Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic.

Rheumatic autoimmune diseases are associated with a myriad of comorbidities. Of particular importance due to their morbimortality are cardiovascular diseases. COVID-19 greatly impacted the world population in many different areas. Patients with rheumatic diseases had to face changes in their healthcare, in addition to unemployment, a decrease in physical activity, social isolation, and lack of access to certain medications. This review summarizes the impact of COVID-19 pandemic on cardiovascular risk factors, comorbidities, and unhealthy behaviors in patients with rheumatic inflammatory autoimmune diseases, particularly focused on rheumatoid arthritis and systemic lupus erythematosus. Searches were carried out in MEDLINE/PubMed and Scopus from August to December 2022. Four reviewers screened the title and abstract of retrieved records. Potentially eligible reports were then reviewed in full text. Differences were reconciled by either consensus or discussion with an external reviewer. During the COVID-19 pandemic, patients with rheumatic diseases showed an increase in the prevalence of mental health disorders (43.2-57.7%), reduced physical activity (56.8%), and a worsening in eating behaviors. Alcohol intake increased (18.2%), especially in early phases of the pandemic. Smoking prevalence decreased (28.2%). Dyslipidemia and hypertension showed no changes. The pandemic and lockdown affected rheumatic patients not only in disease-related characteristics but in the prevalence of their cardiovascular comorbidities and risk factors. Lifestyle changes, such as healthy eating, physical activity, and optimal management of their rheumatic diseases and comorbidities, are essential to manage the long-lasting consequences of the COVID-19 outbreak. Key Points • During the COVID-19 pandemic, anxiety, depression, sedentarism, obesity, and a worsening in eating behaviors increased. •Patients with rheumatic diseases and comorbidities have worse clinical outcomes and a higher cardiovascular disease burden than those without them. •Comparative studies are necessary to precisely elucidate the pandemic's impact on the prevalence of cardiovascular disease, risk factors, and comorbidities in patients with rheumatoid arthritis and systemic lupus erythematosus.

Improving thromboprophylaxis in the medical inpatients: The role of the resident in an academic hospital.

INTRODUCTION: Venous thromboembolism (VTE) is one of the main causes of preventable in-hospital death. It is recommended for hospitals to have an appropriate thromboprophylaxis (TP) protocol to avoid VTE complications. OBJECTIVE: To determine the effect of the resident physician feedback to the staff physician in TP appropriateness after the Caprini RAM score implementation. METHODS: Caprini RAM was implemented by the residents in medical patients. Patients were divided in low, moderate, high, and highest-risk groups, with TP recommendation accordingly. In cases with inadequate TP, the resident provided feedback to the staff physician for adjustment. Change to appropriate TP was assessed retrospectively. RESULTS: A total of 265 records were included. Before intervention, 193 (72.8%) patients had appropriate TP and post-intervention, 207 (78.1%) patients received adequate TP (p < .001). CONCLUSIONS: Feedback from the internal medicine resident to staff physician improves appropriate TP in medical inpatients as a quality of care strategy.

Association of soluble cell adhesion molecules and lipid levels in rheumatoid arthritis patients.

OBJECTIVES: To evaluate the relationship between soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intracellular adhesion molecule-1 (sICAM-1), and lipid levels in rheumatoid arthritis (RA) patients with and without carotid plaque (CP). METHODS: Cross-sectional study nested of a RA cohort. RA patients without a previous cardiovascular event or statins' therapy, aged 40-75 years were recruited at an outpatient cardio-rheumatology clinic. Carotid ultrasound was performed in all study subjects. RA patients with CP were included and matched to RA patients without CP by age, gender, and traditional cardiovascular risk factors. Blood samples were drawn at the time of recruitment to measure sVCAM-1, sICAM-1, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lipid levels. Correlations between cell adhesion molecules, disease activity indexes, ESR and CRP with lipid levels were assessed with Spearman's correlation coefficient (rs). RESULTS: We included 71 RA patients, 37 with CP and 34 without CP. RA (n = 71) patients had a moderate negative correlation of sVCAM-1 with total cholesterol (TC) (rs = - 0.366, p = 0.002) and low-density lipoprotein (LDL) (rs = - 0.316, p = 0.007), and a small negative correlation with high-density lipoprotein (rs = - 0.250, p = 0.036). ESR showed a small negative correlation with LDL (rs = - 0.247, p = 0.038). Patients with CP had a moderate negative correlation between sVCAM and TC (rs = - 0.405, p = 0.013). Patients without CP showed a moderate negative correlation between sVCAM with TC (rs = - 0.364, p = 0.034) and LDL (rs = - 0.352, p = 0.041), and sICAM with VLDL (rs = - 0.343, p = 0.047). CONCLUSIONS: RA patients showed an inverse association of sVCAM-1 and lipid levels. More studies are needed to define the precise role of sVCAM-1 in the lipid paradox of RA.

Subclinical systolic dysfunction by speckle tracking echocardiography in patients with systemic lupus erythematosus.

BACKGROUND: We aimed to compare the prevalence of subclinical left ventricular systolic dysfunction in Hispanic systemic lupus erythematosus (SLE) patients versus healthy controls. MATERIAL AND METHODS: This cross-sectional study included 46 SLE patients who fulfilled the 2019 European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) classification criteria for SLE and with age ≥ 18 years. For comparison, we included a control group with 46 non-SLE subjects matched by age (±5 years) and gender. A transthoracic echocardiogram was performed on every participant. The echocardiographic measurements evaluated were left ventricular ejection fraction (LVEF), relative wall thickness (RWT), and tricuspid annular plane systolic excursion (TAPSE). Left ventricular-Global Longitudinal Strain (GLS) was evaluated, and a value higher than -18% was classified as subclinical left ventricular systolic dysfunction. Comparisons between groups were made using the Chi-square test or Fisher's exact test for qualitative variables, and Student's t-test or the Mann-Whitney's U test for quantitative variables. A p-value <.05 was considered significant. RESULTS: We found a significant difference in the presence of subclinical left ventricular systolic dysfunction between SLE-patients and controls (37.0% vs 8.7%, p = .001). We also found that SLE patients had a lower left ventricular GLS (-18.90% vs -20.51%, p = .011), TAPSE (21.63 mm vs 23.60 mm, p = .009), and LVEF (57.17% vs 62.47%, p = <.001) than controls. Systemic lupus erythematosus diagnosis was independently associated with the presence of subclinical left ventricular systolic dysfunction with an OR of 6.068 (CI 95% 1.675-21.987) (p = .006). Subclinical systolic dysfunction was more common in men (29.4% vs 3.4%, p = .020), patients with obesity (17.6% vs 0%, p = .045), or hypertension (47.1% vs 6.9%, p = .001). CONCLUSION: Systemic lupus erythematosus Hispanic patients had a higher prevalence of subclinical left ventricular systolic dysfunction, and worse left ventricular GLS, LVEF, and TAPSE values than matched healthy controls. Additionally, we found that male gender, obesity, and hypertension are associated with the presence of subclinical left ventricular systolic dysfunction in SLE patients. The inclusion of speckle tracking echocardiography as part of the cardiovascular evaluation of SLE patients may help identify high cardiovascular risk patients.

Statin indication according to the 2019 World Health Organization cardiovascular disease risk charts and carotid ultrasound in Mexican mestizo rheumatoid arthritis patients.

BACKGROUND: We aimed to assess the concordance of recommendation for initiating statin therapy according to the 2019 World Health Organization (WHO) cardiovascular disease (CVD) risk charts and to the presence of carotid plaque (CP) identified with carotid ultrasound in Mexican mestizo rheumatoid arthritis (RA) patients, and to determine the proportion of patients reclassified to a high cardiovascular risk after the carotid ultrasound was performed. METHODS: This was a cross-sectional study nested of a RA patients' cohort. A total of 157 Mexican mestizo RA patients were included. The cardiovascular evaluation was performed using the 2019 WHO CVD risk charts (laboratory-based model) for the Central Latin America region. A carotid ultrasound was performed in all patients. The indication to start statin therapy was considered if the patient was classified as high risk, moderate risk if > 40 years with total cholesterol (TC) > 200 mg/dl or LDL-C > 120 mg/dl, and low risk if > 40 years with TC > 300 mg/dl, according to the WHO CVD risk chart or if the patient had carotid plaque (CP). Cohen's kappa (k) coefficient was used to evaluate the concordance between statin therapy initiation. RESULTS: Initiation of statin therapy was considered in 49 (31.2%) patients according to the 2019 WHO CVD risk charts and 49 (31.2%) patients by the presence of CP. Cardiovascular risk reclassification by the presence of CP was observed in 29 (18.9%) patients. A slight agreement (k = 0.140) was observed when comparing statin therapy recommendations between 2019 WHO CVD risk charts and the presence of CP. CONCLUSION: The WHO CVD risk charts failed to identify a large proportion of patients with subclinical atherosclerosis detected by the carotid ultrasound and the concordance between both methods was poor. Therefore, carotid ultrasound should be considered in the cardiovascular evaluation of RA patients.

Cardiovascular risk reclassification according to six cardiovascular risk algorithms and carotid ultrasound in psoriatic arthritis patients.

The objective was to compare the prevalence of subclinical atherosclerosis and cardiovascular risk (CVR) reclassification using six CVR algorithms and a carotid ultrasound in psoriatic arthritis (PsA) patients and controls. The method was cross-sectional study. A total of 81 patients aged 40-75 years, who fulfilled the 2006 CASPAR criteria and 81 controls matched by age, gender, and comorbidities were recruited. CVR was evaluated according to six CVR algorithms, including Framingham Risk Score (FRS)-lipids, FRS-body mass index (BMI), Atherosclerotic Cardiovascular Disease (ASCVD) Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, and Reynolds Risk Score (RRS). A carotid ultrasound was performed to identify the presence of carotid plaque (CP) defined as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing of the surrounding lumen ≥ 0.5mm. Patients with presence of CP, classified in the low-moderate risk by the CVR algorithms, were reclassified to a higher risk category. CP was more prevalent in PsA patients (44.4% vs 24.7%, p = 0.008), as was subclinical atherosclerosis (51.9% vs 33.3%, p = 0.017). When comparing the CVR reclassification to a higher risk category, a difference was found in the six CVR algorithms. The reclassification was more prevalent in PsA patients: 30.8% vs 12.3%, p = 0.004 with FRS-lipids; 28.4% vs 9.9%, p = 0.003 with FRS-BMI; 40.7% vs 19.8%, p = 0.003 with SCORE; 30.9% vs 16.0%, p = 0.026 with ASCVD algorithm; 37.0% vs 19.8%, p = 0.015 with RRS; and 33.3% vs 16.0%, p = 0.011 with QRISK3. The CVR algorithms underestimate the actual CVR of PsA patients. A carotid ultrasound should be considered as part of the CVR evaluation of PsA patients. KEY POINTS: • Subclinical atherosclerosis was more prevalent in psoriatic arthritis patients than controls. • Cardiovascular risk reclassification, through a carotid ultrasound, according to traditional cardiovascular risk algorithms was more common in psoriatic arthritis patients. • The cardiovascular risk algorithm that showed the lowest reclassification rate in psoriatic arthritis patients was the FRS-BMI. • All cardiovascular risk algorithms underestimate the actual risk of psoriatic arthritis patients, preventing the initiation of an adequate cardiovascular treatment.

Statin indication according to the 2019 World Health Organization cardiovascular disease risk charts and carotid ultrasound in Mexican mestizo rheumatoid arthritis patients

Abstract Background: We aimed to assess the concordance of recommendation for initiating statin therapy according to the 2019 World Health Organization (WHO) cardiovascular disease (CVD) risk charts and to the presence of carotid plaque (CP) identified with carotid ultrasound in Mexican mestizo rheumatoid arthritis (RA) patients, and to determine the proportion of patients reclassified to a high cardiovascular risk after the carotid ultrasound was performed. Methods: This was a cross-sectional study nested of a RA patients' cohort. A total of 157 Mexican mestizo RA patients were included. The cardiovascular evaluation was performed using the 2019 WHO CVD risk charts (laboratory-based model) for the Central Latin America region. A carotid ultrasound was performed in all patients. The indication to start statin therapy was considered if the patient was classified as high risk, moderate risk if > 40 years with total cholesterol (TC) > 200 mg/dl or LDL-C > 120 mg/dl, and low risk if > 40 years with TC > 300 mg/dl, according to the WHO CVD risk chart or if the patient had carotid plaque (CP). Cohen's kappa (k) coefficient was used to evaluate the concordance between statin therapy initiation. Results: Initiation of statin therapy was considered in 49 (31.2%) patients according to the 2019 WHO CVD risk charts and 49 (31.2%) patients by the presence of CP. Cardiovascular risk reclassification by the presence of CP was observed in 29 (18.9%) patients. A slight agreement (k = 0.140) was observed when comparing statin therapy recommendations between 2019 WHO CVD risk charts and the presence of CP. Conclusion: The WHO CVD risk charts failed to identify a large proportion of patients with subclinical atherosclerosis detected by the carotid ultrasound and the concordance between both methods was poor. Therefore, carotid ultra-sound should be considered in the cardiovascular evaluation of RA patients.

Echocardiographic evaluation of pulmonary hypertension, right ventricular function, and right ventricular-pulmonary arterial coupling in patients with rheumatoid arthritis.

INTRODUCTION: Rheumatoid arthritis (RA) patients are at increased risk for developing cardiovascular disease, including right heart failure. The evaluation of right ventricle (RV) using the relationship between tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic pressure (RVSP) is of clinical prognostic relevance. Mild echocardiographic pulmonary hypertension (ePH) has been associated with worse RV function. The aim of this study was to evaluate RV function as measured by TAPSE to RVSP ratio in rheumatoid arthritis patients compared to matched healthy controls. METHOD: A case-control study with 67 RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and 45 matching controls was included. A transthoracic echocardiogram was performed to all patients. TAPSE was measured as the distance traveled from end-diastole to end-systole. RVSP was calculated using the modified Bernoulli equation. Comparisons were done using Chi-square and Mann-Whitney's U test or Student's t test. RESULTS: Patients with RA had significantly reduced ventricular function (TAPSE 23 [21-25] vs 25 [23-26], p = 0.033) and TAPSE/RVSP ratio was significantly lower in RA-patients than controls (TAPSE to RVSP ratio 0.809 [0.67-1.01] vs 0.933 [0.79-1.11], p = 0.009). RA-patients with mild ePH had similar RV function, evaluated by TAPSE, in comparison to RA-patients with normal RVSP. CONCLUSION: RA-patients had worse RV function measured by TAPSE and worse TAPSE/RVSP ratio than controls. Also, RA-patients with mild ePH had reduced right ventricular-pulmonary arterial coupling in comparison with patients with RA and normal RVSP. These echocardiographic findings could justify aggressive treatment for these patients and assess their evolution. Key Points • Right ventricular (RV) function and RV coupling with the pulmonary artery (RV-PA coupling) were worse in patients with RA in comparison to healthy controls. • Values of right ventricular systolic pressure (RVSP) were similar between RA-patients and non-RA controls. • Prevalence of normal RVSP, mild echocardiographic pulmonary hypertension (ePH), and pulmonary hypertension was similar between RA-patients and non-RA matched controls •Patients with RA and mild ePH had reduced RV-PA coupling in comparison with RA-patients with normal RVSP.

Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study.

Rheumatoid arthritis (RA) is a chronic, inflammatory disease closely linked with atherosclerosis. Recommended cardiovascular disease (CVD) integral evaluation includes screening for asymptomatic atherosclerosis plaques with carotid ultrasound (US). The aim of this study is to evaluate the carotid US characteristics, including carotid intima media thickness (cIMT) and carotid plaque (CP), and compare RA-patients and controls in a Mexican-mestizo population. METHOD: Prospective cross-sectional, observational study comparing RA-patients and matched controls without RA. Medical history and physical exam was performed in all subjects by a rheumatologist and two clinical blinded radiologists did the carotid US. Increased cIMT was defined as ≥0.9 mm. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a cIMT ≥1.2 mm. Multivariable analysis was done comparing RA-patients and control subjects characteristics with carotid US. RESULT: In the final analysis 209 patients were included, 103 patients with RA and 106 controls. Bilateral CP was found more than twice in RA than controls (15.5% vs 6.6%). Unilateral CP was more common in either side evaluated, being heterogeneous plaques the most common in RA-patients. The prevalence of increased cIMT was found higher in RA-patients either in both sides (right 37.9% vs 15.1%, P = 0.00; left 43.7% vs 19.8%, P = 0.00) were statistically significant. CONCLUSION: It was confirmed that RA-patients have greater subclinical atherosclerosis represented in the carotid US measuring cIMT and CP as surrogates. RA-patients with subclinical atherosclerotic disease have more heterogeneous plaques characteristics.

The best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.

Abdominal Aortic Dissection and Cold-Intolerance After Whole-Body Cryotherapy: A Case Report.

Whole-body cryotherapy (WBC) involves short exposures to air temperatures below -100°C and is purported to enhance recovery after exercise and accelerate rehabilitation after injury. It is generally considered a procedure with few side effects, but there are no large studies that have established its safety profile. We present the case of a 56-year-old patient who developed an abdominal aortic dissection after receiving 15 sessions of WBC. The patient had no other strong risk factors for aortic dissection. Exposure to cold temperatures, including WBC, has multiple hemodynamic effects, including increases in blood pressure, heart rate, and an adrenergic response. We suggest that these changes could act as a trigger for the onset of aortic dissections. This could be the first reported cardiovascular complication associated with WBC.

Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) have a high risk for comorbid conditions which increase mortality, hospital admissions, costs of care and inability. To evaluate the prevalence of comorbidities in Mexican mestizo patients with RA and determine the associated risk factors. Cross-sectional study in which RA patients admitted to our outpatient clinic were consecutively enrolled. We collected data regarding demographics, disease characteristics and comorbidities at the time of the patient's visit to the clinic. We analyzed 225 patients. Their mean age was 55.7 ± 8.3 years; disease duration, 9.5 (3.8-15.5) years; female gender, 93.8%; Disease Activity Score using 28 joints-C-reactive protein, 3 (2-4); methotrexate use, 84.9%; use of any other conventional disease modifying anti-rheumatic drug, 65.7%; use of biological agents, 8%. The most frequently associated diseases were: hypertension, 29.8%; dyslipidemia, 27.1%; osteoporosis, 19.1%; diabetes, 12.4%; hypothyroidism, 6.2%; solid malignancies 4.4%. Risk factors were also evaluated, the most prevalent was overweight in 101 (44.9%) of our patients. A total of 71 (31.6%) had obesity. We also detected high blood pressure in 12.4%, hyperglycemia in 27.1% and hyperlipidemia in 49.8%. Due to the high frequency of comorbidities among RA patients, it is important to follow existing recommendations for their timely detection and management. Cardiovascular diseases must be evaluated with priority. The initial evaluation should include a thorough examination to prevent the deleterious effect of comorbidities in RA.

Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management.

Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.

A comparative observational multicenter analysis of the clinical performance of vascular compression devices following transradial arterial access / Análisis comparativo multicéntrico observacional del desempeño clínico de dispositivos de compresión vascular posterior a acceso arterial transradial

Abstract: Introduction: Multiple vascular compression aimed for transradial access have been developed. We aimed to compare the time required to achieve hemostasis in three different radial vascular compression devices. Methods: ST and non-ST elevation MI, unstable and stable angina as well as diagnostic coronary angiograms patients with transradial vascular access (TVA) in 2 centers were enrolled between June 2010-November 2010. Patients were divided according the TVA compression device (TAVCD) used. Group I received TR Band(tm) (Terumo, Tokyo, Japan), Group II received Neptuno(tm) (Biotronik, Berlin, Deutschland) and Group III received Finale(tm) (Merit Medical, South Jordan, UT).Patients were evaluated immediately after TVACD implantation and 24 hour post-procedure follow up. Results: 60 patients were enrolled in this observational study (Group I = 22 patients; Group II = 18; Group III = 20). All patients demonstrated evidence of radial pulse after hemostasis. 28% developed a superficial hematoma (Group I, 31%; Group II, 30%; Group III, 22%). Pain at the access site was uncommon among patients in both immediate and follow-up evaluations, however, 3% (Group I and II) presented paresthesia immediately following the procedure that resolved by the 24-hour evaluation. Conclusion: In our study, all three evaluated radial compression devices successfully achieved hemostasis regardless of the slight alterations of mechanism, yet similarity in aim of non-occlusive compression. Group I (TR band) had a slight increase in compression time recorded but all groups required an approximate three hours to display no evidence of bleeding. None of the patients in the study presented major vascular complications. We consider that further investigation of radial compression devices as compared to manual compression are necessary to evaluate their advantages and may further simplify the procedure

Resumen: Introducción: Múltiples dispositivos de compresión vascular para el acceso radial han sido desarrollados. Nuestro objetivo es comparar el tiempo requerido para lograr la hemostasis con tres diferentes dispositivos de compresión vascular radial. Métodos: Pacientes de angiografía coronaria de diagnóstico, con elevación y no elevación del ST, con angina de pecho inestable y estable, así como pacientes con acceso vascular radial (AVR) en dos centros, fueron incluidos entre junio y noviembre de 2010. Los pacientes fueron divididos según el dispositivo de compresión AVR (DCAVR) usado. Al Grupo I se le dio el TR Band(tm) (Terumo, Tokio, Japón), el Grupo II recibió el Neptuno(tm) (Biotronik, Berlín, Alemania) y el grupo III recibió el Final(tm) (Merit Medica, South Jordan, UT). Los pacientes fueron evaluados inmediatamente después de la implantación del DCAVR y a las 24 horas de postprocedimiento para seguimiento. Resultados: 60 pacientes fueron incluidos en este estudio observacional (Grupo I = 22 pacientes; Grupo II = 18; Grupo III = 20). Todos los pacientes mostraron evidencia de pulso radial después de la hemostasis. 28% desarrolló un hematoma superficial (Grupo I, 31%; Grupo II, 30%; Grupo III, 22%). El dolor en el sitio de acceso fue poco común entre los pacientes de los dos evaluaciones inmediatas y de seguimiento, sin embargo, el 3% (Grupo I y II) presentó parestesias inmediatamente después del procedimiento que se resolvieron para la evaluación de 24 horas. Conclusión: En nuestro estudio, los tres dispositivos de compresión radiales evaluados lograron con éxito la hemostasis sin importar las pequeñas variaciones del mecanismo, dando resultados similares en el objetivo de la compresión no oclusiva. Grupo I (Banda TR) tuvo un ligero aumento en el tiempo de compresión registrado pero todos los grupos requieren un tiempo aproximado de tres horas para mostrar ninguna evidencia de sangrado. Ninguno de los pacientes en el estudio presentó mayores complicaciones vasculares. Consideramos necesario hacer investigación adicional de los dispositivos de compresión radiales, en comparación con la compresión manual para evaluar sus ventajas y poder simplificar aún más el procedimiento.

Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in rheumatoid arthritis (RA) patients. Guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA) 2013 and the Adult Treatment Panel III (ATP-III) differ in their strategies to recommend initiation of statin therapy. The presence of carotid plaque (CP) by carotid ultrasound is an indication to begin statin therapy. We aimed to compare the recommendation to initiate statin therapy according to the ACC/AHA 2013 guidelines, ATP-III guidelines, and CP by carotid ultrasound. We then carried out an observational, cross-sectional study of 62 statin-naive Mexican mestizo RA patients, aged 40 to 75, who fulfilled the 1987 or 2010 ACR/European League Against Rheumatism (EULAR) classification criteria. CP was evaluated with B-mode ultrasound. Cohen's kappa (k) was used to assess agreement between ACC/AHA 2013 guidelines, ATP-III guidelines, and the presence of CP, considering a p < 0.05 as statistically significant. Agreement was classified as slight (0.01-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), and an almost perfect agreement (0.81-1.00). Slight agreement (k = 0.096) was found when comparing statin recommendation between CP and ATP-III. Fair agreement (k = 0.242) was revealed between ACC/AHA 2013 and ATP-III. Comparison between ACC/AHA 2013 and CP showed moderate agreement (k = 0.438). ACC/AHA 2013 guidelines could be an adequate and cost-effective tool to evaluate the need of statin therapy in Mexican mestizo RA patients, with moderate agreement with the presence of CP by ultrasound.

Evaluation of left ventricular function using volumetric computed tomography in the clinical setting.

OBJECTIVE: To correlate the left ventricular parameters obtained with 64-slice Volumetric Computed Tomography (VCT) with those obtained with the reference standard, cardiovascular magnetic resonance (CMR) imaging. METHODS: VCT and a 3.0T MRI scanner were used. Results from both studies were independently evaluated by two cardiologists. A linear correlation and a paired Student's t test were used to analyze the data with a P<0.05 being considered significant. RESULTS: Thirty consecutive patients were evaluated with VCT and CMR. The left ventricular indices for CMR and VCT were, respectively, mass 86.4±25.8 vs. 82.7±27.6g (P=0.31); ESV 45.5±27.8 vs. 48.7±40.4ml (P=.405); EDV 101.3±32.7 vs. 105.1±44.0ml (P=0.475); SV 55.9±16.1 vs. 56.8±15.6ml (P=0.713); LVEF 57.5±13.2% vs. 56.9±12.4% (P=0.630). No differences in intraobserver variability for both methods were found, CT r=0.96, r(2)=0.92 P<0.0001 and MR r=0.96 r(2)=0.93 P<0.0001. There was no significant statistical difference in the presence of artifacts. CONCLUSION: There is a close correlation between CMRI and VCT in the evaluation of LV function. VCT is as useful as 3T CMR, and could be incorporated as another resource for evaluating LV function.

Safety and Clinical Outcome of the Delivery of Radiofrequency Nerve Ablation Therapy in a Renal Artery of Unusual Anatomy.

INTRODUCTION: Catheter-based renal sympathetic denervation is an emerging therapy for resistant hypertension (RHTN) patients, resulting in a significant blood pressure reduction. The presence of accessory renal arteries and anomalous branching patterns are reported in approximately 20-27 % of patients. However, accessory renal arteries, when smaller than 4 mm in diameter, they are out of the inclusion criteria for renal denervation therapy. For this reason patients with evidence of accessory renal arteries have been excluded in previous clinical trials. Recent data suggest that accessory renal arteries may play an important role in non-response therapy when they do not receive renal denervation treatment. CASE REPORT: In this report, we present the outcome of a patient with resistant hypertension and an anomalous right renal artery, having undergone denervation of both principal and accessory renal arteries. The renal ablation by radiofrequency energy of a distant accessory renal artery resulted in a safe procedure with no clinical complications. CONCLUSION: Consistent with literature the RDN of all, main and accessory renal arteries, was effective in decreasing patient blood pressure while decreasing the need for antihypertensive medication.