The Quest for Quality Electrocardiographic Recording

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Use of High-Pass and Low-Pass Electrocardiographic Filters in an International Cardiological Community and Possible Clinical Effects

Background: High-pass and low-pass fi lters applied to 12-lead Electrocardiograms (ECG) are fundamental to avoid artifacts, but an inappropriate use may lead to misdiagnosis. Our goal is to evaluate cutoff points for these fi lters used as routine by cardiology professionals from different countries, and to determine to what extent they adjust to the established guidelines. Methods: We designed a descriptive study where 12-lead ECGs were included, both from adults and teenagers, distributed between August 2016 and February 2017 within the Ibero-American Forum on Arrhythmias on the Internet (FIAI) through the instant messaging apps WhatsApp and Telegram. Results: 48% of ECGs had at least one of the two fi lter cutoff points printed. The bandwidth recommended by different scientifi c societies (≤ 0.05 Hz and ≥ 150 Hz) was present in 2%. The most frequent low frequency cutoff value was 0.5 Hz (47%) and the high frequency one was between 25 Hz and 40 Hz (74%). As to the last consensus guidelines, we registered that 32% of ECGs met the low frequency cutoff point and just 5% the high frequency cutoff point. Conclusions: There is a high ratio of tracings lacking printed information on the fi lter used, and those that do have it, use inappropriate cutoff points in a high percentage, which may have significant diagnostic consequences.Facultad de Ciencias Médica

Use of High-Pass and Low-Pass Electrocardiographic Filters in an International Cardiological Community and Possible Clinical Effects

Background: High-pass and low-pass fi lters applied to 12-lead Electrocardiograms (ECG) are fundamental to avoid artifacts, but an inappropriate use may lead to misdiagnosis. Our goal is to evaluate cutoff points for these fi lters used as routine by cardiology professionals from different countries, and to determine to what extent they adjust to the established guidelines. Methods: We designed a descriptive study where 12-lead ECGs were included, both from adults and teenagers, distributed between August 2016 and February 2017 within the Ibero-American Forum on Arrhythmias on the Internet (FIAI) through the instant messaging apps WhatsApp and Telegram. Results: 48% of ECGs had at least one of the two fi lter cutoff points printed. The bandwidth recommended by different scientifi c societies (≤ 0.05 Hz and ≥ 150 Hz) was present in 2%. The most frequent low frequency cutoff value was 0.5 Hz (47%) and the high frequency one was between 25 Hz and 40 Hz (74%). As to the last consensus guidelines, we registered that 32% of ECGs met the low frequency cutoff point and just 5% the high frequency cutoff point. Conclusions: There is a high ratio of tracings lacking printed information on the fi lter used, and those that do have it, use inappropriate cutoff points in a high percentage, which may have significant diagnostic consequences.Facultad de Ciencias Médica

Left ventricular ballooning syndrome due to vasospasm of the middle portion of the left anterior descending coronary artery

We report a case that shows vasospasm to be one of the mechanisms responsible for left ventricular ballooning syndrome. Our case suggests that identical ventriculographic findings in patients with tako-tsubo syndrome and those with coronary vasospasm of a long left anterior descending artery coronary artery may be due to a common etiology

Principales acciones terapéuticas y rehabilitadoras en pacientes con insensibilidad congénita al dolor

Introduction: congenital insensitivity to pain is a hereditary whose main characteristic is absolute analgesia to pain.Objective: to describe the main existing therapeutic actions for patients with congenital insensitivity to pain in its diverse subtypes.Method: a total of 30 scientific articles were reviewed, which met the inclusion criteria. Databases such as Medline (PubMEd) and SciELO were consulted. All studies with limited or insufficient quality of evidence, or those in which full-text information was not available, were excluded.Development: at present, studies related to the use of bisphosphonates and minimal scale surgical interventions for the reduction of bone complications of the disease and the use of opioid receptor antagonists such as naloxone with the aim of reducing analgesia in these patients stand out. It also highlights research related to nerve growth factor in conjunction with the expression of the high affinity tyrosinkinase receptor for this factor, which produces a relative improvement with respect to the absolute analgesia that is evidenced in this disease.Conclusions: although the mechanisms by which it is established are not yet fully clarified, there is strong scientific evidence that supports a central role of genetics in the etiology of the disease. There is no highly effective therapeutic alternative in the current medical literature; that is why the basic role of these actions is based on prevention, education and interdisciplinary treatment.Introducción: la insensibilidad congénita al dolor es una enfermedad hereditaria cuya característica principal es la analgesia absoluta al dolor.Objetivo: describir las principales acciones terapéuticas existentes para los pacientes con insensibilidad congénita al dolor en sus diversos subtipos.Método: se consultaron un total de 30 artículos científicos que cumplieron con los criterios de inclusión. Se consultaron bases de datos como Medline (PubMed) y SciELO. Se excluyeron todos los estudios con limitada o insuficiente calidad de la evidencia, o aquellos en los cuales no estuvo disponible la información a texto completo.Desarrollo: en la actualidad resaltan estudios relacionados con el uso de bisfosfonatos e intervenciones quirúrgicas a mínima escala para la reducción de las complicaciones óseas de la enfermedad y la utilización de antagonistas de los receptores opiodes como la naloxona con el objetivo de disminuir la analgesia en dichos pacientes. Destaca, además, investigaciones relacionadas con el factor de crecimiento nervioso en conjunción con la expresión del receptor tirosinkinasa de alta afinidad para dicho factor, el cual produce un mejoramiento relativo respecto a la analgesia absoluta que se evidencia en dicha enfermedad.Conclusiones: aunque los mecanismos por los cuales se instaura aún no están del todo esclarecidos, existe fuerte evidencia científica que fundamenta en la etiología de la enfermedad un rol central de la genética. No existe una alternativa terapéutica de elevada eficacia, hecho por el cual el papel fundamental de dichas acciones tiene como pilares básicos la prevención, la educación y el tratamiento interdisciplinario

Ibrutinib in Combination With Rituximab for Indolent Clinical Forms of Mantle Cell Lymphoma (IMCL-2015): A Multicenter, Open-Label, Single-Arm, Phase II Trial

Ibrutinib; Mantle cell lymphomaIbrutinib; Linfoma de células del mantoIbrutinib; Limfoma de cèl·lules de mantellPURPOSE The need for an individualized management of indolent clinical forms in mantle cell lymphoma (MCL) is increasingly recognized. We hypothesized that a tailored treatment with ibrutinib in combination with rituximab (IR) could obtain significant responses in these patients. METHODS This is a multicenter single-arm, open-label, phase II study with a two-stage design conducted in 12 Spanish GELTAMO sites (ClinicalTrials.gov identifier: NCT02682641). Previously untreated MCL patients with indolent clinical forms defined by the following criteria were eligible: no disease-related symptoms, nonblastoid variants, Ki-67 < 30%, and largest tumor diameter ≤ 3 cm. Both leukemic non-nodal and nodal subtypes were recruited. Patients received ibrutinib 560 mg once daily and a total of eight doses of rituximab 375 mg/m2. Ibrutinib could be discontinued after 2 years in the case of sustained undetectable minimal residual disease (MRD). The primary end point was the complete response (CR) rate achieved after 12 cycles according to Lugano criteria. RESULTS Fifty patients with MCL (male 66%; median age 65 years) were enrolled. After 12 cycles of treatment, 42 (84%; 95% CI, 74 to 94) patients had an overall response, including 40 (80%; 95% CI, 69 to 91) with CR. Moreover, undetectable MRD in peripheral blood was achieved in 87% (95% CI, 77 to 97) of cases. At 2 years, 24 of 35 evaluable patients (69%) could discontinue ibrutinib because of undetectable MRD. Four patients had disease progression; three were non-nodal MCL and carried high genomic complexity and TP53 mutations at enrollment. No unexpected toxicity was seen except one patient with severe aplastic anemia. CONCLUSION Frontline IR combination achieves a high rate of CRs and undetectable MRD in indolent clinical forms of MCL. Discontinuation seems appropriate in cases with undetectable MRD, except for TP53-mutated cases.The funding for the IMCL-2015 was obtained through unrestricted Janssen Clinical Investigator-Initiated Study (IIS) Research Support

Ibrutinib in Combination With Rituximab for Indolent Clinical Forms of Mantle Cell Lymphoma (IMCL-2015): A Multicenter, Open-Label, Single-Arm, Phase II Trial

PURPOSE The need for an individualized management of indolent clinical forms in mantle cell lymphoma (MCL) is increasingly recognized. We hypothesized that a tailored treatment with ibrutinib in combination with rituximab (IR) could obtain significant responses in these patients. METHODS This is a multicenter single-arm, open-label, phase II study with a two-stage design conducted in 12 Spanish GELTAMO sites (ClinicalTrials.gov identifier: NCT02682641). Previously untreated MCL patients with indolent clinical forms defined by the following criteria were eligible: no disease-related symptoms, nonblastoid variants, Ki-67 < 30%, and largest tumor diameter <= 3 cm. Both leukemic non-nodal and nodal subtypes were recruited. Patients received ibrutinib 560 mg once daily and a total of eight doses of rituximab 375 mg/m(2). Ibrutinib could be discontinued after 2 years in the case of sustained undetectable minimal residual disease (MRD). The primary end point was the complete response (CR) rate achieved after 12 cycles according to Lugano criteria. RESULTS Fifty patients with MCL (male 66%; median age 65 years) were enrolled. After 12 cycles of treatment, 42 (84%; 95% CI, 74 to 94) patients had an overall response, including 40 (80%; 95% CI, 69 to 91) with CR. Moreover, undetectable MRD in peripheral blood was achieved in 87% (95% CI, 77 to 97) of cases. At 2 years, 24 of 35 evaluable patients (69%) could discontinue ibrutinib because of undetectable MRD. Four patients had disease progression; three were non-nodal MCL and carried high genomic complexity and TP53 mutations at enrollment. No unexpected toxicity was seen except one patient with severe aplastic anemia. CONCLUSION Frontline IR combination achieves a high rate of CRs and undetectable MRD in indolent clinical forms of MCL. Discontinuation seems appropriate in cases with undetectable MRD, except for TP53-mutated cases