Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction. / Impacto del sexo en los tiempos de cateterismo y en el uso de pretratamiento antiagregante plaquetario en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST).

OBJECTIVES: To assess differences in the clinical management of nonST-segment elevation myocardial infarction (NSTEMI), including in-hospital events, according to biological sex. MATERIAL AND METHODS: Prospective observational multicenter study of patients diagnosed with NSTEMI and atherosclerosis who underwent coronary angiography. RESULTS: We enrolled 1020 patients in April and May 2022; 240 (23.5%) were women. Women were older than men on average (72.6 vs 66.5 years, P .001), and more women were frail (17.1% vs 5.6%, P .001). No difference was observed in pretreatment with any P2Y12 inhibitor (prescribed in 68.8% of women vs 70.2% of men, P = .67); however, more women than men were prescribed clopidogrel (56% vs 44%, P = .009). Women prescribed clopidogrel were more often under the age of 75 years and not frail. Coronary angiography was performed within 24 hours less corooften in women (29.8% vs 36.9%, P = .03) even when high risk was recognized. Frailty was independently associated with deferring coronary angiography in the adjusted analysis; biological sex by itself was not related. The frequency and type of revascularization were the same in both sexes, and there were no differences in in-hospital cardiovascular events. CONCLUSION: Women were more often prescribed less potent antithrombotic therapy than men. Frailty, but not sex, correlated independently with deferral of coronary angiography. However, we detected no differences in the frequency of coronary revascularization or in-hospital events according to sex.

OBJETIVO: Evaluar las diferencias en el manejo clínico y eventos intrahospitalarios en una cohorte de pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) en función del sexo. METODO: Estudio observacional, prospectivo y multicéntrico que incluyó pacientes consecutivos con diagnóstico de SCASEST sometidos a coronariografía con enfermedad ateroesclerótica responsable. RESULTADOS: Entre abril y mayo de 2022 se incluyeron 1.020 pacientes; de ellos, 240 eran mujeres (23,5%). En comparación con los hombres, las mujeres fueron mayores (72,6 años vs 66,5 años; p 0,001) y más frágiles (17,1% vs 5,6%; p 0,001). No hubo diferencias en el pretratamiento con un inhibidor del receptor P2Y12 (68,8% vs 70,2%, p = 0,67), aunque las mujeres recibieron más pretratamiento con clopidogrel (56% vs 44%, p = 0,009), principalmente aquellas de edad 75 años y sin fragilidad. En las mujeres se realizaron menos coronariografías precoces (# 24 h) (29,8% vs 36,9%; p = 0,03) a pesar de presentar la misma indicación (criterios de alto riesgo). En el análisis ajustado, la fragilidad, pero no el sexo, se asoció de forma independiente con la realización de una coronariografía diferida. La tasa y el tipo de revascularización fue igual en ambos sexos, y no hubo diferencias en los eventos cardiovasculares intrahospitalarios. CONCLUSIONES: Las mujeres recibieron con mayor frecuencia un tratamiento antitrombótico menos potente. La fragilidad y no el sexo se asoció con la realización de coronariografía diferida. Sin embargo, no hubo diferencias en la tasa de revascularización coronaria ni en los eventos intrahospitalarios en función del sexo.

Mortality attributable to secondhand smoke exposure in the autonomous communities of Spain.

INTRODUCTION AND OBJECTIVES: Exposure to secondhand smoke (SHS) causes cardiovascular disease, respiratory disease, and cancer. The aim of this study was to estimate the mortality attributed to SHS in people aged ≥ 35 years in Spain and its autonomous communities (AC) by sex from 2016 to 2021. METHODS: Estimates of SHS-attributable mortality were calculated by applying the prevalence-dependent method where SHS exposure was derived from the adjustment of small-area models and based on the calculation of population-attributed fractions. Sex, age group, AC, and cause of death (ischemic heart disease and lung cancer) were included. The estimates of attributed mortality are presented with their 95% confidence interval (95%CI). Crude and age-standardized rates were estimated for each sex and AC. RESULTS: From 2016 to 2021, SHS exposure caused 4,970 (95%CI, 4,787-5,387) deaths, representing 1.6% of total mortality for ischemic heart disease and lung cancer. The burden of attributed mortality differed widely among the AC, with Andalusia having the highest burden of attributed mortality (crude rate: 46.6 deaths per 100 000 population in men and 17.0/100 000 in women). In all the AC, the main cause of death in both sexes was ischemic heart disease. The highest burden of mortality was observed in nonsmokers. CONCLUSIONS: The burden of SHS-attributable mortality was high and varied geographically. The results of this study should be considered to advance tobacco control legislation in Spain.

Chagas Cardiomyopathy and Aerobic Exercise: a Systematic Review / CARDIOPATIA CHAGÁSICA E EXERCÍCIO FÍSICO AERÓBICO: uma revisão sistemática

A cardiomiopatia chagásica é uma consequência crônica da doença de Chagas e representa uma das principais causas de morbidade e mortalidade na América Latina. O exercício físico aeróbico tem sido reconhecido pelos seus benefícios à saúde cardiovascular. Portanto, o estudo tem como objetivo avaliar os efeitos do exercício físico aeróbico na função cardíaca, capacidade de exercício e qualidade de vida em pacientes com cardiomiopatia chagásica. Foi utilizado um referencial teórico-metodológico baseado na análise de estudos encontrados nas bases de dados PubMed, Scopus e Web of Science durante um período de cinco anos. Os resultados indicam que o exercício físico aeróbio pode ser uma estratégia terapêutica complementar eficaz, contribuindo para a melhoria da função cardíaca, aumento da capacidade de exercício e melhoria da qualidade de vida dos pacientes. No entanto, é importante destacar a necessidade de mais estudos para padronizar os protocolos de exercício e identificar os mecanismos específicos pelos quais o exercício beneficia os pacientes com cardiomiopatia chagásica. Conclui-se que, apesar das limitações existentes, a prática de exercício físico aeróbico apresenta potencial significativo para reabilitação cardíaca em indivíduos acometidos pela doença de Chagas e deve ser considerada como parte do plano de tratamento.

A cardiopatia chagásica é uma consequência crônica da doença de Chagas e representa uma das principais causas de morbimortalidade na América Latina. O exercício físico aeróbico tem sido reconhecido por seus benefícios à saúde cardiovascular. Assim, o estudo tem como objetivo avaliar os efeitos do exercício físico aeróbico na função cardíaca, na capacidade de exercício e na qualidade de vida de pacientes com cardiopatia chagásica. Utilizou-se um referencial teórico-metodológico baseado na análise de estudos encontrados nas bases de dados PubMed, Scopus e Web of Science, em sete anos. Os resultados indicam que o exercício físico aeróbico pode ser uma estratégia terapêutica complementar eficaz, contribuindo para a melhoria da função cardíaca, aumento da capacidade de exercício e melhoria da qualidade de vida dos pacientes. No entanto, destaca-se a necessidade de mais estudos para padronizar protocolos de exercício e identificar os mecanismos específicos pelos quais o exercício beneficia pacientes com cardiopatia chagásica. Conclui-se que, apesar das limitações existentes, a prática de exercício físico aeróbico apresenta um potencial significativo para a reabilitação cardíaca em indivíduos acometidos pela doença de Chagas, devendo ser considerada como parte do plano de tratamento.

Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva / Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease

Introducción: Un porcentaje importante de pacientes finalmente diagnosticados de amiloidosis cardIaca por transtirretina (ATTR) fueron previamente diagnosticados de cardiopatía hipertensiva (CHTA), ya que ambas enfermedades suelen cursar con insuficiencia cardíaca (IC) con fracción de eyección preservada (ICFEp) e hipertrofia ventricular. Nuestros objetivos fueron evaluar las diferencias clínicas, electrocardiográficas y ecocardiográficas, y analizar si existe un pronóstico diferencial entre ambas entidades nosológicas. Material y métodos: Se incluyeron retrospectivamente todos los pacientes con CHTA a los que se solicitó una gammagrafía cardíaca con 99mTc-Difosfonatos (GDPD) y estudio de cadenas ligeras en sangre y orina para despistaje de ATTR en nuestro centro, en el periodo 2016-2021. Para el análisis, se excluyeron aquellos diagnosticados de otros tipos de amiloidosis. Resultados: Se analizaron un total de 72 pacientes: 33 fueron diagnosticados de ATTR y 39 de CHTA, finalmente. Los pacientes con ATTR presentaron mayores niveles de troponina I ultrasensible (TnI-US) y propéptido natriurético cerebral N-terminal (NT-ProBNP); en electrocardiograma (ECG) presentaron más frecuentemente patrón de seudoinfarto y alteraciones de la conducción; en ecocardiograma transtorácico (ETT) presentaron mayor grado de hipertrofia ventricular, disfunción ventricular izquierda y parámetros de peor función diastólica, con presiones de llenado más elevadas. En el seguimiento a 4 años, el grupo de ATTR mostró mayor necesidad de marcapasos (MCP), sin evidenciarse evidencias en cuanto a mortalidad, desarrollo de fibrilación auricular o más ingresos por IC. Conclusiones: En nuestra serie, los pacientes con ATTR presentaron diferencias clínicas, electrocardiográficas y ecocardiográficas respecto a aquellos con CHTA, con mayor riesgo necesidad de MCP en el seguimiento.(AU)

Introduction: A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. Materials and methods: We retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. Results: A total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). Conclusions: In our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.(AU)

Cambios en Mecánica Respiratoria en Usuarios Pediátricos en Ventilación Mecánica Post Cirugía de Cardiopatía Congénita Sometidos a Kinesiología Respiratoria versus Succión Endotraqueal. Revisión Estructurada / Changes in Respiratory Mechanics in Pediatric Users on Mechanical Ventilation Post Congenital Heart Disease Surgery Undergoing Respiratory Kinesiology versus Endotracheal Suction. Structured Review

Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.

Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.

Neurodesarrollo a los 2 años en cardiopatía congénita: utilidad pronóstica de los marcadores de daño cerebral / Neurodevelopmental outcomes in congenital heart disease: Usefulness of biomarkers of brain injury

Introducción: En la actualidad, las alteraciones del neurodesarrollo son la complicación más frecuente en los pacientes con cardiopatía congénita (CC) en edad escolar. Analizamos la incidencia de eventos neurológicos agudos (ENA) en pacientes con CC sometidos a cirugía cardiaca y la utilidad de los neuromarcadores para predecir el neurodesarrollo. Métodos: Estudio prospectivo observacional en recién nacidos (RN) con CC diagnosticada prenatalmente, y sometidos a cirugía el primer año de vida. Se evaluaron: 1) biomarcadores sanguíneos de lesión cerebral (S100B, enolasa neuronal específica) en sangre de cordón y periquirúrgicos; 2) datos clínicos y analíticos perinatales y periquirúrgicos; 3) tratamientos y complicaciones, y 4) neurodesarrollo (escala de Bayley III) a los 2 años. Resultados: Se incluyeron 84 RN con CC de diagnóstico fetal, confirmada posnatalmente, sometidos a cirugía cardiaca en el primer año de vida. Diecisiete pacientes tenían corazón univentricular, 20 pacientes obstrucción izquierda y 10 síndromes genéticos. Fallecieron en el periodo posquirúrgico 5 pacientes (5,9%) y 9 pacientes presentaron ENA (10,7%). Las puntuaciones medias en el test de Bayley III fueron normales, pero el 31% tuvieron alteración cognitiva, motora o en el lenguaje. Los pacientes con síndromes genéticos, ENA y CC univentriculares tuvieron peor neurodesarrollo. La elevación de S100B en el postoperatorio inmediato se correlacionó con peores puntuaciones. Conclusiones: Los pacientes con CC sometidos a cirugía tienen mayor riesgo de sufrir alteraciones del neurodesarrollo. Los pacientes con síndromes genéticos o corazones univentriculares presentan peores resultados. Presentar ENA posquirúrgico puede contribuir a peores resultados. Niveles de S100B elevados en el postoperatorio se correlacionan con peores resultados en los test de neurodesarrollo a los 2 años...(AU)

Introduction: At present, neurodevelopmental abnormalities are the most frequent type of complication in school-aged children with congenital heart disease (CHD). We analysed the incidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulness of neuromarkers for the prediction of neurodevelopment outcomes. Methods: Prospective observational study in infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. We assessed the following variables: (1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood and preoperative blood samples; (2) clinical and laboratory data from the immediate postnatal and perioperative periods; (3) treatments and complications; (4) neurodevelopment (Bayley-III scale) at age 2 years. Results: The study included 84 infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflow obstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7% (9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normal range, but 31% of patients had abnormal scores in the cognitive, motor or language domains. Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmental outcomes. Elevation of S100B in the immediate postoperative period was associated with poorer scores. Conclusions: Children with a history of cardiac surgery for CHD in the first year of life are at risk of adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univentricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes. Elevation of S100B levels in the postoperative period was associated with poorer neurodevelopmental outcomes at 2 years...(AU)

Safety of Low-Dose Oral Minoxidil in Patients With Hypertension and Arrhythmia: A Multicenter Study of 264 Patients / Seguridad de minoxidil oral a dosis bajas en pacientes con hipertensión o arritmias: estudio multicéntrico de 264 pacientes

Background and objective Systemic adverse effects (AE) are a major concern of low-dose oral minoxidil (LDOM) treatment, especially in patients with arterial hypertension or arrhythmia. The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia. Patients and methods Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia. Results A total of 254 patients with hypertension [176 women (69.3%) and 78 men (30.7%)] with a mean age of 56.9 years (range 19–82) were included. From them, the dose of LDOM was titrated in 128 patients, allowing the analysis of 382 doses. Patients were receiving a mean of 1.45 (range 0–5) antihypertensive drugs. Systemic AE were detected in 26 cases (6.8%) and included lightheadedness (3.1%), fluid retention (2.6%), general malaise (0.8%), tachycardia (0.8%) and headache (0.5%), leading to LDOM discontinuation in 6 cases (1.5%). Prior treatment with doxazosin (P<0.001), or with three or more antihypertensive drugs (P=0.012) was associated with a higher risk of discontinuation of LDOM. Conclusions LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia, similar to general population (AU)

Antecedentes y objetivo Los efectos adversos sistémicos son una de las principales limitaciones del uso de minoxidil oral a dosis bajas (MODB), especialmente en pacientes con hipertensión arterial o arritmias. El objetivo de este estudio fue evaluar la seguridad de MODB en estos pacientes. Material y método Estudio retrospectivo multicéntrico con pacientes con antecedentes de hipertensión o arritmias tratados con MODB para cualquier tipo de alopecia. Resultados Se incluyó un total de 254 pacientes con hipertensión (176 mujeres [69,3%] y 78 hombres [30,7%]) con una edad media de 56,9 años (rango 19 – 82). La dosis de MODB se incrementó gradualmente en 128 pacientes, obteniendo un total de 382 dosis analizadas. Los sujetos estaban tomando de media 1,45 fármacos antihipertensivos (rango 0 – 5). Se detectaron EA sistémicos en 26 casos (6,8%), incluyendo mareo (3,1%), retención de líquidos (2,6%), malestar general (0,8%), taquicardia (0,8%) y cefalea (0,5%), requiriendo suspensión del MODB en seis casos (1,5%). Los pacientes en tratamiento con doxazosina (p < 0,001) o con tres o más antihipertensivos (p = 0,012) presentaron mayor riesgo de suspensión de MODB. Conclusión El tratamiento con MODB mostró un perfil de seguridad favorable en pacientes con hipertensión o arritmias, similar al de la población general (AU)

[Artíulo traducido] Seguridad de minoxidil oral a dosis bajas en pacientes con hipertensión o arritmias: estudio multicéntrico de 264 pacientes / Safety of Low-Dose Oral Minoxidil in Patients With Hypertension and Arrhythmia: A Multicenter Study of 264 Patients

Antecedentes y objetivo Los efectos adversos sistémicos son una de las principales limitaciones del uso de minoxidil oral a dosis bajas (MODB), especialmente en pacientes con hipertensión arterial o arritmias. El objetivo de este estudio fue evaluar la seguridad de MODB en estos pacientes. Material y método Estudio retrospectivo multicéntrico con pacientes con antecedentes de hipertensión o arritmias tratados con MODB para cualquier tipo de alopecia. Resultados Se incluyó un total de 254 pacientes con hipertensión (176 mujeres [69,3%] y 78 hombres [30,7%]) con una edad media de 56,9 años (rango 19 – 82). La dosis de MODB se incrementó gradualmente en 128 pacientes, obteniendo un total de 382 dosis analizadas. Los sujetos estaban tomando de media 1,45 fármacos antihipertensivos (rango 0 – 5). Se detectaron EA sistémicos en 26 casos (6,8%), incluyendo mareo (3,1%), retención de líquidos (2,6%), malestar general (0,8%), taquicardia (0,8%) y cefalea (0,5%), requiriendo suspensión del MODB en seis casos (1,5%). Los pacientes en tratamiento con doxazosina (p < 0,001) o con tres o más antihipertensivos (p = 0,012) presentaron mayor riesgo de suspensión de MODB. Conclusión El tratamiento con MODB mostró un perfil de seguridad favorable en pacientes con hipertensión o arritmias, similar al de la población general (AU)

Background and objective Systemic adverse effects (AE) are a major concern of low-dose oral minoxidil (LDOM) treatment, especially in patients with arterial hypertension or arrhythmia. The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia. Patients and methods Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia. Results A total of 254 patients with hypertension [176 women (69.3%) and 78 men (30.7%)] with a mean age of 56.9 years (range 19–82) were included. From them, the dose of LDOM was titrated in 128 patients, allowing the analysis of 382 doses. Patients were receiving a mean of 1.45 (range 0–5) antihypertensive drugs. Systemic AE were detected in 26 cases (6.8%) and included lightheadedness (3.1%), fluid retention (2.6%), general malaise (0.8%), tachycardia (0.8%) and headache (0.5%), leading to LDOM discontinuation in 6 cases (1.5%). Prior treatment with doxazosin (P<0.001), or with three or more antihypertensive drugs (P=0.012) was associated with a higher risk of discontinuation of LDOM. Conclusions LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia, similar to general population (AU)

Neurodevelopmental outcomes in congenital heart disease: Usefulness of biomarkers of brain injury.

INTRODUCTION: At present, neurodevelopmental abnormalities are the most frequent type of complication in school-aged children with congenital heart disease (CHD). We analysed the incidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulness of neuromarkers for the prediction of neurodevelopment outcomes. METHODS: Prospective observational study in infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. We assessed the following variables: (1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood and preoperative blood samples; (2) clinical and laboratory data from the immediate postnatal and perioperative periods; (3) treatments and complications; (4) neurodevelopment (Bayley-III scale) at age 2 years. RESULTS: the study included 84 infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflow obstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7% (9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normal range, but 31% of patients had abnormal scores in the cognitive, motor or language domains. Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmental outcomes. Elevation of S100B in the immediate postoperative period was associated with poorer scores. CONCLUSIONS: children with a history of cardiac surgery for CHD in the first year of life are at risk of adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univentricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes. Elevation of S100B levels in the postoperative period was associated with poorer neurodevelopmental outcomes at 2 years. Studies with larger samples and longer follow-ups are needed to define the role of these biomarkers of brain injury in the prediction of neurodevelopmental outcomes in patients who undergo surgery for management of CHD.

Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease. / Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva.

INTRODUCTION: A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. MATERIALS AND METHODS: We retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. RESULTS: A total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). CONCLUSIONS: In our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.

Safety of Low-Dose Oral Minoxidil in Patients With Hypertension and Arrhythmia: A Multicenter Study of 264 Patients. / [Artíulo traducido] Seguridad de minoxidil oral a dosis bajas en pacientes con hipertensión o arritmias: estudio multicéntrico de 264 pacientes.

BACKGROUND AND OBJECTIVE: Systemic adverse effects (AE) are a major concern of low-dose oral minoxidil (LDOM) treatment, especially in patients with arterial hypertension or arrhythmia. The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia. PATIENTS AND METHODS: Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia. RESULTS: A total of 254 patients with hypertension [176 women (69.3%) and 78 men (30.7%)] with a mean age of 56.9 years (range 19-82) were included. From them, the dose of LDOM was titrated in 128 patients, allowing the analysis of 382 doses. Patients were receiving a mean of 1.45 (range 0-5) antihypertensive drugs. Systemic AE were detected in 26 cases (6.8%) and included lightheadedness (3.1%), fluid retention (2.6%), general malaise (0.8%), tachycardia (0.8%) and headache (0.5%), leading to LDOM discontinuation in 6 cases (1.5%). Prior treatment with doxazosin (P<0.001), or with three or more antihypertensive drugs (P=0.012) was associated with a higher risk of discontinuation of LDOM. CONCLUSIONS: LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia, similar to general population.

Safety of Low-Dose Oral Minoxidil in Patients With Hypertension and Arrhythmia: A Multicenter Study of 264 Patients.

BACKGROUND AND OBJECTIVE: Systemic adverse effects (AE) are a major concern of low-dose oral minoxidil (LDOM) treatment, especially in patients with arterial hypertension or arrhythmia. The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia. PATIENTS AND METHODS: Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia. RESULTS: A total of 254 patients with hypertension [176 women (69.3%) and 78 men (30.7%)] with a mean age of 56.9 years (range 19-82) were included. From them, the dose of LDOM was titrated in 128 patients, allowing the analysis of 382 doses. Patients were receiving a mean of 1.45 (range 0-5) antihypertensive drugs. Systemic AE were detected in 26 cases (6.8%) and included lightheadedness (3.1%), fluid retention (2.6%), general malaise (0.8%), tachycardia (0.8%) and headache (0.5%), leading to LDOM discontinuation in 6 cases (1.5%). Prior treatment with doxazosin (P<0.001), or with three or more antihypertensive drugs (P=0.012) was associated with a higher risk of discontinuation of LDOM. CONCLUSIONS: LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia, similar to general population.

Frank's sign associated with the severity of ischemic heart disease in patients under 65 years old / Signo de Frank asociado con la gravedad de la cardiopatía isquémica en adultos de edad inferior o igual a 65 años

Background and objective Frank's sign is the diagonal ear fold which has been associated with ischemic heart disease. The objective of this work was to evaluate the relationship of Frank's sign with severity of ischemic heart disease in adults ≤ 65 years old in the northeast of Mexico. Patients and methods A cross-sectional study was conducted in patients ≤ 65 years old who underwent coronary angiography consecutively over a period of 5 months in 2022. Severe coronary artery disease (CAD) was associated with Frank's sign and other common cardiovascular risks. To determine the association, bivariate and multivariate analysis was performed using logistic regression that included variables with a value of p<0.05. Statistical analysis was performed with SPSS version 22. Results We included 311 patients ≤ 65 years, of whom 80% were men. The median age was 57 years (range 28–65). Frank's sign was positive in 62% of the population. The main clinical characteristics in patients with Frank's sign were type 2 diabetes mellitus (55%), p=0.003, dyslipidemia (53%), p=0.026 and smoking (68%), p=0.002. In the multivariate analysis, the independent variables associated with severe CAD were Frank's Sign OR 3.26; 95% CI (1.98–5.38), p≤0.001, male gender OR 2.28; 95% CI (1.20–4.35), p=0.012, and dyslipidemia OR 1.81; 95% CI (1.11–2.97), p=0.017. Conclusions There is an independent association between Frank's sign with the presence of severe CAD in patients ≤ 65 years old, which may be useful for screening and prevention (AU)

Antecedentes y objetivo El signo de pliegue diagonal de la oreja o signo de Frank se ha asociado con cardiopatía isquémica. El objetivo de este trabajo fue evaluar la relación del signo de Frank con la gravedad de la cardiopatía isquémica en adultos≤65años en el noreste de México. Pacientes y métodos Se realizó un estudio transversal en pacientes ≤65años sometidos a coronariografía de manera consecutiva en un periodo de 5 meses en 2022. Se relacionó la enfermedad arterial coronaria (EAC) grave con el signo de Frank y los factores de riesgo cardiovascular tradicionales. Para determinar la asociación se realizó análisis bivariado y multivariado mediante regresión logística que incluyó las variables con valor de p<0,05. El análisis estadístico se realizó con el programa SPSS versión 22. Resultados Se incluyeron 311 pacientes≤65años, de los cuales el 80% fueron hombres. La mediana de edad fue 57 años (rango de 28-65 años). El 62% de los pacientes presentó el signo de Frank. Las principales características clínicas en pacientes con signo de Frank fueron diabetes mellitus tipo 2 (55%), p=0,003, dislipidemia (53%), p=0,026 y tabaquismo (68%), p=0,002. En el análisis multivariado las variables independientes asociadas a EAC grave fueron el signo de Frank (OR: 3,26; IC 95%: 1,98-5,38; p≤0,001), sexo masculino (OR: 2,28; IC 95%: 1,20-4,35; p=0,012) y dislipidemia (OR: 1,81; IC 95%: 1,11-2,97; p=0,017). Conclusiones Existe asociación independiente del signo de Frank con la presencia de EAC grave en pacientes≤65años, que puede ser útil para el cribado y la prevención (AU)

Conglomerados espaciales de mortalidad por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica en la provincia de Santiago de Cuba / Space conglomerates of mortality due to cancer, ischemic heart disease and ischemic cerebrovascular disease in Santiago de Cuba province i: en

Introducción: Uno de los aspectos que más interés suscita en lo referente a la distribución geográfica de la mortalidad por cáncer es la formación de conglomerados espaciales. Objetivo: Identificar el patrón espacial de la mortalidad por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica mediante la detección y descripción de conglomerados espaciales en la provincia de Santiago de Cuba. Métodos: Se realizó un estudio ecológico exploratorio espacial de los fallecimientos por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica durante el período comprendido desde el 1 de enero hasta el 31 de diciembre de 2019 en la provincia de Santiago de Cuba, para lo cual se procedió a la detección de conglomerados espaciales de elevada y baja mortalidad por las causas antes citadas. Se empleó el método de escaneo espacial estadístico con el programa Satscan y las variables independientes fueron divididas en demográficas y clínicas. Resultados: De los 36 conglomerados espaciales de mortalidad detectados, 23 correspondieron al cáncer (65,8 %), 7 a cardiopatía isquémica (18,4 %) y 6 a enfermedad cerebrovascular isquémica (15,8 %); asimismo, 44,7 % del total eran de elevado riesgo y 55,3 % de bajo riesgo. Conclusiones: El patrón de la distribución espacial de mortalidad por cáncer de próstata, pulmón, mama, colon, esófago, cardiopatía isquémica y enfermedad cerebrovascular isquémica se caracterizó por la formación de conglomerados espaciales de elevada y baja mortalidad.

Introduction: One of the aspects that more interest raises regarding the geographical distribution of mortality due to cancer is the formation of space conglomerates. Objective: To identify the space pattern of mortality due to cancer, ischemic heart disease and ischemic cerebrovascular disease by means of the detection and description of space conglomerates in Santiago de Cuba province. Methods: A space exploratory ecological study of deaths due to cancer, ischemic heart disease and ischemic cerebrovascular disease was carried out during January 1st to December 31, 2019 in Santiago de Cuba province, for which space conglomerates of high and low mortality due to the abovementioned causes were detected. The statistical space escanning method was used with the Satscan program and the independent variables were divided in demographic and clinical. Results: Of the 36 space conglomerates of mortality detected, twenty three corresponded to cancer (65.8%), seven to ischemic heart disease (18.4%) and six to ischemic cerebrovascular disease (15.8%); also, 44.7% of the total was of high risk and 55.3% of low risk. Conclusions: The space distribution pattern of mortality due to prostate, lung, breast, colon, esophagus cancer, ischemic heart disease and ischemic cerebrovascular disease was characterized by the formation of high and low mortality space conglomerates.

Primer registro de procedimientos de intervencionismo cardiovascular pediátrico realizados en un laboratorio estatal de hemodinamia pediátrica en El Salvador / First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador

Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

Manejo interdisciplinario de la obesidad y el sobrepeso en rehabilitación cardiaca: revisión de la Sociedad Mexicana para el Cuidado del Corazón / Interdisciplinary management of obesity and overweight in cardiac rehabilitation: review of the Mexican Society for Heart Care (Sociedad Mexicana para el Cuidado del Corazón, SOMECCOR)

Resumen Antecedentes: La obesidad es un trastorno multifactorial caracterizado por un aumento en la adiposidad corporal, de amplia prevalencia en nuestro país, a cualquier edad y ligada a grandes consecuencias adversas, incluyendo el desarrollo de cardiopatías. Los programas de rehabilitación cardiaca (RC) son intervenciones interdisciplinarias encaminadas no solo a restaurar la funcionalidad perdida de los pacientes que han sufrido un desenlace cardiovascular, sino también a corregir aquellos factores de riesgo que lo propiciaron y que interfieren en los resultados adaptativos del mismo. La obesidad contribuye a perpetuar el riesgo de cardiopatía y suele ser resistente a las modificaciones del estilo de vida de manera convencional. Objetivo: Establecer pautas en el reconocimiento de la obesidad con directrices de atención al paciente con cardiopatía dentro de los programas de RC y su abordaje interdisciplinario. Método: A través de una extensiva revisión bibliográfica y después de una discusión interdisciplinaria, se elaboró el presente documento para fijar una postura sobre el abordaje de la obesidad en el contexto de los programas de RC en pacientes con cardiopatía. Resultados y conclusiones: Nuestra Sociedad reconoce el abordaje interdisciplinario de los pacientes con obesidad y cardiopatía en su prevención primaria y secundaria, insta a la precisión en su diagnóstico y valoración, y recomienda que su eje primario debe estar basado en primera instancia en las modificaciones del estilo de vida (entrenamiento físico, atención nutricional e intervención psicoemocional), en tanto que la terapia farmacológica y la cirugía bariátrica pudieran ser coadyuvantes en la optimización de los resultados en pacientes selectos.

Abstract Background: Obesity is a multifactorial disorder characterized by increased body adiposity with a wide prevalence in our country, at any age, and linked to major adverse consequences, including the development of heart disease. Cardiac rehabilitation (CR) programs are interdisciplinary interventions aimed not only at restoring the lost functionality of patients who have suffered a cardiovascular outcome, but also at correcting those risk factors that led to it and that interfere with its adaptive results. Obesity contributes to perpetuating heart disease risk and is often resistant to conventional lifestyle modifications. Objective: Establish guidelines in the recognition of obesity with care guidelines for patients with heart disease within CR programs and their interdisciplinary approach. Method: Through an extensive bibliographical review and after an interdisciplinary discussion, this document was prepared to establish a position on the approach to obesity in the context of CR programs in patients with heart disease. Results and conclusions: Our Society recognizes the interdisciplinary approach of our patients with obesity and heart disease in its primary and secondary prevention, urges precision in its diagnosis and assessment, recommends that its primary axis must be based in the first instance on lifestyle modifications (physical training, nutritional care and psycho-emotional intervention), while pharmacological therapy and bariatric surgery could be coadjuvants in optimizing the results in selected patients.

First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador.

OBJECTIVE: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. MATERIAL AND METHOD: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. RESULTS: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. CONCLUSIONS: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

OBJETIVO: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. MATERIAL Y MÉTODO: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. RESULTADOS: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. CONCLUSIONES: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

An unusual cardiac involvement in mixed connective tissue disease / Una afección cardíaca poco común en la enfermedad mixta del tejido conjuntivo

Mixed connective tissue disease is an autoimmune disorder with overlapping features of systemic lupus erythematosus, systemic sclerosis and polymyositis. Cardiac involvement is common, being pericarditis the most frequent manifestation, as also pulmonary hypertension. The authors present a case of a woman with one year of symptoms of polyarthritis and myalgia with gradual muscle weakness and weight loss, with severe impaired mobility in the last months. The initial evaluation showed an inflammatory systemic condition with an infiltrative pattern in echocardiogram, with pulmonary hypertension, that was confirmed by cardiac magnetic resonance. After an extensive study, where infiltrative cardiomyopathies were a differential diagnosis, the patient meet criteria to mixed connective disease with signs of pulmonary hypertension and an atypical cardiac involvement. Immunosuppressive treatment and rehabilitation were initiated and one year after the patient remains asymptomatic without any limitations. (AU)

La enfermedad mixta del tejido conectivo es un trastorno autoinmune con características superpuestas de lupus eritematoso sistémico, esclerosis sistémica y polimiositis. La afectación cardiaca es común, siendo la pericarditis la manifestación más frecuente, al igual que la hipertensión pulmonar. Los autores presentan el caso de una mujer con un año de síntomas de poliartritis y mialgia con debilidad muscular gradual y pérdida de peso, con grave deterioro de la movilidad en los últimos meses. La evaluación inicial mostró un cuadro inflamatorio sistémico con patrón infiltrativo en ecocardiograma, con hipertensión pulmonar, que se confirmó por resonancia magnética cardiaca. Tras un amplio estudio, en el que las miocardiopatías infiltrativas constituyeron un diagnóstico diferencial, la paciente cumplía criterios de conectivopatía mixta con signos de hipertensión pulmonar y una afectación cardiaca atípica. Se inició tratamiento inmunosupresor y rehabilitación y un año después la paciente permanece asintomática sin limitaciones. (AU)

Abordaje terapéutico de cardiopatías congénitas en el síndrome de Down / Congenital heart disease in Down's syndrome

Resumen Antecedentes: El síndrome de Down es la anomalía cromosómica más frecuente y se asocia con defectos cardiacos congénitos, elementos clínicos de una alta morbilidad y mortalidad infantil. Objetivo: Describir los desenlaces clínicos de los pacientes con síndrome de Down sometidos a cirugía e intervencionismo como tratamiento de las cardiopatías congénitas en esta institución. Material y métodos: Estudio retrospectivo que incluyó pacientes menores de 18 años con síndrome de Down y patología cardiaca asociada durante los últimos 10 años. Las variables estudiadas fueron: peso, talla, sexo, edad, tipo de cardiopatía, procedimiento correctivo, tiempo de estancia intrahospitalaria y en unidad de terapia intensiva, morbilidad y mortalidad. Resultados: 368 pacientes pediátricos fueron llevados a corrección quirúrgica o intervencionista, de los cuales 197 (54%) pertenecían al sexo femenino, la mediana de edad fue de 24 meses (rango intercuartílico [RIQ]: 14-48) en el grupo quirúrgico y de 36 meses (RIQ: 17-85) en el intervencionista. Las cardiopatías congénitas más frecuentes fueron: persistencia del conducto arterioso (31%), comunicación interventricular (28%), canal atrioventricular (CAV) (20%), comunicación interauricular (16%) y tetralogía de Fallot con el 4% respectivamente. La estancia hospitalaria fue de 9 días (RIQ: 7-15) en el grupo quirúrgico y de 3 días (RIQ: 2-5) en el hemodinámico. Las morbilidades fueron infección postoperatoria en 30 pacientes (14%) y en 19 pacientes (9%) bloqueo atrioventricular completo. La mortalidad global incluyendo tanto el quirúrgico como el intervencionista fue del 2%. Conclusiones: Los resultados terapéuticos, quirúrgicos e intervencionistas, en los niños con síndrome de Down y cardiopatías congénitas han mejorado en forma muy satisfactoria. Es de destacar la menor prevalencia del CAV en la población mexicana. Es indispensable realizar evaluación cardiológica a los niños con síndrome de Down y aquellos con cardiopatías congénitas llevarlos a corrección de manera oportuna para favorecer la sobrevida y calidad de vida.

Abstract Background: Down syndrome is the most common chromosomal abnormality, it is associated with a wide variety of congenital heart defects, being considered as clinical elements of high infant morbidity and mortality. Objective: To describe the clinical outcomes of patients with Down syndrome undergoing surgery and interventionism as treatment for congenital heart disease at this Institution. Material and methods: 368 patients with Down syndrome and associated congenital heart disease were diagnosed. The variables studied were weight, stature, sex, age, type of heart disease, corrective procedure, length of stay in the hospital and intensive care unit, morbidity and mortality. Results: 368 pediatric patients underwent surgical or interventional correction. Of which 197 (54%) were female, the median age was 24 months (interquartile range [IQR]: 14-48) in the surgical group and 36 months (IQR: 17-85) in the interventional group. The most frequent congenital heart diseases were: PCA (31%), IVC (28%), CAV (20%), ASD (16%) and tetralogy of Fallot with 4% respectively. Hospital stay was 9 days (IQR: 7-15) in the surgical group and 3 days (IQR: 2-5) in the hemodynamic group. Morbidities were postoperative infection in 30 patients (14%) and complete atrioventricular block in 19 patients (9%). Overall mortality including both surgical and interventional was 2%. Conclusions: The therapeutic, surgical and interventional results in children with Down syndrome and congenital heart disease have improved very satisfactorily. The lower prevalence of the atrioventricular canal in the Mexican population is noteworthy. It is essential to carry out a cardiological evaluation of children with Down syndrome and those with congenital heart disease to correct them in a timely manner to promote survival and quality of life.

Comorbidities and clinical symptoms can modify myocardial function: a cross-sectional study with PET/CT / Comorbilidades y síntomas clínicos que pueden modificar la función miocárdica: estudio transversal con PET/TC

Abstract Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score ≥ 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse mechanical, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased left ventricular ejection fraction, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusion: The high burden of comorbidities and symptoms in our population alters myocardial function regardless of the level of ischemia.

Resumen Objetivo: La asociación de comorbilidades y síntomas cardíacos que alteran la función miocárdica podría ayudar a los médicos a identificar correctamente a poblaciones de riesgo. Métodos: Se realizó un estudio transversal en población abierta de pacientes referidos a una unidad de PET/CT en la Ciudad de México para evaluación de la función miocárdica, perfusión y circulación coronaria. La isquemia se definió como una suma de diferencia de puntuación (SDS) ≥ 2. La asociación entre las comorbilidades y los síntomas cardíacos se fundamentó mediante modelos de regresión logística y análisis de tendencias. Realizamos un análisis de interacción para evaluar la adición de cualquier síntoma acompañante a condiciones comórbidas en el deterioro de la función miocárdica. Resultados: Se incluyeron 1.273 pacientes, 66,1% del sexo masculino, con una edad media de 62,4 (± 12.7) años, 360 (28,7%) con isquemia, 925 (72,7%) con al menos una comorbilidad y 676 (53,1%) con al menos una menos un síntoma cardíaco asociado. En pacientes sin isquemia, la diabetes mellitus tipo 2, la hipertensión arterial y los síntomas cardíacos adversos se asociaron con parámetros mecánicos, de perfusión y de flujo coronario adversos. Se observó una tendencia con el número acumulado de comorbilidades y síntomas cardíacos con aumento de la isquemia y disminución del flujo coronario. Solo en la disminución de la FEVI se demostró un efecto de interacción entre el aumento de las comorbilidades y los síntomas adversos. Conclusión: La alta carga de comorbilidades y síntomas en nuestra población altera la función miocárdica independientemente del nivel de isquemia.