Regulation of human neutrophil IL-1ß secretion induced by Escherichia coli O157:H7 responsible for hemolytic uremic syndrome.

Shiga-toxin producing Escherichia coli (STEC) infections can cause from bloody diarrhea to Hemolytic Uremic Syndrome. The STEC intestinal infection triggers an inflammatory response that can facilitate the development of a systemic disease. We report here that neutrophils might contribute to this inflammatory response by secreting Interleukin 1 beta (IL-1ß). STEC stimulated neutrophils to release elevated levels of IL-1ß through a mechanism that involved the activation of caspase-1 driven by the NLRP3-inflammasome and neutrophil serine proteases (NSPs). Noteworthy, IL-1ß secretion was higher at lower multiplicities of infection. This secretory profile modulated by the bacteria:neutrophil ratio, was the consequence of a regulatory mechanism that reduced IL-1ß secretion the higher were the levels of activation of both caspase-1 and NSPs, and the production of NADPH oxidase-dependent reactive oxygen species. Finally, we also found that inhibition of NSPs significantly reduced STEC-triggered IL-1ß secretion without modulating the ability of neutrophils to kill the bacteria, suggesting NSPs might represent pharmacological targets to be evaluated to limit the STEC-induced intestinal inflammation.

Assessment of interleukin-10 promoter variant (-1082A/G) and cytokine production in patients with hemolytic uremic syndrome.

Introduction: Hemolytic uremic syndrome (HUS) is a condition that results in acute kidney failure mainly in children, which is caused by Shiga toxin-producing Escherichia coli and inflammatory response. Although anti-inflammatory mechanisms are triggered, studies on the implication in HUS are scarce. Interleukin-10 (IL-10) regulates inflammation in vivo, and the interindividual differences in its expression are related to genetic variants. Notably, the single nucleotide polymorphism (SNP) rs1800896 -1082 (A/G), located in the IL-10 promoter, regulates cytokine expression. Methods: Plasma and peripheral blood mononuclear cells (PBMC) were collected from healthy children and HUS patients exhibiting hemolytic anemia, thrombocytopenia, and kidney damage. Monocytes identified as CD14+ cells were analyzed within PBMC by flow cytometry. IL-10 levels were quantified by ELISA, and SNP -1082 (A/G) was analyzed by allele-specific PCR. Results: Circulating IL-10 levels were increased in HUS patients, but PBMC from these patients exhibited a lower capacity to secrete this cytokine compared with those from healthy children. Interestingly, there was a negative association between the circulating levels of IL-10 and inflammatory cytokine IL-8. We observed that circulating IL-10 levels were threefold higher in HUS patients with -1082G allele in comparison to AA genotype. Moreover, there was relative enrichment of GG/AG genotypes in HUS patients with severe kidney failure. Discussion: Our results suggest a possible contribution of SNP -1082 (A/G) to the severity of kidney failure in HUS patients that should be further evaluated in a larger cohort.

Nasal immunization with H7 flagellin protects mice against hemolytic uremic syndrome secondary to Escherichia coli O157:H7 gastrointestinal infection.

Introduction: Shiga-toxin (Stx) producing Escherichia coli (STEC) O157:H7 is the most frequent serotype associated with hemolytic uremic syndrome (HUS) after gastrointestinal infections. Protection against HUS secondary to STEC infections has been experimentally assayed through the generation of different vaccine formulations. With focus on patients, the strategies have been mainly oriented to inhibit production of Stx or its neutralization. However, few approaches have been intended to block gastrointestinal phase of this disease, which is considered the first step in the pathogenic cascade of HUS. The aim of this work was to assay H7 flagellin as a mucosal vaccine candidate to prevent the systemic complications secondary to E. coli O157:H7 infections. Materials and methods: The cellular and humoral immune response after H7 nasal immunization in mice were studied by the analysis of systemic and intestinal specific antibody production, as well as cytokine production and lymphocyte proliferation against H7 flagellin ex vivo. Results: Immunized mice developed a strong and specific anti-H7 IgG and IgA response, at systemic and mucosal level, as well as a cellular Th1/Th2/Th17 response. H7 induced activation of bone marrow derived dendritic cells in vitro and a significant delayed-type hypersensitivity (DTH) response in immunized mice. Most relevant, immunized mice were completely protected against the challenge with an E. coli O157:H7 virulent strain in vivo, and surviving mice presented high titres of anti-H7 and Stx antibodies. Discussion: These results suggest that immunization avoids HUS outcome and allows to elicit a specific immune response against other virulence factors.

Etiological diagnosis of post-diarrheal hemolytic uremic syndrome (HUS): humoral response contribution.

BACKGROUND: Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolysis, thrombocytopenia, and thrombus formation leading to tissue injury. HUS is classified according to its etiology as post-diarrheal or atypical HUS. Differential diagnosis of both entities continues to be a challenge for pediatric physicians. METHODS: The aim was to improve the rapid etiological diagnosis of post-diarrheal HUS cases based on the detection of Shiga toxin (Stx)-producing Escherichia coli (STEC) infection by screening of stx1/stx2 and rfbO157 in cultured stools by multiplex PCR, and the additional detection of anti-lipopolysaccharide (anti-LPS) O157, O145, and O121 antibodies by Glyco-iELISA test. In addition, we studied patients' relatives to detect circulating pathogenic strains that could contribute to HUS diagnosis and/or lead to the implementation of measures to prevent dissemination of familial outbreaks. This study describes the diagnosis of 31 HUS patients admitted to Hospital Municipal de Niños Prof Dr Ramón Exeni during the 2017-2020 period. RESULTS: Stool PCR confirmed the diagnosis of STEC associated with HUS in 38.7% of patients (12/31), while anti-LPS serology did in 88.9% (24/27). In those patients in which both methods were carried out (n = 27), a strong association between the results obtained was found. We found that 30.4% of HUS patients had at least one relative positive for STEC. CONCLUSIONS: We could identify 96.3% (26/27) of HUS cases as secondary to STEC infections when both methods (genotyping and serology) were used. The results demonstrated a high circulation of STEC in HUS families and the prevalence of the STEC O157 serotype (83%) in our pediatric cohort. A higher-resolution version of the Graphical abstract is available as Supplementary information.

Humoral response to the BBIBP-CorV vaccine over time in healthcare workers with or without exposure to SARS-CoV-2.

SARS-CoV-2-specific humoral response was analyzed over time in a group of healthcare workers with or without exposure to SARS-CoV-2, who underwent vaccination with BBIBP-CorV (Sinopharm) vaccine in Argentina. Seroconversion rates in unexposed subjects after the first and second doses were 40 % and 100 %, respectively, showing a significant increase in antibody concentrations from dose 1 to dose 2 (p < 0.0001). The highest antibody concentrations were found in younger subjects and women, remaining significantly associated in a multivariable linear regression model (p = 0.005). A single dose of the BBIBP-CorV vaccine induced a strong antibody response in individuals with prior SARS-CoV-2infection, while a second dose did not increase this response. A sharp increase in antibody concentrations was observed following SARS-CoV-2 infection in those participants who became infected after the first and second doses (p = 0.008). Individuals with SARS-CoV-2 exposure prior to vaccination showed significantly higher anti-spike IgG antibody levels, at all-time points, than those not exposed (p < 0.001). Higher antibody titers were induced by a single dose in previously SARS-CoV-2 infected individuals than those induced in naïve subjects by two doses of the vaccine (p < 0.0001). Three months after the second dose both groups showed a decline in antibody levels, being more abrupt in unexposed subjects. Overall, our results showed a trend towards lower antibody concentrations over time following BBIBP-CorV vaccination. Sex and age seem to influence the magnitude of the humoral response in unexposed subjects while the combination of exposure to SARS-CoV-2 plus vaccination, whatever the sequence of the events was, produced a sharp increase in antibody levels. Evaluation of the humoral responses over time and the analysis of the induction and persistence of memory B and T cell responses, are needed to assess long-term immune protection induced by BBIBP-CorV vaccine.

Differential Outcome between BALB/c and C57BL/6 Mice after Escherichia coli O157:H7 Infection Is Associated with a Dissimilar Tolerance Mechanism.

Enterohemorrhagic Escherichia coli (EHEC) infections can result in a wide range of clinical presentations despite that EHEC strains belong to the O157:H7 serotype, one of the most pathogenic forms. Although pathogen virulence influences disease outcome, we emphasize the concept of host-pathogen interactions, which involve resistance or tolerance mechanisms in the host that determine total host fitness and bacterial virulence. Taking advantage of the genetic differences between mouse strains, we analyzed the clinical progression in C57BL/6 and BALB/c weaned mice infected with an E. coli O157:H7 strain. We carefully analyzed colonization with several bacterial doses, clinical parameters, intestinal histology, and the integrity of the intestinal barrier, as well as local and systemic levels of antibodies to pathogenic factors. We demonstrated that although both strains had comparable susceptibility to Shiga toxin (Stx) and the intestinal bacterial burden was similar, C57BL/6 showed increased intestinal damage, alteration of the integrity of the intestinal barrier, and impaired renal function that resulted in increased mortality. The increased survival rate in the BALB/c strain was associated with an early specific antibody response as part of a tolerance mechanism.

Absence of interleukin-10 reduces progression of shiga toxin-induced hemolytic uremic syndrome.

Hemolytic Uremic Syndrome (HUS), a disease triggered by Shiga toxin (Stx), is characterized by hemolytic anemia, thrombocytopenia and renal failure. The inflammatory response mediated by polymorphonuclear neutrophils (PMNs) and monocytes is essential to HUS onset. Still, the role of anti-inflammatory cytokines is less clear. The deficiency of IL-10, an anti-inflammatory cytokine, leads to severe pathology in bacterial infections but also to beneficial effects in models of sterile injury. The aim of this work was to analyze the role of IL-10 during HUS. Control and IL-10 lacking mice (IL-10-/-) were intravenously injected with Stx type 2 (Stx2) and survival rate was evaluated. PMN and circulating and renal pro- and anti-inflammatory factors were analyzed by FACS and enzyme-linked immunosorbent assay (ELISA) respectively. IL-10-/- mice showed a higher survival associated with lower renal damage reflected by reduced plasma urea and creatinine levels than control mice. Circulating PMN increased at 72 h in both mouse strains accompanied by an up-regulation of CD11b in control mice. In parallel, renal PMN were significantly increased only in control mice after toxin. Plasma TNF-α, IL-6 and corticosterone levels were higher increased in IL-10-/- than control mice. Simultaneously renal TNF-α raised constantly but was accompanied by increased TGF-ß levels in IL-10-/- mice. These results demonstrate that the profile of circulating and renal cytokines after Stx2 differed between strains suggesting that balance of these factors could participate in renal protection. We conclude that IL-10 absence has a protective role in an experimental model of HUS by reducing PMN recruitment into kidney and renal damage, and increasing mice survival.

Lo mejor del Congreso 2020 de la Sociedad Europea de Cardiología: la experiencia digital / The best of the 2020 European Society of Cardiology Congress: the digital experience / O melhor do Congresso da Sociedade Europeia de Cardiologia 2020: a experiência digital

Resumen: La necesidad de distanciamiento social impuesta por la actual pandemia por coronavirus obligó a las diferentes sociedades científicas a realizar sus actividades en formato completamente virtual. La Sociedad Europea de Cardiología no ha sido la excepción. Desde el 29 de agosto al 1 de septiembre de 2020 se celebró este evento sin precedentes que, además de contar con 125.000 profesionales de 213 países, permitió el acceso gratuito a todos los cibernautas. De esta manera, la actualidad en cardiología pudo llegar a todos los rincones del mundo, pese a las circunstancias tan complejas. Como ya es tradición de la revista, realizamos un resumen de los principales ensayos presentados durante el congreso: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)

Summary The need for social distancing imposed by the current coronavirus pandemic, forced the different scientific societies to carry out their activities in a completely virtual format. And the European Society of Cardiology has not been the exception. From August 29 to September 1 of 2020, this unprecedented event was held which, in addition to having 125,000 health professionals from 213 countries, allowed free access to all netizens. In this way, current affairs in cardiology could reach all corners of the world, despite such complex circumstances. As is the tradition of the magazine, we present a summary of the main essays presented during the congress: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)

Resumo A necessidade de distanciamento social imposto pela atual pandemia do coronavírus, obrigou as diferentes sociedades científicas a desenvolverem suas atividades de forma totalmente virtual. E a Sociedade Europeia de Cardiologia não foi exceção. De 29 de agosto a 1º de setembro 2020, foi realizado esse evento inédito que, além de contar com 125.000 profissionais de saúde de 213 países, possibilitou o acesso gratuito a todos os internautas. Dessa forma, a atualidade da cardiologia pode atingir todos os cantos do mundo, apesar de circunstâncias tão complexas. Como é tradição da revista, apresentamos um resumo dos principais ensaios apresentados durante o congresso: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)

Role of Shiga Toxins in Cytotoxicity and Immunomodulatory Effects of Escherichia coli O157:H7 during Host-Bacterial Interactions in vitro.

Enterohemorrhagic Escherichia coli (EHEC) strains are food-borne pathogens that can cause different clinical conditions. Shiga toxin 2a and/or 2c (Stx2)-producing E. coli O157:H7 is the serotype most frequently associated with severe human disease. In this work we analyzed the hypothesis that host cells participate in Stx2 production, cell damage, and inflammation during EHEC infection. With this aim, macrophage-differentiated THP-1 cells and the intestinal epithelial cell line HCT-8 were incubated with E. coli O157:H7. A time course analysis of cellular and bacterial survival, Stx2 production, stx2 transcription, and cytokine secretion were analyzed in both human cell lines. We demonstrated that macrophages are able to internalize and kill EHEC. Simultaneously, Stx2 produced by internalized bacteria played a major role in macrophage death. In contrast, HCT-8 cells were completely resistant to EHEC infection. Besides, macrophages and HCT-8 infected cells produce IL-1ß and IL-8 inflammatory cytokines, respectively. At the same time, bacterial stx2-specific transcripts were detected only in macrophages after EHEC infection. The interplay between bacteria and host cells led to Stx production, triggering of inflammatory response and cell damage, all of which could contribute to a severe outcome after EHEC infections.

Lo mejor del Congreso AHA/ACC 2019 / The best of the 2019 AHA/ACC Congress / O melhor do Congresso da AHA/ACC 2019

Resumen: Del 16 al 18 de noviembre de 2019 se celebró en la ciudad de Philadelphia una nueva reunión del congreso anual del American College of Cardiology. Es uno de los eventos más relevantes de la cardiología mundial, y contó en esta oportunidad con la participación de destacados profesionales que presentaron los últimos ensayos clínicos en las sesiones de Late Breaking Science, abordando diferentes aspectos de la especialidad: estrategias innovadoras para reducir el riesgo cardiovascular, resultados de los ensayos de isquemia, controversias en el manejo contemporáneo de la estenosis aórtica, estado del arte del manejo de pacientes con síndromes coronarios agudos, desafíos en insuficiencia cardíaca y nuevas fronteras en la terapia lipídica. A continuación presentamos un resumen de los principales trabajos presentados: - The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF). - The COLchicine Cardiovascular Outcomes Trial (COLCOT). - Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcathether Aortic Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results. - RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes (ISCHEMIA).

Summary: A new meeting of the annual congress of the American College of Cardiology, was held from November 16 to 18 last year; located in the city of Philadelphia. As one of the most important events in global cardiology, it was attended by leading professionals who were the last clinical trials in the Late Breaking Science sessions, which addressed different aspects of the specialty: innovative strategies to reduce cardiovascular risk, results of the trials of ischemia, controversies in the contemporary management of aortic stenosis, state of the art of the management of patients with acute coronary syndromes, challenges in heart failure and new frontiers in lipid therapy. We will make a brief summary of the main presented trials: - The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF). - The COLchicine Cardiovascular Outcomes Trial (COLCOT). - Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcathether Aortic Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results. - RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes (ISCHEMIA).

Resumo: Uma nova reunião do congresso anual do Colégio Americano de Cardiologia, foi realizada de 16 a 18 de novembro do ano passado; localizado na cidade de Filadélfia. Como um dos eventos mais importantes da cardiologia global, contou com a presença de profissionais líderes que apresentaram os últimos ensaios clínicos nas sessões de Late Breaking Science, que abordaram diferentes aspectos da especialidade: estratégias inovadoras para reduzir o risco cardiovascular, resultados dos ensaios de isquemia, controvérsias no tratamento contemporâneo da estenose aórtica, estado da arte do tratamento de pacientes com síndromes coronárias agudas, desafios na insuficiência cardíaca e novas fronteiras na terapia lipídica. Faremos um breve resumo dos principais trabalhos apresentados: - The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF). - The COLchicine Cardiovascular Outcomes Trial (COLCOT). - Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcathether Aortic Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results. - RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes (ISCHEMIA).

Lo mejor del Congreso Uruguayo de Cardiología 2019 / The best of the 2019 Uruguayan Congress of Cardiology / O melhor do Congresso Uruguaio de Cardiologia 2019

Resumen: El 35° Congreso Uruguayo de Cardiología tuvo lugar en Punta del Este, del 7 al 9 de noviembre. Como cada año, constituyó una oportunidad de actualización en diferentes áreas de la cardiología, contando con la participación de invitados nacionales e internacionales. Asimismo, se dio a conocer la actividad científica desarrollada por diferentes autores mediante la exposición de temas libres. A continuación, comentamos los siete artículos premiados por el Comité Científico. - Prevención de muerte súbita (PREMUDE) en jugadores de fútbol: 10 años de valoración precompetitiva. - Perfil clínico de la fibrilación auricular en el posoperatorio de cirugía cardíaca. - Protocolo de cardio-oncología para el seguimiento de pacientes con riesgo de disfunción ventricular por quimioterapia. - Implicancia del uso del score de calcio coronario en la re-estratificación del riesgo cardiovascular en prevención primaria. - Análisis de la morbimortalidad asociada a implante percutáneo de válvula aórtica: valor de variables clínicas y scores de riesgo a mediano plazo. - Anticoagulación en bioprótesis valvular aórtica. Ensayo clínico randomizado multicéntrico. - Strain global longitudinal del ventrículo izquierdo permite predecir mejoría funcional y sobrevida en pacientes con insuficiencia mitral severa asintomática y función normal. Metaanálisis.

Summary: The 35th Uruguayan Congress of Cardiology was held in Punta del Este in November 7th to 9th. As every year, it was an opportunity to update in different cardiovascular areas with participation of national and international guests. Scientific activity of different authors was also announced, through exposition of several articles. We will comment the seven awarded abstracts. - Sudden death prevention (PREMUDE) in soccer players: 10 years of pre-competitive assessment. - Clinical profile of atrial fibrillation in the postoperative period of cardiac surgery. - Cardio-oncology protocol for the follow-up of patients at risk of ventricular dysfunction due to chemotherapy. - Implication of the use of coronary calcium score in the re-stratification of cardiovascular risk in primary prevention. - Analysis of morbidity and mortality associated with percutaneous aortic valve implantation: value of clinical variables and medium-term risk scores. - Anticoagulation in aortic valve bioprosthesis. Multicenter randomized clinical trial. - Longitudinal global left ventricular strain allows prediction of functional improvement and survival in patients with severe asymptomatic mitral regurgitation and normal function. Meta-analysis.

Resumo: O 35º Congresso Uruguaio de Cardiologia, aconteceu em Punta del Este, de 7 a 9 de novembro. Como todos os anos, foi uma oportunidade de atualização em diferentes áreas cardiológicas, graças à experiência de convidados nacionais e internacionais. Também foi anunciada a atividade científica de diferentes serviços, através da exposição de vários artigos. Propomos comentar os sete artigos premiados. - Prevenção de morte súbita (PREMUDE) em jogadores de futebol: 10 anos de avaliação pré-competitiva. - Perfil clínico da fibrilação atrial no pós-operatório de cirurgia cardíaca. - Protocolo cardio-oncológico para acompanhamento de pacientes com risco de disfunção ventricular devido à quimioterapia. - Implicação do uso do escore de cálcio coronariano na ré estratificação do risco cardiovascular na prevenção primária. - Análise da morbimortalidade associada ao implante valvar aórtico percutâneo: valor de variáveis clínicas e escores de risco a médio prazo. - Anticoagulação na bioprótese valvar aórtica. Ensaio clínico randomizado multicêntrico. - O strain global longitudinal do ventrículo esquerdo permite predizer melhora funcional e sobrevida em pacientes com insuficiência mitral assintomática grave e função normal. Meta-análise.

Lo mejor del Congreso Virtual ACC/WCC 2020 / The best of the 2020 ACC/WCC Virtual Congress / O melhor do Congresso Virtual ACC/WCC 2020

Resumen: La pandemia generada por el SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) ha constituido un desafío mundial. En momentos de dificultad como los que se han presentado recientemente, es aún más necesaria la investigación para avanzar en el diagnóstico y tratamiento de las diferentes patologías. Utilizando el amplio desarrollo de los medios de comunicación, este año el Congreso del Colegio Americano de Cardiología (ACC por su sigla en inglés) se celebró del 28 al 30 de marzo en un formato virtual, permitiendo a profesionales de todo el mundo acceder a múltiples actividades científicas con el mismo nivel de excelencia que en las sesiones presenciales. Realizaremos un breve resumen de alguno de los principales trabajos científicos presentados: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR-PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.

Summary The SARS-CoV-2 pandemic has been a global challenge. In times of difficulty such as those that have recently arisen, research is even more necessary to advance in the diagnosis and treatment of different pathologies. Using the extensive development of the media, this year the American Congress of Cardiology was held from March 28 to 30 in a virtual format, allowing professionals from around the world to access multiple scientific activities with the same level of excellence as in face-to-face sessions. We will make a brief summary of some of the main scientific papers presented: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR-PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial:. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial. - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.

Resumo: A pandemia de SARS-CoV-2 tem sido um desafio global. Em tempos de dificuldade como os que surgiram recentemente, a pesquisa é ainda mais necessária para avançar no diagnóstico e tratamento de diferentes patologias. Utilizando o amplo desenvolvimento da mídia, este ano o Congresso Americano de Cardiologia foi realizado de 28 ao 30 de março em um formato virtual, permitindo que profissionais de todo o mundo acessassem diversas atividades científicas com o mesmo nível de excelência que nas sessões presenciais. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR - PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial. - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.

Coronavirus y sistema cardiovascular / Coronavirus and cardiovascular system / Coronavírus e sistema cardiovascular

Resumen: La pandemia actual generada por el nuevo coronavirus (SARS-CoV-2) ha constituido desde su aparición, el foco de preocupación sanitaria a nivel mundial. Su elevada transmisibilidad asociada a la ausencia de un tratamiento eficaz, implica un duro impacto en el área de investigación. Los reportes sobre formas de presentación atípicas, factores de riesgo asociados y fármacos ensayados para disminuir su morbimortalidad, saturan los medios de comunicación. La comunidad cardiológica se encuentra activamente presente, ya que las manifestaciones cardiovasculares son frecuentes y variadas, así como también se ha observado un aumento del riesgo de mala evolución en aquellos individuos con enfermedad cardiovascular previa. El objetivo de la revisión es aportar la evidencia disponible en este tópico, haciendo la salvedad del carácter dinámico de la información.

Summary: The current pandemic caused by the new coronavirus (SARS-CoV-2) has been the focus of global health concern since its appearance. Its high transmissibility associated with the absence of an effective treatment implies a hard impact in the research area. Reports of atypical presentation forms, associated risk factors, and drugs tested to decrease morbidity and mortality saturate the media. The cardiology community is actively present since cardiovascular manifestations are frequent and varied, as well as an increased risk has been observed in those patients with previous cardiovascular disease. The objective of this review is to contribute the available evidence on this particular topic, making the caveat, of the dynamic nature of the information.

Resumo: A atual pandemia causada pelo coronavírus (SARS-CoV-2) tem sido o foco de preocupações globais com a saúde desde o seu surgimento. Sua alta transmissibilidade associada à ausência de um tratamento efetivo implica forte impacto na área de pesquisa. Relatos de formas de apresentação atípicas, fatores de risco associados e medicamentos testados para diminuir a morbimortalidade saturam a mídia. A comunidade de cardiologia está ativamente presente, pois as manifestações cardiovasculares são frequentes e variadas, bem como um risco aumentado foi observado nos pacientes com doença cardiovascular anterior. O objetivo desta revisão é contribuir com as evidências disponíveis sobre esse tópico em particular, tornando a advertência da natureza dinâmica das informações.

Insuficiencia mitral aguda secundaria a rotura de músculo papilar, posinfarto agudo de miocardio durante la pandemia COVID-19. Reporte de caso / Acute mitral regurgitation secondary to rupture of the papillary muscle, after acute myocardial infarction during the COVID-19 pandemic. Case report / Regurgitação mitral aguda secundária a ruptura do músculo papilar, após infarto agudo do miocárdio durante a pandemia de COVID-19. Relato de caso

Resumen: La insuficiencia mitral aguda por rotura de músculo papilar, como complicación del infarto agudo de miocardio (IAM), ha disminuido su incidencia con las estrategias de reperfusión miocárdica coronaria. La actual pandemia (COVID-19) ha generado alerta en la comunidad cardiológica por el riesgo de consultas tardías en pacientes con síndrome coronario agudo, con las consecuencias derivadas de una reperfusión tardía. Presentamos el caso de una paciente con IAM que en la evolución padece esta complicación.

Summary: Acute mitral regurgitation from ruptured papillary muscle such, as complication of acute myocardial infarction, has decreased its incidence with myocardial coronary reperfusion strategies. The current pandemic (COVID-19) has generated an alert in the cardiology community due to the risk of late consultations in patients with acute coronary syndrome, with the consequences derived from a late reperfusion. We present the case of a patient with acute myocardial infarction who in evolution suffers this complication.

Sumário: Regurgitação mitral aguda do músculo papilar rompido, como complicação do infarto agudo do miocárdio, sua incidência diminuiu com estratégias de reperfusão miocárdica coronário. A pandemia atual (COVID-19) gerou um alerta na comunidade de cardiologia devido ao risco de consultas tardias em pacientes com síndrome coronariana aguda, com as consequências derivado de uma reperfusão tardia. Apresentamos o caso de uma paciente com infarto agudo do miocárdio que na evolução sofre essa complicação.

Lo mejor del Congreso 2019 del American College of Cardiology / The best of the 2019 American College of Cardiology Congress / O melhor do Congresso do Colégio Americano de Cardiologia 2019

Resumen: Como todos los años, en esta oportunidad se celebró el 68º Congreso del Colegio Americano de Cardiología (ACC, por su sigla en inglés) entre los días 16 y 18 de marzo en Nueva Orleans, Luisiana. Ambientado en la ciudad del Mardi Gras y el jazz, nuevamente convocó a la cardiología mundial para promover el conocimiento a través de la presentación de múltiples actividades científicas. Contó con la presencia de más de 16.000 asistentes y se recibieron 2.300 artículos, muchos de los cuales, sin duda, modificarán la práctica clínica actual. Cabe destacar, asimismo, la presentación de la Guía de Prevención Primaria de la Enfermedad Cardiovascular, donde resalta el casi total abandono del ácido acetilsalicílico en prevención primaria debido a la falta de beneficio neto. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study

Summary: As every year, on this occasion the 68th Congress of the American College of Cardiology was held from March 16 to 18 in New Orleans, Louisiana. Set in the city of Mardi Gras and jazz, it once again called on global cardiology to promote knowledge through the presentation of multiple scientific activities. It counted with the presence of more than 16.000 attendees and 2.300 articles were received, many of which will undoubtedly modify the current clinical practice. It is also worth mentioning the presentation of the Primary Prevention of Cardiovascular Disease Guideline, which highlights the almost total discontinuation of acetylsalicylic acid in primary prevention due to the lack of net benefit. We will make a brief summary of some of the main scientific papers presented: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study

Resumo: Como todos os anos, nesta ocasião, o 68º Congresso do Colégio Americano de Cardiologia (ACC após sua sigla em inglês) foi realizado de 16 a 18 de março em Nova Orleans, Louisiana. Situado na cidade do Mardi Gras e jazz, mais uma vez convidou a cardiologia do mondo para promover o conhecimento através da apresentação de múltiplas atividades científicas. Contou com a presença de mais de 16.000 participantes e 2.300 artigos recebidos, muitos dos quais sem dúvida modificarão a prática clínica atual. Também vale ressaltar a apresentação da Diretriz para a Prevenção Primária de Doenças Cardiovasculares, que destaca o quase total abandono do ácido acetilsalicílico na prevenção primária devido à falta de benefício líquido. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study