprosthesis presence. This cross-section coincides with the border of the fluid bifurcation. Additionally, the irregular geometry caused by endovascular aneurysm repair contributes to flow disruption as the endoprosthesis adjusts to the endothelium, reshaping itself to conform with the vessel wall. In this context, significant alterations in velocity values, pressure differentials fluctuating by up to 10%, and low wall shear stress indicate the pronounced influence of the endovascular prosthesis on blood flow behavior. These flow disturbances, when compounded by the heart rate, can potentially lead to changes in vascular anatomy and displacement, resulting in a disruption of the prosthesis-endothelium continuity and thereby causing clinical complications in the patient.

Geographic differences in patients with acute myocardial infarction in the PARADISE-MI trial.

AIM: The globalization of clinical trials has highlighted geographic differences in patient characteristics, treatments, and outcomes. We examined these differences in PARADISE-MI. METHODS AND RESULTS: Overall, 23.0% were randomized in Eastern Europe/Russia, 17.5% in Western Europe, 12.2% in Southern Europe, 10.1% in Northern Europe, 12.0% in Latin America (LA), 9.3% in North America (NA), 10.0% in East/South-East Asia and 5.8% in South Asia (SA). Those from Asia, particularly SA, were different from patients enrolled in the other regions, being younger and thinner. They also differed in terms of comorbidities (high prevalence of diabetes and low prevalence of atrial fibrillation), type of myocardial infarction (more often ST-elevation myocardial infarction), and treatment (low rate of primary percutaneous coronary intervention). By contrast, patients from LA did not differ meaningfully from those randomized in Europe or NA. Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (34.8%) and beta-blockers (65.5%) was low in SA, whereas mineralocorticoid receptor antagonist use was lowest in NA (22%) and highest in Eastern Europe/Russia (53%). Rates of the primary composite outcome of cardiovascular death or incident heart failure varied two-fold among regions, with the lowest rate in SA (4.6/100 person-years) and the highest in LA (9.2/100 person-years). Rates of incident heart failure varied almost six-fold among regions, with the lowest rate in SA (1.0/100 person-years) and the highest in Northern Europe (5.9/100 person-years). The effect of sacubitril/valsartan was not modified by region. CONCLUSION: In PARADISE-MI, there were substantial regional differences in patient characteristics, treatments and outcomes. Although the generalizability of these findings to a 'real-world' unselected population may be limited, these findings underscore the importance of considering both regional and within-region differences when designing global clinical trials.

Comorbidity profile and outcomes in patients with chronic heart failure in a Latin American country: Insights from the Colombian heart failure registry (RECOLFACA).

BACKGROUND: Heart failure (HF) is usually accompanied by cardiovascular and non-cardiovascular comorbidities, which may significantly impact its prognosis. In this study we aimed to characterize the comorbidity profile and its impact in mortality in patients with HF diagnosis from the Colombian Heart Failure Registry (RECOLFACA). METHODS: RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess the impact of the comorbidities in mortality. A p-value of <0.05 was considered significant. RESULTS: From the total 2528 patients included in the registry, 2514 patients (58% males, mean age 68 years) had information regarding comorbidity diagnoses. 2321 patients (92.3%) reported at least one comorbidity. Arterial hypertension was the most frequent individual diagnosis (72%; n = 1811), followed by anemia (30.1%, n = 726). The most frequently observed coexisting comorbidities were coronary disease (CHD) with dyslipidemia, and chronic kidney disease (CKD) with type 2 Diabetes Mellitus (T2DM). Different patterns of comorbidity coexistence were observed when comparing HF patients by sex and left-ventricular ejection fraction (LVEF) classification. The only comorbidities that were significantly associated with mortality after multivariate adjustment were T2DM (HR 1.45. 95% CI 1.01-2.12), anemia (HR 1.48. 95% CI 1.02-2.16), and CHD (HR 1.59. 95% CI 1.09-2.33). CONCLUSION: Multiple comorbidities were frequently observed in the patients from the RECOLFACA. T2DM, anemia and CHD were significantly associated with a higher risk of mortality, highlighting the importance of promoting an optimal follow-up and control of these conditions.

Las dislipidemias y su tratamiento en centros de alta complejidad en Colombia / Dyslipidaemias and their treatment in high complexity centres in Colombia

ANTECEDENTES Y OBJETIVO: Los datos sobre la distribución de las dislipidemias en Colombia son limitados. El objetivo primario de este estudio fue describir la frecuencia de las dislipidemias; los objetivos secundarios fueron: la frecuencia de comorbilidades cardiovasculares, el uso de estatinas y otros hipolipemiantes, la frecuencia de intolerancia a estatinas, el porcentaje de pacientes en metas de c-LDL, y estimar la distribución del riesgo cardiovascular (RCV). MATERIALES Y MÉTODOS: Estudio transversal con recolección de datos retrospectiva que incluyó a 461 pacientes con diagnóstico de dislipidemia tratados en 17 centros cardiovasculares de alta complejidad en las 6 principales áreas geográficas y económicas de Colombia. RESULTADOS: La media (DE) de edad de los pacientes incluidos fue de 66,4 (±12,3) años. El 53,4% (246) eran mujeres. Las dislipidemias se distribuyeron así: dislipidemia mixta (51,4%), hipercolesterolemia (41,0%), hipertrigliceridemia (5,4%), hipercolesterolemia familiar (3,3%) y c-HDL bajo (0,7%). El medicamento más prescrito fue atorvastatina (75,7%), seguido de rosuvastatina (24,9%). El 55% del total de pacientes y el 28,6% de aquellos con enfermedad coronaria no estaban en metas de c-LDL a pesar del tratamiento. La frecuencia de intolerancia a estatinas fue del 2,6%. CONCLUSIONES: La dislipidemia mixta y la hipercolesterolemia son las dislipidemias más frecuentes. Un porcentaje considerable de pacientes en tratamiento, incluidos aquellos con enfermedad coronaria, no lograron sus objetivos de c-LDL. Este inadecuado control lipídico influye en el RCV y requiere un cambio en las estrategias terapéuticas, intensificando el tratamiento con estatinas o adicionando nuevos fármacos en los pacientes con mayor RCV

BACKGROUND AND OBJECTIVE: Data is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). MATERIALS AND METHODS: Cross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. RESULTS: Mean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. CONCLUSIONS: Mixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR

Dyslipidaemias and their treatment in high complexity centres in Colombia. / Las dislipidemias y su tratamiento en centros de alta complejidad en Colombia.

BACKGROUND AND OBJECTIVE: Data is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). MATERIALS AND METHODS: Cross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. RESULTS: Mean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. CONCLUSIONS: Mixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR.

Comunicación interventricular post infarto agudo del miocardio / Post acute myocardial infarction interventricular communication

La comunicación interventricular es una de las complicaciones mecánicas posteriores al infarto agudo del miocardio que genera alta morbilidad y mortalidad. Luego del uso de trombolíticos esta complicación ha disminuido y ha hecho que esta entidad sea cada vez menos frecuente. En este artículo se expone el caso de un paciente con síndrome coronario agudo sin terapia de reperfusión inicial, con posterior ruptura del septum interventricular, en quien se evidenció la utilidad de la ecocardiografía en el diagnóstico de dicha entidad.

Interventricular communication is a one of the mechanical complications after acute myocardial infarction that generates high morbidity and mortality. After the use of thrombolytics this complication has decreased and has made it increasingly less frequent. This article presents the case of a patient with acute coronary syndrome without initial reperfusion therapy, with subsequent rupture of the interventricular septum, in whom the use of echocardiography in the diagnosis of this entity evidenced its usefulness.

Woman with Brugada syndrome and epilepsy: a unifying diagnosis?

A woman with a past medical history of epilepsy was transferred to our hospital for episodic changes in mental status, jerking movements, and decreased hearing that were thought to represent seizure activity. While in the hospital, she was diagnosed with Brugada syndrome. Her antiepileptic medications were adjusted while she was monitored on constant electroencephalography, video, and cardiac telemetry. It was found that the patient's seizures were not caused by hypoperfusion of her brain secondary to cardiac arrhythmia. Instead, we theorize that she had an underlying systemic, genetic sodium ion channel dysfunction.

Histoplasmosis epidemica: II. Hallazgos en la Cueva del eden (Cunday, Tolima) / Epidemic hystoplasmosis: II. Findings at the Eden Cave (Cunday, Tolima, Col.)

Se informa el estudio realizado en la Cueva del Eden (Cunday, Tolima) para aislar, de las tierras de la cueva y de murcielagos alli capturados, al Histoplasma Capsulatum, como agente causal de una anterior epidemia de histoplasmosis ocurrida entre visitantes de la cueva. El agente se aislo en 8 de las 27 muestras de tierra y guano de murcielago. Se capturaron 233 ejemplares pertenecientes a 4 generos de murcielagos y en los cultivos practicados en higado, pulmon y bazo de cien de ellos, no fue posible aislar el H. Capsulatum