Multidisciplinary management of cardiovascular disease in women: Delphi consensus.

Background: Current clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women. Methods: Through a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up. Results: After two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men. Conclusions: The high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic.

Exercise-based cardio-oncology rehabilitation for cardiotoxicity prevention during breast cancer chemotherapy: The ONCORE randomized controlled trial.

BACKGROUND: Breast cancer (BC) treatment with anthracyclines and/or anti-human epidermal growth factor receptor-2 (HER2) antibodies is associated with an increased risk of cardiovascular disease complications, including cancer therapy-related cardiac dysfunction (CTRCD). While Cardio-Oncology Rehabilitation (CORe) programs including exercise have emerged to minimize these risks, its role in preventing CTRCD is unclear. OBJECTIVES: We investigated the effectiveness of an exercise-based CORe program in preventing CTRCD [left ventricular ejection fraction (LVEF) drop ≥10% to a value <53% or a decrease >15% in global longitudinal strain (GLS)]. Secondary outcomes examined changes in cardiac biomarkers, physical performance including peak oxygen consumption, psychometric and lifestyle outcomes. Safety, adherence, and patient satisfaction were also assessed. METHODS: This is a randomized controlled trial including 122 early-stage BC women receiving anthracyclines and/or anti-HER2 antibodies, randomized to CORe (n = 60) or usual care with exercise recommendation (n = 62). Comprehensive assessments were performed at baseline and after cardiotoxic treatment completion. The average duration of the intervention was 5.8 months. RESULTS: No cases of CTRCD were identified during the study. LVEF decreased in both groups, but was significantly attenuated in the CORe group [-1.5% (-2.9, -0.1); p = 0.006], with no changes detected in GLS or cardiac biomarkers. The CORe intervention led to significant body mass index (BMI) reduction (p = 0.037), especially in obese patients [3.1 kg/m2 (1.3, 4.8)]. Physical performance and quality-of-life remained stable, while physical activity level increased in both groups. No adverse events were detected. CONCLUSIONS: This study suggests that CORe programs are safe and may help attenuate LVEF decline in BC women receiving cardiotoxic therapy and reduce BMI in obese patients.

Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both sexes equally. However, in comparison to men, in women, it often is underrecognized and undertreated in both primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between women and men, and this may impact how both groups present when they become ill. Moreover, some diseases affect more frequently women than men such as myocardial ischemia or infarction without obstructive coronary disease, Takotsubo syndrome, some atrial arrhythmias, or heart failure with preserved ejection fraction. Therefore, diagnostic and therapeutic strategies that have been established largely on the basis of clinical studies with a predominantly male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes for women with the most frequent cardiovascular pathologies including coronary artery disease, arrhythmia, heart failure, and valvopathies. In addition, we will describe diseases that exclusively affect women that are related to pregnancy, and some of them are life-threatening. Although the lack of research on women plays a role in the poorer outcomes in women, especially in ischemic heart disease, some techniques such as transcatheter aortic valve implantation and transcatheter edge-to-edge therapy seem to have better outcomes in women.

Thirty-second sit-to-stand test as an alternative for estimating peak oxygen uptake and 6-min walking distance in women with breast cancer: a cross-sectional study.

PURPOSE: To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. METHODS: This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18-70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. RESULTS: The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p < 0.001; n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p < 0.001; n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r2 = 0.390; r2 = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). CONCLUSION: The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142.

A randomized trial to evaluate the impact of exercise-based cardiac rehabilitation for the prevention of chemotherapy-induced cardiotoxicity in patients with breast cancer: ONCORE study protocol.

BACKGROUND: Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. METHODS: The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. DISCUSSION: The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142.

Cardiopatía isquémica en la mujer: ¿cada vez más diferencias? / Ischemic heart disease in women: Increasing differences?

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Muerte cardiaca asociada a ganglioneuroma suprarrenal / No disponible

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[Current topics (2005) in clinical cardiology: cardiovascular disease in women]. / Temas de actualidad en cardiología clínica y extrahospitalaria. Un nuevo proyecto: enfermedad cardiovascular en la mujer.

Ischemic heart disease has mistakenly been considered of little relevance to women because it occurs infrequently during the fertile years. This is despite the fact that a larger percentage of women than men die from cardiovascular disease. There are differences in cardiovascular risk factors and disease between females and males, including differences in clinical presentation, disease course, diagnostic criteria, prognosis, and treatment. There is a need for increased information and education, earlier and more aggressive control of risk factors, and a more appropriate approach to diagnosis and treatment. The American Heart Association has published guidelines on the prevention of cardiovascular disease in women and the European Society of Cardiology is planning to publish a scientific statement on the management of heart disease in women. Spanish cardiologists should also consider adopting a similar approach.

[Renal failure is an independent predictor of mortality in hospitalized heart failure patients and is associated with a worse cardiovascular risk profile]. / La insuficiencia renal es un predictor independiente de la mortalidad en pacientes hospitalizados por insuficiencia cardíaca y se asocia con un peor perfil de riesgo cardiovascular.

INTRODUCTION AND OBJECTIVES: Most clinical trials that demonstrated the negative impact of renal failure on survival in patients with congestive heart failure (CHF) included a relatively small proportion of subjects with a high creatinine level and were performed in patients with depressed left ventricular systolic function. Our aim was to investigate the clinical characteristics and prognosis of hospitalized CHF patients with depressed or preserved systolic function and different degrees of renal dysfunction. PATIENTS AND METHOD: The study included 552 consecutive CHF patients admitted to a hospital department of cardiology between 2000-2002. Renal function was determined from the estimated glomerular filtration rate (GFR), and patients were divided into three groups: GFR>60, GFR 30-60, and GFR<30 mL.min per 1.73 m2 (severe renal failure), containing 56.5%, 35.5%, and 8.0% of patients, respectively. RESULTS: Patients with severe renal failure had the worst cardiovascular risk profile: older age, higher prevalence of cardiovascular risk factors, anemia, inflammatory markers in plasma, and less prescription of angiotensin-converting enzyme (ACE) inhibitors. Survival in this patient group was significantly poorer than in other groups (relative risk or RR=2.4; 95% CI, 1.3-4.4) in those with either depressed (RR=3.8; 95% CI, 1.4-10.6) or preserved (RR=2.9; 95% CI, 1.2-6.9) systolic function, independent of other prognostic factors. The negative impact of severe renal failure on prognosis was reduced by ACE inhibitor use. CONCLUSIONS: Renal failure is common and a strong predictor of mortality in hospitalized CHF patients with or without depressed systolic function. It is associated with a worse risk profile.

La insuficiencia renal es un predictor independiente de la mortalidad en pacientes hospitalizados por insuficiencia cardíaca y se asocia con un peor perfil de riesgo cardiovascular / Renal failure is an independent predictor of mortality in hospitalized heart failure patients and is associated with a worse cardiovascular risk profile

Introducción y objetivos. El impacto negativo de la insuficiencia renal (IR) en la supervivencia de los pacientes con insuficiencia cardíaca congestiva (ICC) se ha descrito en ensayos clínicos realizados, principalmente, en pacientes con función sistólica deprimida (FS-D). El objetivo es valorar las características clínicas y el pronóstico en pacientes hospitalizados por ICC y diferentes grados de disfunción renal en los grupos con FS-D y función sistólica preservada (FS-P). Pacientes y método. Se analizó a 552 pacientes ingresados entre el año 2000 y el 2002 en el servicio de cardiología con ICC. La función renal se valoró utilizando la tasa de filtración glomerular (TFG) y se consideraron 3 grupos: TFG > 60, 30-60 y < 30 ml/min/1,73 m² (IR grave) presente en el 56,5, el 35,5 y el 8,0% de los pacientes, respectivamente. Resultados. La IR grave se asoció con el perfil de riesgo cardiovascular más adverso: mayor edad, mayor prevalencia de factores de riesgo cardiovascular, anemia, marcadores de inflamación y una menor prescripción de inhibidores de la enzima de conversión de la angiotensina (IECA). Los pacientes con IR grave tenían una supervivencia inferior a la de los otros grupos (riesgo relativo ([RR] = 2,4; intervalo de confianza [IC] del 95%, 1,3-4,4), tanto en FS-D (RR = 3,8; IC del 95%, 1,4-10,6) como en FS-P (RR = 2,9; IC del 95%, 1,2-6,9) e independiente de otras variables con influencia pronóstica. La prescripción de IECA en los enfermos con IR atenuó el impacto negativo de ésta sobre el pronóstico. Conclusiones. La IR es un predictor común y potente de mortalidad en pacientes hospitalizados por ICC, tanto con FS-P como FS-D, y se asocia con un perfil de riesgo más elevado

Introduction and objectives. Most clinical trials that demonstrated the negative impact of renal failure on survival in patients with congestive heart failure (CHF) included a relatively small proportion of subjects with a high creatinine level and were performed in patients with depressed left ventricular systolic function. Our aim was to investigate the clinical characteristics and prognosis of hospitalized CHF patients with depressed or preserved systolic function and different degrees of renal dysfunction. Patients and method. The study included 552 consecutive CHF patients admitted to a hospital department of cardiology between 2000-2002. Renal function was determined from the estimated glomerular filtration rate (GFR), and patients were divided into three groups: GFR>60, GFR 30-60, and GFR<30 mL/min per 1.73 m² (severe renal failure), containing 56.5%, 35.5%, and 8.0% of patients, respectively. Results. Patients with severe renal failure had the worst cardiovascular risk profile: older age, higher prevalence of cardiovascular risk factors, anemia, inflammatory markers in plasma, and less prescription of angiotensin-converting enzyme (ACE) inhibitors. Survival in this patient group was significantly poorer than in other groups (relative risk or RR=2.4; 95% CI, 1.3-4.4) in those with either depressed (RR=3.8; 95% CI, 1.4-10.6) or preserved (RR=2.9; 95% CI, 1.2-6.9) systolic function, independent of other prognostic factors. The negative impact of severe renal failure on prognosis was reduced by ACE inhibitor use. Conclusions. Renal failure is common and a strong predictor of mortality in hospitalized CHF patients with or without depressed systolic function. It is associated with a worse risk profile

Temas de actualidad en cardiología clínica y extrahospitalaria. Un nuevo proyecto: enfermedad cardiovascular en la mujer / Current Topics (2005) in Clinical Cardiology: Cardiovascular Disease in Women

De acuerdo con los objetivos de las monografías de Temas de Actualidad en Cardiología, y en lo que se refiere a avances en estimulación cardíaca durante el año 2005, conviene destacar para el clínico 3 aspectos de interés. El tratamiento coadyuvante en la insuficiencia cardíaca avanzada y refractaria mediante estimulación biventricular con marcapasos ha pasado a ser una indicación de tipo I, con lo que cabe esperar modificaciones en la práctica clínica. Por otra parte, la Sección de Estimulación Cardíaca, en nombre de la Sociedad Española de Cardiología, ha participado en la elaboración de un documento de consenso nacional sobre enfermedad del sueño donde quedan recogidas las diferentes alteraciones cardíacas relacionadas con el síndrome de apnea del sueño. Las enfermedades del ritmo cardíaco y, en especial, las bradiarritmias constituyen en la actualidad una línea novedosa de investigación para conocer la posibilidad de influir positivamente en la evolución de este síndrome mediante estimulación cardíaca permanente. Finalmente, se tratará sobre los sistemas diseñados para reducir la estimulación innecesaria en el ventrículo derecho que en muchas ocasiones se produce con las diversas modalidades de estimulación antibradicardia. Estos novedosos sistemas evitarán, en buena parte de los pacientes, los conocidos efectos perjudiciales que con frecuencia se observan durante la estimulación en el ápex de ventrículo derecho (AU)

Ischemic heart disease has mistakenly been considered of little relevance to women because it occurs infrequently during the fertile years. This is despite the fact that a larger percentage of women than men die from cardiovascular disease. There are differences in cardiovascular risk factors and disease between females and males, including differences in clinical presentation, disease course, diagnostic criteria, prognosis, and treatment. There is a need for increased information and education, earlier and more aggressive control of risk factors, and a more appropriate approach to diagnosis and treatment.The American Heart Association has published guidelines on the prevention of cardiovascular disease in women and the European Society of Cardiology is planning to (..) (AU)

[Anemia as a new predictor of mortality in patients hospitalized with congestive heart failure]. / Anemia como nuevo predictor de la mortalidad de pacientes hospitalizados por insuficiencia cardíaca congestiva.

BACKGROUND AND OBJECTIVE: The search for novel and modifiable risk factors in heart failure (HF), a condition with still high mortality and morbidity rates, can open new strategies for treatment of a growing number of patients. We decided to evaluate the prevalence of anemia and determine its influence on the prognosis of hospitalized HF patients. PATIENTS AND METHOD: 557 consecutive patients hospitalized for HF between 31st January 2000 and 31st December 2002 in a Cardiology Department of a tertiary hospital were studied. Demographic and clinical characteristics, as well as treatment upon hospital discharge and survival data were obtained in May 2003. RESULTS: Mean follow-up was 1.4 years. 44.5% of the whole group of patients presented anemia with mean (standard deviation) hemoglobin levels of 111 (12) g/l, were older, with higher prevalence of ischemic cardiopathy, had higher levels of globular sedimentation rate but lower cholesterol and glomerular filtration rate levels. The prescription of angiotensin converting enzyme inhibitors and betablockers was less frequent among patients with anemia. The presence of anemia was related in a independent way with higher mortality (relative risk: 2.554; p = 0.001), the relation between survival and haemoglobin levels being direct. CONCLUSION: The prevalence of anemia among hospitalized HF patients is very high and its presence constitutes a powerful mortality determinant in this group of patients.

Anemia como nuevo predictor de la mortalidad de pacientes hospitalizados por insuficiencia cardíaca congestiva / Anemia as a new predictor of mortality in patients hospitalized with congestive heart failure

Fundamento y objetivo: La búsqueda de nuevos factores de riesgo modificables en la insuficiencia cardíaca congestiva (ICC), enfermedad que sigue teniendo una alta mortalidad y morbilidad, puede abrir nuevas vías de tratamiento en el cada vez más amplio grupo de pacientes que la presentan. El objetivo de este estudio ha sido evaluar la prevalencia de la anemia y determinar su influencia sobre el pronóstico de los pacientes hospitalizados por ICC. Pacientes y método: Se ha estudiado a 557 pacientes que ingresaron de forma consecutiva entre el 1 de enero de 2000 y el 31 de diciembre de 2002 en el Servicio de Cardiología de un hospital terciario con el diagnóstico de la ICC. Se han valorado datos demográficos, clínicos, el tratamiento prescrito al alta y la situación vital en mayo de 2003. Resultados: El seguimiento medio ha sido de 1,4 años. Los pacientes con anemia, que constituían el 44,5% del grupo total, tenían valores medios (desviación estándar) de hemoglobina de 111 (12) g/l, eran más ancianos y presentaban una mayor prevalencia de cardiopatía isquémica y valores más elevados de velocidad de sedimentación globular, pero cifras inferiores de colesterol y tasa de filtración glomerular. La proporción de pacientes que recibieron inhibidores de la enzima conversiva de la angiotensina y bloqueadores beta fue inferior entre los que tenían anemia. La presencia de anemia se relacionó de forma independiente de otras variables clínicas y de tratamiento, con una mayor mortalidad (riesgo relativo: 2,554; p = 0,001), siendo directa la relación entre los valores de hemoglobina y la supervivencia. Conclusión: La anemia es muy prevalente en pacientes hospitalizados por ICC y es un poderoso determinante de la mortalidad en este grupo de pacientes

Background and objective: The search for novel and modifiable risk factors in heart failure (HF), a condition with still high mortality and morbidity rates, can open new strategies for treatment of a growing number of patients. We decided to evaluate the prevalence of anemia and determine its influence on the prognosis of hospitalized HF patients. Patients and method: 557 consecutive patients hospitalized for HF between 31st January 2000 and 31st December 2002 in a Cardiology Department of a tertiary hospital were studied. Demographic and clinical characteristics, as well as treatment upon hospital discharge and survival data were obtained in May 2003. Results: Mean follow-up was 1.4 years. 44.5% of the whole group of patients presented anemia with mean (standard deviation) hemoglobin levels of 111 (12) g/l, were older, with higher prevalence of ischemic cardiopathy, had higher levels of globular sedimentation rate but lower cholesterol and glomerular filtration rate levels. The prescription of angiotensin converting enzyme inhibitors and betablockers was less frequent among patients with anemia. The presence of anemia was related in a independent way with higher mortality (relative risk: 2.554; p = 0.001), the relation between survival and haemoglobin levels being direct. Conclusion: The prevalence of anemia among hospitalized HF patients is very high and its presence constitutes a powerful mortality determinant in this group of patients

Cuarenta años de experiencia en el tratamiento quirúrgico de la pericarditis constructiva / Forty years experience in the treatment of constructive pericarditis

Con el fin de conocer los resultados tempranos y tardíos de la pericardiectomía en el tratamiento de la pericarditis constrictiva, en el Instituo Nacional de Cardiología Ignaci Chávez de México, revisamos los expedientes de 58 enfermos, que se sometieron a esta investigación entre 1947 y 1986. Los factores etiológiocos más frecuentes fueron la tuberculosis y el origen idiopático (en 68.3% y 24.1% respectivamente). Antes de la intervención quirúrgica el 3.4% de los pacientes estaban en clase funcional I de la New York Heart Association, 31% en clase II, 48,3% en clase III y 16.2% en clase IV. La mortalidad operativa global fue del 6.89% y en la última década fue del 0%. La complicación operatoria más frecuente fue el bajo gasto, que ocurrió en el 15.5% de los pacientes. El desgarro accidental de la aurícula derecha ocurrió en el 8.6% de los casos. El tiempo de seguimiento fue de 5.6 ñ 6.3 años (con un máximo de 25.6 años). La mortalidad por paciente y año fue del 2.04%. La supervivencia a los cinco y diez años, excluida la mortalidad operatoria fue de 82% y 71% respectivamente. Después de la pericardiectomía el 76% de los enfermos estaba en clase funcional I de la New York Heart Association (p <0.001), el 16% en clase II (p <0.001), el 8% en clase III (p <0.001) y el 0% en clase IV (p <0.05). No hubo correlación entre la clase IV funcional preoperatoria ni la duración de los síntomas antes del diagnóstico y la mortalidad temprana y tardía, y la clase funcional postoperatoria. Se concluye que la pericardiectomía es el tratamiento de elección en la pericarditis constrictiva sintomática, al producir una importante y duradera mejoría en los síntomas y en la capacidad funcional, con una baja mortalidad operatoria, sobre todo en la última década

Aspectos electrocardiograficos de la repolarización ventricular derecha en la comunicación interauricular / Apeuliar right ventricular repolarization pattern in atrial septal defect

Para conocer el valor de una característica, según nuestras observaciones, forma de repolarización ventricular derecha para el diagnóstico de la comunicación interauricular, se estudiaron 100 pacientes con bloqueo troncular de la rama derecha del haz de His de grado intermedio, en los que mediante estudio hemodinámico se demostró el defecto septal auricular. Dicha repolarización ventricular drecha característica estudiada, consiste en un segmento S-T recto y largo ( de más de 60 milisegundos) que forma, en su prolongación en el espacio con la rama ascendente de la onda T, un ángulo de 60 grados a aun mayor. El dato fue positivo en 82 casos (sensibilidad del 82%). No hubo diferencias entre los grupos de edades ni el grado hipertensión arterial pulmonar, en cuanto a la frecuencia de aparición del signo. Se formó un grupo control de 65 enfermos con bloqueo proximal de la rama derecha de grado intermedio, en los que se descartó la comunicación interauricular. En 14 casos se encontró el signo electrocardiográfico descrito (especificidad del 78.4%). El valor predictivo positivo fue del 85.4% y el valor predictivo negativo del 73.9%, con eficiencia diagnóstica del 80.6% En 67 pacientes en los que se practicó el cierre quirúrgico del defecto, el dato desapareció en el 87.7% de los casos. Se concluye que la mencionada forma de repolarización ventricular derecha, en presencia de bloqueo troncular de la rama derecha de haz de His, apoya el diagnóstico de comunicación interauricular

Utilidad de las derivaciones DI y AVL en el diagnóstico del infarto del ventrículo derecho / The value of DI and AVL leads in the diagnosis of right ventricle infarct

Para conocer la sensibilidad y especificidad de la depresión del segmento S-T en las derivaciones DI y AVL, para el diagnóstico de extensión al ventrículo derecho de un infarto postero-inferior, se estudiaron 34 especímenes de autopsias realizadas en el Instituto Nacional de Cardiología Ignacio Chávez, en las que se evidenció histológicamente la presencia de un infarto postero-inferior, con adecuada documentación clínica, electrocardiográfica y enzimática. En 23 el infarto estaba extendido al ventrículo derecho y en 11 se limitaba al ventrículo izquierdo. No hubo diferencias significativas en cuanto a la gravedad y extensión de las obstrucciones coronarias entre los dos grupos estudiados. La sensibilidad de la depresión del segmento S-T en DI para el diagnóstico de extensión al ventrículo derecho fue del 82.6%, la especificidad del 81.8%, el valor predictivo positivo del 91.3%, el valor predictivo negativo del 81.8% y la eficiencia diagnóstica del 88.2%. Se concluye que el signo electrocardiográfico descrito es útil para el diagnóstico de extensión al ventrículo derecho del infarto postero-inferior

Evolución a largo plazo del infarto de ventrículo derecho / Long term follow-up of right ventricular infarction

Se estudia la evolución a largo plazo de 36 supervivientes a la fase hospitalaria de un infarto posteroinferior extendido al ventrículo derecho. El grupo lo constituyeron 7 mujeres y 29 varones con una edad media de 55 años. El tiempo de seguimiento fué de 39 meses como promedio. Se analizó la evolución en la fase aguda y se correlacionó con la mortalidad, complicaciones y capacidad funcional en la evolución a largo plazo. La mortalidad fué del 5.5%. Cinco pacientes desarrollarón un nuevo infarto de miocardio (16%). Ningún enfermo tuvo manifestación de insuficiencia cardíaca derecha durante su evolución tardía y en un solo caso se detectó insuficiencia tricuspídea. La mayor parte de los pacientes estaban en clase funcional I (55.5%) el 36.6% en clase II y el 8.3% en clase III. Ser concluye que la mortalidad a largo plazo de los pacientes con infarto del ventrículo derecho no es mayor que la de otros enfermos con infarto de miocardio; que la gran mayoría evolucionan favorablemente en cuanto a capacidad funcional y cuando no es así habitualmente es debido a una mala función ventricular izquierda secundaria a la gravedad y extensión de las lesiones coronarias; el subgrupo de pacientes con grave disfunción ventricular derecha durante la fase aguda del infarto no tuvo pronóstico peor a largo plazo