Cardiovascular prevention in elderly patients.

In recent decades, life expectancy has been increasing significantly. In this scenario, health interventions are necessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease. However, the number of elderly patients included in clinical trials is low, thus current clinical practice guidelines do not include specific recommendations. This document aims to review prevention recommendations focused in patients ≥ 75 years with high or very high cardiovascular risk, regarding objectives, medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs. Also, we will show why geriatric syndromes such as frailty, dependence, cognitive impairment, and nutritional status, as well as comorbidities, ought to be considered in this population regarding their important prognostic impact.

Remarkable oxygen consumption improvement after auricular flutter ablation in a patient with constrictive pericarditis and severe mitral stenosis.

Atrial function is a key factor in cardiac output and oxygen consumption (VO2). Substantial improvements in VO2 have been reported after restoring sinus rhythm (SR) in patients with atrial fibrillation. However, there are no published data on how atrial function affects VO2 in patients with both constrictive pericarditis (CP) and severe mitral stenosis (MS). A 53-year-old caucasian patient consulted for exacerbated heart failure (EHF). His medical record lists ischemic heart disease, severe MS, and CP after thoracic radiotherapy. The electrocardiogram showed atrial flutter (AFL) with controlled ventricular rate. Normal left ventricular ejection fraction was observed. Ergospirometry showed an impaired maximum VO2 (VO2 max) of 6 ml/kg/min. On the electrophysiological study typical AFL was diagnosed and ablated achieving a great exercise capacity improvement, correlated with an increase of VO2 max to 16 ml/kg/min a week after ablation, and disappearance of EHF symptoms. This case illustrates how restoration of SR resulted in a clinical substantial improvement. Radiofrequency catheter ablation is warranted as the most effective option in this context. .

Microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease.

RATIONALE: Microalbuminuria (MAB), a marker of endovascular dysfunction, is a predictor of cardiovascular events and all-cause mortality in the general population. There is evidence of vascular dysfunction in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To assess the prevalence and relationship of MAB with clinical and physiological parameters in stable patients with COPD. METHODS: We measured urinary albumin rate (urinary albumin to creatinine ratio: UACR), smoking history, arterial blood pressure, gas exchange, body mass index, lung function, BODE index (body mass index, airflow obstruction, dyspnea, exercise performance), and comorbidity index in 129 patients with stable COPD and 51 smokers with normal spirometry without known cardiovascular disease. MAB levels were compared between groups. A multivariate analysis was performed to determine the best determinants of MAB levels. MEASUREMENTS AND MAIN RESULTS: MAB was higher in patients with COPD than in control smokers (8 [5th-95th percentile (P5₋95), 2.9-113] vs. 4.2 [P5₋95, 1.8-22.7] mg/g, P < 0.001]). The difference remained significant even after using the standard pathologic threshold (MAB, 30-299 mg/g in women and 20-299 mg/g in men; 24% in patients with COPD vs. 6% in control smokers; P = 0.005). In patients with COPD, there was a negative correlation between Pa(O2) and MAB (r = -0.40, P < 0.001). Using multivariate analysis, MAB was only associated with the Pa(O2) (relative risk, 0.934; 95% confidence interval, 0.880-0.992; P < 0.001) and with the systolic arterial blood pressure (relative risk, 1.034; 95% confidence interval, 1.011-1.057; P = 0.003). CONCLUSIONS: MAB is frequent in patients with COPD and is associated with hypoxemia independent of other cardiovascular risk factors. Further studies are necessary to investigate whether MAB could be an early simple biomarker of cardiovascular compromise in patients with COPD.

Efecto de la braquiterapia preoperatoria sobre la función ovárica estrógenica, en pacientes con cáncer cervicouterino / Effect of the preoperative brachytherapy over the estrogenic ovarian function, in patients with cervicouterine cancer

Se estudiaron 8 pacientes portadoras de cáncer cérvicouterino, etapa I B, con tumores mayores o iguales a 5 cm de diámetro, menores de 38 años, que fueron tratadas con braquiterapia preoperatoria y cirugía tipo Wertheim, conservando el ovario derecho. La dosis mínima de radiación recibida por el ovario derecho, fue de 458 rads, tanto esta paciente como el resto, presenta valores de estradiol plasmático que indican castración, después de la cirugía. Asimismo hay un aumento de las gonadotrofinas en todos los casos. Se comparan y comentan estos resultados con los de grupo control de radioterapia y de cirugía exclusiva