Use of portable single-lead electrocardiogram device as an alternative for QTc monitoring in critically ill patients.

PURPOSE: Acquired QT prolongation is frequent and leads to a higher mortality rate in critically ill patients. KardiaMobile 1L® (KM1L) is a portable, user-friendly single lead, mobile alternative to conventional 12-lead electrocardiogram (12-L ECG) that could be more readily available, potentially facilitating more frequent QTc assessments in intensive care units (ICU); however, there is currently no evidence to validate this potential use. METHODS: We conducted a prospective diagnostic test study comparing QT interval measurement using KM1L with conventional 12-L ECG ordered for any reason in patients admitted to an ICU. We compared the mean difference using a paired t-test, agreement using Bland-Altman analysis, and Lin's concordance coefficient, numerical precision (proportion of QT measurements with <10 ms difference between KM1L and conventional 12-L ECG), and clinical precision (concordance for adequate discrimination of prolonged QTc). RESULTS: We included 114 patients (61.4% men, 60% cardiovascular etiology of hospitalization) with 131 12-L ECG traces. We found no statistical difference between corrected QT measurements (427 ms vs. 428 ms, p = .308). Lin's concordance coefficient was 0.848 (95% CI 0.801-0.894, p = .001). Clinical precision was excellent in males and substantial in females (Kappa 0.837 and 0.781, respectively). Numerical precision was lower in patients with vasoactive drugs (-13.99 ms), QT-prolonging drugs (13.84 ms), antiarrhythmic drugs (-12.87 ms), and a heart rate (HR) difference of ≥5 beats per minute (bpm) between devices (-11.26 ms). CONCLUSION: Our study validates the clinical viability of KM1L, a single-lead mobile ECG device, for identifying prolonged QT intervals in ICU patients. Caution is warranted in patients with certain medical conditions that may affect numerical precision.

Adherence to treatment guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) or angiotensin receptor - neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cocotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aims to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS: Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart Failure (HF) medications prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS: Out of 2528 patients in the registry, 1384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION: Prescription rates and target dose achievement is sub-optimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.

Análisis del programa de apoyo al paciente de evolocumab (Repatha®) para pacientes con enfermedades cardiovasculares en Colombia / Analysis of the evolocumab (Repatha®) patient support program for patients with cardiovascular disease in Colombia

Antecedentes: Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial. El objetivo es describir las características demográficas, los patrones de tratamiento, cumplimiento terapéutico y continuidad del tratamiento y explorar las variables relacionadas con la falta de adherencia de los pacientes inscritos en un programa de apoyo al paciente (PSP, por sus siglas en inglés) cardiovascular para al tratamiento con evolocumab en Colombia. Métodos: Estudio observacional-retrospectivo del registro de datos de los pacientes que ingresaron al programa PSP de evolocumab. Resultados: El análisis incluyó a 930 pacientes inscritos en el PSP (2017-2021). La edad media fue de 65,1 años (DE±1,1) y el 49,1% eran mujeres. La tasa media de cumplimiento del tratamiento con evolocumab fue del 70,5% (DE±21,8). Un total de 367 pacientes (40,5%) reportaron una tasa de cumplimiento superior al 80%. El análisis de continuidad incluyó a 739 pacientes (81,5%); el 87,8% de estos pacientes fueron considerados persistentes en el tratamiento. Un total de 871 pacientes (93,7%) reportaron al menos un evento adverso durante el período de seguimiento (en su mayoría no graves). Conclusión: Este es el primer estudio de la vida real sobre el tratamiento para la dislipidemia en un programa de apoyo a pacientes en Colombia. La adherencia encontrada fue superior al 70%, cifra similar a los hallazgos de otros estudios de vida real. Entre las causas del bajo cumplimiento se destacan las barreras administrativas y médicas para la suspensión o abandono del tratamiento con evolocumab. (AU)

Background: Cardiovascular diseases are considered the leading cause of death globally. This study describes the demographic characteristics, treatment patterns, self-reported compliance and persistence, and to explore variables related to non-adherence of patients enrolled in the cardiovascular patient support program (PSP) for evolocumab treatment in Colombia. Methods: This retrospective observational of the data registry of patients who entered the evolocumab PSP program. Results: The analysis included 930 patients enrolled in the PSP (2017-2021). Mean age was 65.1 (SD±13.1) and49.1% patients were female. The mean compliance rate to evolocumab treatment was 70.5% (SD±21.8). A total of 367 patients (40.5%) reported compliance higher than 80%. Persistence analysis included 739 patients (81.5%) where 87.8% of these patients were considered persistent to treatment. A total of 871 patients (93.7%) reported the occurrence of at least one adverse event during the follow-up period (mostly non-serious). Conclusion: This is the first real-life study describing patient characteristics, compliance and continuity of treatment for dyslipidemia in a patient support program in Colombia. The overall adherence found was higher than 70%; similar to findings reported in other real-life studies with iPCSK9. However, the reasons for low compliance were different, highlighting the high number of administrative and medical reasons for suspension or abandonment of treatment with evolocumab. (AU)

Analysis of the evolocumab (Repatha®) patient support program for patients with cardiovascular disease in Colombia. / Análisis del programa de apoyo al paciente de evolocumab (Repatha®) para pacientes con enfermedades cardiovasculares en Colombia.

BACKGROUND: Cardiovascular diseases are considered the leading cause of death globally. This study describes the demographic characteristics, treatment patterns, self-reported compliance and persistence, and to explore variables related to non-adherence of patients enrolled in the cardiovascular patient support program (PSP) for evolocumab treatment in Colombia. METHODS: This retrospective observational of the data registry of patients who entered the evolocumab PSP program. RESULTS: The analysis included 930 patients enrolled in the PSP (2017-2021). Mean age was 65.1 (SD±13.1) and49.1% patients were female. The mean compliance rate to evolocumab treatment was 70.5% (SD±21.8). A total of 367 patients (40.5%) reported compliance higher than 80%. Persistence analysis included 739 patients (81.5%) where 87.8% of these patients were considered persistent to treatment. A total of 871 patients (93.7%) reported the occurrence of at least one adverse event during the follow-up period (mostly non-serious). CONCLUSION: This is the first real-life study describing patient characteristics, compliance and continuity of treatment for dyslipidemia in a patient support program in Colombia. The overall adherence found was higher than 70%; similar to findings reported in other real-life studies with iPCSK9. However, the reasons for low compliance were different, highlighting the high number of administrative and medical reasons for suspension or abandonment of treatment with evolocumab.

Uso de modelos de predicción de eventos cardiovasculares para pronóstico de lesión vascular coronaria significativa / Use of cardiovascular events prediction models for the prognosis of a severe coronary artery lesion

Resumen Objetivos: Determinar el mejor punto de corte y el grado de conformidad de las escalas de riesgo, Framingham, PROCAM y Reynolds, para el diagnóstico de lesión vascular coronaria arterioesclerótica severa a través de la comparación de las áreas bajo la curva de acuerdo con las curvas operativas del receptor (COR). Métodos: Estudio de corte transversal en adultos que fueron sometidos a arteriografía coronaria. Se aplicaron las escalas Framingham, PROCAM y Reynolds, las dos primeras ajustadas según estudio de calibración colombiano. Luego se realizó la recolección de los datos de manera concurrente en instituciones de referencia en cardiología y hemodinámica en Bogotá. Resultados: De 200 pacientes estudiados, 66% eran mujeres, 37,5% mayores de 70 años, 53,2% con hipertensión, 52,7% en sobrepeso u obesidad, 61,5% presentaron valores altos de Proteína C Reactiva ultrasensible (PCRus) y 50% tenían al menos una lesión coronaria mayor de 70%. Se encontraron los mejores puntos de corte, de acuerdo con cada curva de características operativas del receptor (COR): Framingham ajustado 5,8% (sensibilidad 80%, especificidad 41%). PROCAM ajustado 1,7% (sensibilidad 78%, especificidad 45%) y Reynolds 3,8% (sensibilidad 68%, especificidad 45%). Adicionalmente, se encontró que las tres escalas presentaron áreas bajo la curva (ABC) de 0,59, 0,59 y 0,57, respectivamente.

Abstract Objectives: To determine the best cut-off point and the level of agreement of the Framingham, PROCAM, and Reynolds risk scales, for the diagnosis of a severe atherosclerotic coronary artery lesion by comparing the areas under the receiver operator characteristics (ROC) curves. Methods: A cross-sectional study was carried out on adults that were subjected to coronary angiography. The Framingham, PROCAM, and Reynolds were applied, with the first two adjusted to a Colombian calibration study. Data were collected concurrently in the institutions of reference in Cardiology and haemodynamics in Bogota. Results: Of the 200 patients study, 66% were female, and 37.5% greater than 70 years-old. Hypertension was recorded in 53.2%, and overweight and obesity in 52.7%. Elevated levels of high sensitivity C-Reactive Protein (hsCRP) were observed in 61.5% of cases and 50% had at least one major coronary lesion greater than 70%. The best cut-off points according to each of the ROC curves: Adjusted Framingham, 5.8% (sensitivity, 80%, specificity, 41%), Adjusted PROCAM, 1.7% (sensitivity, 78%, specificity, 45%) and Reynolds, 3.8% (sensitivity, 68%, specificity, 45%). Additionally, the three areas under the curve (AUC) were 0.59, 0.59, and 0.57, respectively.

In memoriam: Doctor Juan Karlo Urrea Zapata, Más que a un colega, adios "al amigo" / In memoriam: Dr. Juan Karlo Urrea Zapata, Goodbye to a "friend" more than colleague

Son pocas las personas que han despertado en la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, tan grandes sentimientos de amor, apoyo, admiración y respeto. Karlo (el amigo, como le decíamos de cariño), logró demostrarnos a todos, que a pesar de la enfermedad, de las complicaciones y quizás de las injusticias de la vida, se debe mantener siempre la esperanza, las ganas de luchar y ante todo, disfrutar cada segundo con las tres cosas que él decía, eran realmente importantes en la vida: la familia, los amigos y la Cardiología. Karlo nació en Medellín en 1971, luego se trasladó con su familia a Cali, donde pasaría la mayor parte de su vida. Médico y Cirujano de la Universidad Libre de Cali, realizó su especialización de Medicina Interna y Cardiología en Bogotá, en la Pontificia Universidad Javeriana, donde se desempeñó posteriormente como profesor de Cardiología y Medicina Interna, hasta que el diagnóstico de su enfermedad, lo llevó de regreso con su familia a Cali, donde dirigió de forma ejemplar algunas de las más reconocidas unidades de Cardiología de la ciudad y continuó con su incesante labor docente en varias universidades. Incansable académico, logró posicionarse en nuestra Sociedad como un gran profesional, con un perfil prometedor, que haciendo uso de su inagotable entusiasmo e ímpetu, logró convencer al presidente de la Sociedad en su momento, de crear "Actualidad Cardiológica", y más adelante, "Puesta al día en Cardiología", uno de sus grandes legados, que rápidamente se convirtió en un espacio para la discusión académica, revisiones de tema y posicionamiento crítico en aspectos relevantes del ejercicio de la Cardiología. Logró convocar a especialistas de diversos centros de mediana y alta complejidad, con el objetivo de generar diversidad, inclusión y redes de trabajo conjunto, tarea que llevó a cabalidad y con gran entereza hasta este año. Karlo fue destacado docente de varias universidades, investigador y conferencista, lo que le permitió compartir sus conocimientos en múltiples escenarios. Sus publicaciones, videos educativos y presentaciones nos seguirán acompañando por mucho tiempo..

Uso de estatinas y riesgo de caídas en ancianos: revisión sistemática de la literatura / Statin and risk of falls in the elderly: A sytematic review of the literature

Antecedentes. La alta incidencia de eventos cardiovasculares en la población anciana ha demostrado la eficacia de las estatinas en la reducción de la mortalidad por eventos coronarios; sin embargo, se han producido efectos adversos, tales como mialgia, miopatía, mionecrosis, sin mencionar las caídas como consecuencia de daño muscular con el uso de estatinas. Objetivo. El objetivo de este estudio es realizar una revisión sistemática para evaluar la literatura sobre la asociación entre el uso de estatinas y el riesgo de caídas. Métodos. Las bases de datos que se incluyeron (PubMed y SCOPUS) con artículos publicados entre enero de 2000 y mayo de 2016. Los términos MESH utilizados para la búsqueda fueron «FALLS» AND «STATIN». Los estudios seleccionados incluyeron cohortes de población de la comunidad (>50 años) y fue analizado siguiendo las recomendaciones metodológicas SIGN (Scottish Intercollegiate Guidelines Network), ya que no se encontró ningún estudio controlado aleatorizado. Resultados. En el estudio de Ham et al. el uso de estatinas ha demostrado ser un factor protector para la presencia de caídas. En el segundo estudio realizado por Scott et al. se encontró un aumento del riesgo de caídas (p=0,029) y un deterioro de la fuerza muscular y la calidad del músculo (valor de p=0,033 y 0,046, respectivamente). En el tercer estudio Haerer et al. se encontró un mayor riesgo de caídas (p=0,63). Conclusiones. La evidencia disponible no permite determinar la asociación entre el uso de estatinas y el riesgo de caídas, aunque sí se encontró asociación con el compromiso de algunos determinantes de la función muscular (AU)

Background. With the high incidence of cardiovascular events in the elderly population the effectiveness of statins in reducing mortality from coronary events has been demonstrated. However, there have been adverse effects, such as myalgia, myopathy, myonecrosis, not to mention the falls as a result of muscle damage with statin use. Objective. The purpose of this study is to conduct a systematic review to assess the literature on the association between statin use and the risk of falls. Methods. The databases that were included PUBMED AND SCOPUS, with articles published from January 2000 to May 2016. The MESH terms used for the search were "FALLS" AND "STATIN". Selected studies included cohort populations from the community (>50 years old), and analysed using the Scottish Intercollegiate (SIGN) methodology guidelines, as no randomised controlled study was found. Results. In the study by Ham et al., statin use was shown to be a protective factor for presence of falls. In the second study by Scott et al., there was an increased risk of falls (P=.029) and an impairment in muscle strength and quality muscle (P=.033 and P=.046, respectively). In the third study Haerer et al., found an increased risk of falls (P=.63). Conclusions. The association between use of statins and risk of falls could not be determined with the available evidence, although an association with the involvement of some determinants of muscular function was found (AU)

[Statin and risk of falls in the elderly: A sytematic review of the literature]. / Uso de estatinas y riesgo de caídas en ancianos: revisión sistemática de la literatura.

BACKGROUND: With the high incidence of cardiovascular events in the elderly population the effectiveness of statins in reducing mortality from coronary events has been demonstrated. However, there have been adverse effects, such as myalgia, myopathy, myonecrosis, not to mention the falls as a result of muscle damage with statin use. OBJECTIVE: The purpose of this study is to conduct a systematic review to assess the literature on the association between statin use and the risk of falls. METHODS: The databases that were included PUBMED AND SCOPUS, with articles published from January 2000 to May 2016. The MESH terms used for the search were "FALLS" AND "STATIN". Selected studies included cohort populations from the community (>50 years old), and analysed using the Scottish Intercollegiate (SIGN) methodology guidelines, as no randomised controlled study was found. RESULTS: In the study by Ham et al., statin use was shown to be a protective factor for presence of falls. In the second study by Scott et al., there was an increased risk of falls (P=.029) and an impairment in muscle strength and quality muscle (P=.033 and P=.046, respectively). In the third study Haerer et al., found an increased risk of falls (P=.63). CONCLUSIONS: The association between use of statins and risk of falls could not be determined with the available evidence, although an association with the involvement of some determinants of muscular function was found.

Evaluación de costo-efectividad de los nuevos anticoagulantes orales en pacientes con fibrilación auricular no valvular / Cost-effectiveness assessment of new oral anticoagulation drugs in patients with non-valvular atrial fibrillation

Resumen La fibrilación auricular es el trastorno más frecuente del ritmo cardíaco y una de las causas potencialmente tratables de cardioembolia y ataque cerebrovascular. La disponibilidad de nuevos anticoagulantes para pacientes con fibrilación auricular no valvular, plantea retos, derivados principalmente de los costos de su uso, perfiles de eficacia y seguridad, tolerancia y disponibilidad. Se llevó a cabo un análisis de costo-efectividad con base en un modelo de Markov, que permite comparar las estrategias de anticoagulación disponibles para fibrilación auricular no valvular en el país (apixabán, dabigatrán, rivaroxabán). La perspectiva empleada fue la del tercero pagador (sistema de salud colombiano), considerando solo costos médicos directos. Se siguieron las guías metodológicas para este tipo de estudios propuestas por ISPOR (International Society for Pharmacoeconomics and Outcomes Research) e INAHTA (International Network of Agencies for Health Technology Assessment). El horizonte temporal fue de 5 años, 10 años y toda la vida, en tanto que la tasa de descuento fue del 3%. Luego de la evaluación del modelo, con base en los análisis de sensibilidad realizados y el umbral de costo-efectividad para Colombia, se encontró que para el caso base, las diferentes moléculas evaluadas, si bien son costo-efectivas, exceden el umbral propuesto para este trabajo, siendo rivaroxabán y dabigatrán las únicas estrategias costo-efectivas con un horizonte temporal a 10 años con una tasa de descuento del 3% y para un horizonte temporal de toda la vida y tasa de descuento del 3%, las tres moléculas alcanzan el umbral de costo-efectividad establecido para Colombia. Dichas consideraciones son altamente sensibles al costo de los medicamentos.

Abstract Atrial fibrillation is the most common heart rate disorder and one of the potentially treatable causes of cardioembolisms and cerebrovascular events. Availability of new anticoagulation drugs in patients with non-valvular atrial fibrillation poses challenges that mostly derive from usage costs, efficacy and security profiles, tolerance and availability. A cost-effectiveness analysis was conducted based on the Markov model, which allows to compare the available anticoagulation strategies for non-valvular atrial fibrillation in the country (apixaban, dabigatran, rivaroxaban). The third payer perspective (according to Colombian health system) was used, taking into consideration only the direct medical costs. The methodological guides followed were suggested by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Network of Agencies for Health Technology Assessment (INAHTA). The time frame was 5 years, 10 years and a lifetime, whilst the discount rate was 3%. After assessing the model based on the conducted sensitivity analysis and the cost-effectiveness threshold for Colombia, it was revealed that for the baseline case the different molecules assessed, despite being cost effective, exceed the threshold proposed for this study. Rivaroxaban and dabigatran are the only cost-effective strategies in a 10-year time frame with a discount rate of 3% and for a lifetime time frame and discount rate of 3% all three molecules reach the costeffectiveness threshold established for Colombia. These considerations are highly sensitive to the cost of the medications.

Relación entre los puntajes del índice de pendiente del segmento ST/frecuencia cardiaca y el índice del cambio del segmento ST sobre el cambio de la frecuencia cardiaca durante la realización de la prueba de esfuerzo convencional con la presentación de nuevos eventos cardiovasculares / Relationship of ST segment/heart rate slope index and ST segment change index scores on the heart rate change during conventional stress test with the presentation of new cardiovascular events

Resumen Introducción: La prueba de esfuerzo convencional es una herramienta diagnóstica de fácil interpretación y accesibilidad que se utiliza de forma frecuente en la evaluación del dolor torácico, no obstante, sus características operativas están influenciadas por múltiples variables resultando en una capacidad limitada para la predicción global de desenlaces cardiovasculares. El uso de los índices y las variables adicionales en su interpretación podrían mejorar la predicción de los desenlaces cardiovasculares. Métodos: Mediante la realización de un estudio descriptivo, analítico y retrospectivo, se evaluó la relación y capacidad de predicción de los índices pendiente ST/FC y ΔST/ΔFC con el desarrollo de eventos cardiovasculares a un año. De un total de 438 estudios, se seleccionaron 138 que cumplían con los criterios para evaluación. Se realizó un análisis descriptivo de las variables de interés y posteriormente se procedió a realizar un análisis univariado y multivariado de las diferentes variables y desenlaces de interés. Conclusiones: Se encontró una relación estadísticamente significativa entre la capacidad del ejercicio, el índice pendiente ST/FC y el desarrollo de los desenlaces cardiovasculares, sin encontrar relación significativa con el índice pendiente ΔST/ΔFC. Se observa discreta mejoría de la capacidad de predicción global de la prueba de esfuerzo convencional con la adición del índice pendiente ST/FC (AUC 0,70 a AUC 0,74). Relationship of ST segment/heart rate slope index and ST segment change index scores on the heart rate change during conventional stress test with the presentation of new cardiovascular events.

Abstract Introduction: Conventional stress test is a diagnostic tool easy to interpret and of easy Access frequently used in the assessment of chest pain; however, its operational characteristics are influenced by multiple variables, resulting in a limited ability for global prediction of cardiovascular outcomes. The use of indexes and additional variables in their interpretation could improve prediction of cardiovascular outcomes. Methods: By conducting a descriptive, analytical and retrospective study, the relationship and prediction ability of the slope ST/HR and ΔST/ΔHR indexes with the development of cardiovascular events were assessed at one year. Out of a total of 438 studies, 138 were selected that complied with the evaluation criteria. A descriptive analysis of the variables of interest was carried out, and later on a univariate and multivariate analysis of the different variables and outcomes of interest. Conclusions: A statistically significant relationship was found between exercise capacity, ST/HR slope index and the development of cardiovascular events, without findings of a significant relationship with the ΔST/ΔHR slope index. A discreet improvement of the global prediction capacity of the conventional stress test with the addition of the ST/HR slope index (AUC 0.70 to AUC 0.74) is observed.

¿Estamos cerrando muchos forámenes ovales permeables en Colombia? Foramen ovale permeable, aneurisma del septum interauricular y riesgo de ataque cerebrovascular criptogénico recurrente. Revisión sistemática de la literatura / Are many patent foramen ovale closure procedures being performed in Colombia? Patent foramen ovale, atrial septal aneurysm and the risk of recurring cryptogenic stroke. Systematic review of literature

Resumen Introducción: el foramen ovale permeable y el aneurisma del septum interauricular, son hallazgos frecuentes en la población general. En los últimos años múltiples estudios han sugerido la asociación entre estas entidades y el accidente cerebrovascular, de origen criptogénico como consecuencia de embolia paradójica, en especial en la población menor de 55 años, que ha estimulado el desarrollo de dispositivos de cierre percutáneo para este tipo de defectos, con el objetivo de reducir la recurrencia de eventos isquémicos cerebrales, sin que se hayan podido demostrar claramente estos beneficios. Objetivo: realizar una revisión sistemática de la literatura para evaluar el riesgo de recurrencia y beneficio de esta intervención. Resultados: Se obtuvieron 1.208 artículos para evaluación, con un total de 11 artículos incluidos para el análisis posterior a la selección, evaluación y aplicación de criterios de inclusión y exclusión, encontrando 3 ensayos clínicos y 8 revisiones sistemáticas y/o metaanálisis. Conclusiones: En pacientes adultos con ataque cerebrovascular isquémico o accidente isquémico transitorio de origen criptogénico a quienes se les ha documentado mediante eco-cardiografía transesofágica la presencia de foramen oval permeable, no existe beneficio en la reducción del riesgo de recurrencia de ataque cerebrovascular, accidente isquémico transitorio o eventos neurológicos, en comparación con la terapia médica convencional.

Abstract Introduction: Patent foramen ovale and atrial septal aneurysm are frequent findings in the average population. Over the last years multiple studies have suggested there is an association between both entities and cerebrovascular accidents of cryptogenic origin as a consequence of paradoxical embolism, specially among population under age 55, which has stimulated the development of devices for percutaneous closure of these defects with the goal of reducing recurring cerebral ischemic events, without a clear demonstration of their efficacy. Motivation: To perform a systematic review of literature to assess the risk of recurrence and benefits of this surgery. Results: 1,208 articles were collected for this evaluation, with a total of 11 papers included in the analysis following selection, assessment and application of selection criteria. 3 of them were clinical trial and 8 were systematic reviews or meta-analysis. Conclusions: In adult patients with cryptogenic cerebrovascular ischemic or transient ischemic attacks with patent foramen ovale documented via transthoracic echocardiogram no decrease has been found in the risk of recurrence of cerebrovascular attacks, transient ischemic accidents or neurological events in comparison with traditional medical therapy