Efecto de la terapia de resincronización ventricular en los parámetros de disfunción endotelial y función sistólica izquierda en pacientes con insuficiencia cardíaca crónica y bloqueo completo de rama izquierda / Endothelial dysfunction, left ventricular function, and chronic heart failure with complete left bundle branch block: effect of resynchronization therapy

Resumen: Introducción: La insuficiencia cardíaca crónica (ICC) es una condición compleja asociada a inflamación sistémica y a disfunción endotelial (DE) cuya patogénesis no es bien comprendida. Objetivo: Evaluar una posible relación entre marcadores de DE periférica con la respuesta a terapia de resincronización ventricular (TRV). Método: 20 pacientes con ICC, QRS ≥120ms y fracción de eyección ventricular izquierda (FEVI) ≤35% se estudiaron pre y 6 meses post-TRV con: Minnesota Living with Heart Failure Questionnaire (MLHFQ); test de marcha (TM-6min); Ecocardiografía-2D y SPECT de perfusión gatillado en reposo; proteína C-reactiva ultra sensible (us-PCR); péptido natriurético cerebral (pro-BNP); células endoteliales circulantes (CEC); moléculas de adhesión soluble vascular (sVCAM) e intercelular (sICAM); interleukina-6 (IL-6) y Factor von Willebrand (FvW). Se clasificaron como respondedores o no a TRV según criterios preestablecidos. Resultados: Promedios basales: pro-BNP 5.290pg/ml; us-PCR 1,7ug/mL; MLHFQ 72; TM-6min 391 metros. Las CEC y sICAM estaban sobre límites normales. Post-TRV, el 50% fue respondedor: 11/20 mejoraron ≥1 clase NYHA y ≥10% del TM-6min; ML-HFQ disminuyó (p<0.0001); FEVI mejoró (p=0.003); volumen final sistólico disminuyó (p=0.008) y también pro-BNP (p=0.03). En los respondedores, las CEC disminuyeron, persistiendo elevadas, sobre lo normal. Existieron correlaciones entre cambios de pro-BNP con TM-6min y entre us-PCR con MLHFQ y FvW (p≤0.004 en todas). Conclusiones: En ICC existe evidencia de significativa DE, expresada por sICAM y CEC, biomarcador periférico sensible. Estas disminuyeron 6 meses post-TRV, persistiendo sobre el límite normal. Otros parámetros funcionales e inflamatorios se correlacionaron en el grupo total, sin diferencias entre grupos respondedores y no respondedores.

Abstract: Introduction: Chronic heart failure (CHF) is a complex condition associated with systemic inflammation and endothelial dysfunction (ED) whose pathogenesis is not well understood. Objective: to evaluate a possible relationship between peripheral ED markers and response to cardiac resynchronization therapy (CRT). Method: 20 patients with CHF, QRS ≥120ms and left ventricular ejection fraction (LVEF) ≤35% were studied before and 6 months post-CRT. Minnesota Living with Heart Failure Questionnaire (MLHFQ); walking test (6min-WT); 2D-echocardiography and gated perfusion SPECT at rest; ultra-sensitive C-reactive protein (us-CRP); brain natriuretic peptide (pro-BNP); circulating endothelial cells (CEC); vascular soluble adhesion (sVCAM) and intercellular adhesion molecules (sICAM); interleukin-6 (IL-6) and von Willebrand Factor (vWF) were measured in all subjects. They were classified as responders or not to CRT, according to pre-established criteria. Results: Basal means: pro-BNP 5,290 pg / ml; us-CRP 1.7 ug/mL; MLHFQ 72; 6min-WT 391 meters. The CEC and IL-6 were above normal limits. Post-CRT, 50% were responders: 11/20 improved ≥1 NYHA class and ≥10% increase in 6min-WT; MLHFQ decreased (p <0.0001); LVEF improved (p = 0.003); final systolic volume decreased (p = 0.008) and also pro-BNP (p= 0.03). In responders CEC decreased, persisting over normal limits. There were correlations between changes of pro-BNP with TM-6min and between us-PCR with MLHFQ and vWF (p≤0.004 in all). Conclusions: In CHF there is evidence of significant ED, expressed by sICAM and CEC, a sensitive peripheral biomarker that decreased 6 months post-CRT although persisting above normal limits. Other functional and inflammatory parameters were correlated in the total group, without differences between responders and non-responders.

Estratificación de riesgo de muerte a mediano plazo de pacientes evaluados por enfermedad coronaria con SPECT de perfusión miocárdica bajo efecto de dipiridamol / Predictive value of dipyridamole myocardial perfusion tomography on survival

Background: Dipyridamole (DIP) is the most commonly employed pharmacological stressor for myocardial perfusion tomography (SPECT) in patients unable to reach an adequate work load. Aim: To assess the predictive capacity of DIP SPECT on survival. Material and Methods: We included 985 adults aged 66 ±11 years (45% women) with rest and DIP-SPECT. The main indications for the procedure were coronary artery disease (CAD) screening in 66% and known CAD in 33%. Participants were followed up for a median of 65 months (interquartile range 54 to 86 months). During the follow up, 261 deaths were recorded and 98% had a specified cause in their death certificate. Results: Myocardial SPECT was abnormal in 44% of participants. Transient ischemic defects were observed in 34%, fixed defects concordant with infarction in 27% and post-stress systolic dysfunction in 23%. Twenty five percent of deaths were attributable to cardiac or ischemic cause and 22% to cancer. In a bivariate analysis, the hazard ratio (HR) of death of any cause was lower in females and higher in the presence of CAD. The multivariate analysis showed that being older than 46 years increased the HR of death of any cause. In a bivariate analysis, the HR for cardiac death was higher when the myocardial SPECT showed ischemia, necrosis or left ventricular dilation. In the multivariate analysis, post-stress left ventricular systolic function was associated with a lower risk of cardiac death. Conclusions: An abnormal myocardial SPECT, perfusion abnormalities, left ventricular systolic function or dilation are independent predictors of cardiac death in these participants.

Variables sociodemográficas relacionadas al síndrome de Burnout en docentes de colegios distritales / Demographic variables related to teacher Burnout syndrome in school district

La presente investigación tuvo como finalidad identificar las variables sociodemográficas relacionadas al Síndrome de Burnout (BO) en docentes de colegios distritales de la localidad de Usaquén, Bogotá. Es una investigación descriptiva con un diseño correlacional-comparativo; se contó con la participación de 251 docentes, seleccionados por muestreo aleatorio simple, quienes respondieron el Inventario de Burnout de Maslach (MBI) y un cuestionario de datos sociodemográficos. Dentro de los resultados se identificó que las variables estrato socioeconómico, horas de trabajo, número de estudiantes, tiempo en el cargo y sección, muestran asociación significativa con las dimensiones de agotamiento emocional y realización personal.

The objective of this research was to identify the levels of BO and demographic variables related with the syndrome in teachers of district schools in Bogota. Therefore, this research was descriptive and used a correlational-comparative design, just as with the participation of 251 teachers who were selected through simple random sampling. Then they responded to the Maslach Burnout Inventory (MBI) and a demographic questionnaire. With respect to the results achieved show that there is a significant association between the three dimensions of BO, especially in the emotional exhaustion and in the personal and the socio-demographic variables are associated with the same socioeconomic status, hours of work, the number of students, time in office and the section in which they work.

Terapias motivacionales breves: diferencias entre la aplicación individual y grupal para la moderación del consumo de alcohol y de las variables psicológicas asociadas al cambio / Brief motivational therapy: differences between individual and group application for the moderation in alcohol consumption and other psychological variables associated with change / Terapias de motivação breves: diferencias entre a aplicação individual e grupal para a moderação do consumo de álcool e das variáveis psicológicas associadas á mudança

Se realizó un estudio de corte empírico-analítico, siguiendo un diseño cuasi experimental, con el fin de someter a prueba y evaluar el impacto de un programa motivacional de terapia breve para el control del consumo de alcohol en bebedores perjudiciales. La variable independiente fue el programa de intervención, estructurado con base en principios de entrevista motivacional y de autocontrol cognitivo. La variable dependiente estuvo constituida por indicadores de consumo (intensidad, frecuencia y riesgo), la etapa motivacional ante el cambio, el estado de los procesos de cambio y las expectativas acerca del consumo. La medición de todas las variables se realizó en tres momentos a través del uso de instrumentos previamente validados: a) preintervención, b) al finalizar la intervención y c) cinco semanas después de terminar el tratamiento. Participaron 180 estudiantes universitarios previamente detectados como bebedores perjudiciales, quienes fueron asignados al azar a uno de tres grupos: a) terapia motivacional individual, b) terapia motivacional grupal y c) ausencia de terapia. Se observó que ambas terapias motivacionales (individual y grupal) condujeron a una disminución significativa en los indicadores de consumo y a una mejoría en el uso de los procesos de cambio responsables del mismo. Sin embargo, la intervención grupal condujo a un impacto superior al de la intervención individual en aspectos como: a) frecuencia de consumo, b) autoeficacia ente situaciones de alto riesgo de consumo, c) percepción de vulnerabilidad y daño y d) uso de procesos conductuales asociados al cambio y al mantenimiento del mismo.

An empirical-analytic study was carried out using a quasi-experimental design with the aim of testing and assessing the impact of a brief intervention motivational program for the control of alcohol consumption in problem drinkers. The independent variable in this study was the intervention program, as structured upon the principles of motivational interviewing and cognitive self-control. Indicators of consumption (intensity, frequency, and risk) were the dependent variable, as were the motivational stage towards change, the state of change processes, and the expectations on consumption. Measurement of all variables was carried out with the use of previously validated instruments in three moments: a) pre-intervention; b) end of intervention and; c) five weeks after treatment. 180 college students, previously detected as heavy drinkers were randomly assigned to one of three groups: (a) Individual motivational interviewing, (b) Group motivational interviewing, and (c) no intervention. Both of the motivational interventions (individual and group) led to a significant decrease in indicators of consumption and to an improvement in the use of those change processes responsible for it. Nevertheless, group intervention led to a more significant impact than individual intervention in aspects such as: (a) consumption frequency and intensity; (b) self-efficacy in situations of a high consumption risk; (c) perception of vulnerability and damage; and (d) use of behavioral processes associated with change and its maintenance.

A fim de provar e avaliar o impacto de um programa motivacional de terapia breve para controlar o consumo de álcool em bebedores prejudiciais levou-se a cabo um estudo empírico-analítico com desenho quase experimental. O programa de intervenção constituiu a variável independente, baseado em princípios de entrevista motivacional e de autocontrole cognitivo. A variável dependente foram os indicadores de consumo (intensidade, freqüência e risco), etapa motivacional ante a mudança, estado dos processos da mudança e expectações acerca do consumo. As variáveis foram medidas em três momentos com instrumentos validados previamente: 1. pré-intervenção, 2. ao finalizar a intervenção e 3. cinco semanas depois de acabado o tratamento. No estudo participaram 180 estudantes universitários detectados previamente como bebedores prejudiciais, designados aleatoriamente a uno de três grupos: 1. terapia motivacional individual, 2. terapia motivacional grupal e 3. ausência de terapia. Ambas as terapias motivacionais (individual e grupal) levaram à redução importante dos indicadores de consumo e a melhorar o uso dos processos de mudança responsáveis do consumo. No entanto, a intervenção grupal conduziu a um impacto maior do que a intervenção individual em aspetos como freqüência de consumo, auto-eficácia em situações de alto risco de consumo, percepção de vulnerabilidade e dano, e uso de processos comportamentais associados à mudança e à conservação desta.