Pericarditis constrictiva en paciente postrasplante cardíaco

We present a case of a 63-year-old patient with a history of orthotopic heart transplantation who evolved within a few months with heart failure to a right predominance secondary to constrictive pericarditis. The diagnosis was made through clinical and imaging methods, mainly Doppler echocardiography. Once diagnosed and taking into account the ominous prognosis of this entity, a radical pericardiectomy was performed with resolution of the clinical problem.A continuación se presenta el caso de un paciente de 63 años con antecedentes de trasplante cardíaco ortotópico, que evolucionó a los pocos meses con insuficiencia cardíaca con predominio derecho secundario a pericarditis constrictiva. El diagnóstico se realizó a través de la clínica y los métodos de imágenes, principalmente la ecocardiografía Doppler. Una vez diagnosticado y teniendo en cuenta el pronóstico ominoso de esta entidad fue sometido a pericardiectomía radical con resolución del cuadro clínico

Caracterização e predição do risco de cirurgias cardiovasculares com uso de bomba de circulação extracorpórea: um estudo transversal

Introduction: Cardiovascular surgery risk prediction models are widely applied in medical practice. However, they have been criticized for their low methodological quality and scarce external validation. An additional limitation added in Latin America is that most of these models have been developed in the United States or Europe, which present marked geographical differences. The objective of this study is to characterize the postoperative clinical events of cardiovascular surgeries with the use of cardiopulmonary bypass pump in a local setting and to evaluate the prediction of postoperative mortality using the EuroSCORE II predictive model. Methods: Cross-sectional study in an urban university hospital in Buenos Aires. Patients ≥21 years of age were included, with a clinical indication for on-pump cardiovascular surgery. Patients with incomplete clinical data regarding EuroSCORE II variables or in-hospital survival, ≥95 years of age, or undergoing heart transplantation were excluded. Results: 195 patients were enrolled. Postoperative mortality estimated by EuroSCORE II presented a clear underestimation of risk (3.0% vs 7.7%). Discrimination (AUC = 0.82; 95% CI 0.74-0.92) and goodness of fit of the model were adequate (χ2 = 7.91; p = 0.4418). The most frequent postoperative complications were postoperative heart failure (35.9%), vasoplegic shock (13.3%), and cardiogenic shock (10.26%). Conclusion: The EuroSCORE II is an appropriate tool to discriminate between different risk categories in patients undergoing on-pump cardiovascular surgery, although it underestimates the risk.Introducción: Los modelos de predicción de riesgo de cirugías cardiovasculares se aplican ampliamente a la práctica médica. Sin embargo, han sido criticados por su baja calidad metodológica y escasa validación externa. En América Latina se agrega la limitación de que la mayoría de estos modelos fueron desarrollados en Estados Unidos o Europa, existiendo diferencias geográficas marcadas. El objetivo de este estudio es caracterizar los eventos clínicos postoperatorios de cirugías cardiovasculares con uso de bomba de circulación extracorpórea en un escenario local y evaluar la predicción de mortalidad postoperatoria del modelo predictivo EuroSCORE II. Métodos: Corte transversal en un hospital universitario urbano de Buenos Aires. Se incluyeron a pacientes ≥21 años de edad, con indicación de cirugía cardiovascular con uso de bomba. Se excluyeron a pacientes con datos clínicos incompletos respecto a las variables del EuroSCORE II o respecto a la sobrevida intrahospitalaria, con ≥95 años de edad o sometidos a trasplante cardíaco. Resultados: Se enrolaron 195 pacientes. La mortalidad postoperatoria estimada por el EuroSCORE II presentó una clara subestimación del riesgo (3,0% vs 7,7%). La discriminación (AUC = 0,82; IC95% 0,74-0,92) y la bondad del ajuste del modelo fueron adecuadas (χ2 = 7,91; p = 0,4418). Las complicaciones postoperatorias más frecuentes fueron insuficiencia cardíaca postoperatoria (35,9%), shock vasopléjico (13,3%) y shock cardiogénico (10,26%). Conclusión: El EuroSCORE II es una herramienta apropiada para discriminar entre diferentes categorías de riesgo en pacientes sometidos a cirugías cardiovasculares con uso de bomba, si bien subestima el riesgo.Introdução: Modelos de predição de risco em cirurgia cardiovascular são amplamente aplicados na prática médica. No entanto, eles foram criticados por sua baixa qualidade metodológica e escassa validação externa. Na América Latina, acrescenta-se a limitação de que a maioria desses modelos foi desenvolvida nos Estados Unidos ou na Europa, com diferenças geográficas marcantes. O objetivo deste estudo é caracterizar os eventos clínicos pós-operatórios de cirurgias cardiovasculares com uso de bomba de circulação extracorpórea em ambiente local e avaliar a predição de mortalidade pós-operatória do modelo preditivo EuroSCORE II. Métodos: Corte transversal em um hospital universitário urbano de Buenos Aires. Foram incluídos pacientes com idade ≥21 anos, com indicação de cirurgia cardiovascular com uso de bomba. Pacientes com dados clínicos incompletos em relação às variáveis ​​do EuroSCORE II ou sobrevida hospitalar, ≥95 anos de idade ou submetidos a transplante cardíaco foram excluídos. Resultados: 195 pacientes foram incluídos. A mortalidade pós-operatória estimada pelo EuroSCORE II apresentou clara subestimação do risco (3,0% vs 7,7%). A discriminação (AUC = 0,82; IC 95% 0,74-0,92) e a qualidade do ajuste do modelo foram adequadas (χ2 = 7,91; p = 0,4418). As complicações pós-operatórias mais frequentes foram insuficiência cardíaca pós-operatória (35,9%), choque vasoplégico (13,3%) e choque cardiogênico (10,26%). Conclusão: O EuroSCORE II é uma ferramenta adequada para discriminar as diferentes categorias de risco em pacientes submetidos à cirurgia cardiovascular com CEC, embora subestime o risco

Effects of serelaxin in patients with acute heart failure

Background: Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. Methods: In this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart failure and had dyspnea, vascular congestion on chest radiography, increased plasma concentrations of natriuretic peptides, mild-to-moderate renal insufficiency, and a systolic blood pressure of at least 125 mm Hg, and we randomly assigned them within 16 hours after presentation to receive either a 48-hour intravenous infusion of serelaxin (30 μg per kilogram of body weight per day) or placebo, in addition to standard care. The two primary end points were death from cardiovascular causes at 180 days and worsening heart failure at 5 days. Results: A total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P=0.77). At day 5, worsening heart failure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio, 0.89; 95% CI, 0.75 to 1.07; P=0.19). There were no significant differences between the groups in the incidence of death from any cause at 180 days, the incidence of death from cardiovascular causes or rehospitalization for heart failure or renal failure at 180 days, or the length of the index hospital stay. The incidence of adverse events was similar in the two groups. Conclusions: In this trial involving patients who were hospitalized for acute heart failure, an infusion of serelaxin did not result in a lower incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days than placebo. (Funded by Novartis Pharma; RELAX-AHF-2 ClinicalTrials.gov number, NCT01870778. opens in new tab.

Three- to five-minute motivational counseling reduces perceived stress in adults with acute myocardial infarction: a pilot study

Introducción. A pesar de la evidencia creciente del impacto del estrés sobre lasalud cardiovascular, la traducción de este conocimiento en prácticas clínicasefectivas es limitada. El objetivo de este estudio es determinar la efectividad deuna intervención motivacional sobre el estrés percibido de adultos internadospor infarto agudo de miocardio (IAM).Métodos. Se incluyeron a pacientes internados por IAM, con estrés autorreferido,aleatorizados a una intervención motivacional breve o a tratamiento estándar.La intervención se realizó durante la hospitalización índice y por consultoriosexternos. La escala de estrés percibido (PSS) fue utilizada para evaluar elestrés de los pacientes en el mes previo.Resultados. Se incluyeron a 22 pacientes, en su mayoría hombres (77,3%) demediana edad (55 [49-80] años). El cambio en la puntuación mediana de la PSSentre la hospitalización índice y el mes posterior al egreso hospitalario fue signicativamente diferente en los pacientes aleatorizados al grupo intervenciónrespecto al grupo control (–11 vs 3 puntos; p=0,0001). La intervención se asociócon una reducción signicativa en la puntuación mediana de la PSS, luegode ajustar por género y edad (β=–13,3; p<0,001).Conclusiones. Una intervención motivacional breve en adultos internados porIAM podría reducir el estrés percibido.Introduction. Though there is growing evidence of the impact of stress on cardiovascular health, the translation of this knowledge into effective clinical practice is limited. The goal of this study is to determine the effectiveness of a motivational intervention on the perceived stress of adults admitted for acute myocardial infarction (AMI). Methods: Patients admitted for AMI, with self-reported stress, were included and randomized to a brief motivational intervention or to standard treatment. The intervention was performed during the index admission and during outpatient follow-up. The perceived stress scale (PSS) was used to evaluate patients’ stress in the previous month. Results: This study included 22 patients, mostly middle-aged (55 [49-80] yearold) men (77.3%). The change in the median PSS score between the index admission and the month after discharge was signi cantly different between patients randomized to the intervention group and to the control group (–11 vs 3 points; p=0.0001). The intervention was also signi canty associated with a reduction in the median score of the PSS, after adjusting for gender and age (β=– 13.3; p<0.001). Conclusions:A brief motivational intervention in adults admitted for AMI could reduce perceived stress.Fil: Tartaglione, Fiorella. Sanatorio de la Trinidad Mitre; ArgentinaFil: Politi, Teresa. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Polit, Raúl. Sanatorio de la Trinidad Mitre; ArgentinaFil: Bortman, Guillermo. Sanatorio de la Trinidad Mitre; Argentin

Prevalencia de hallazgos electrocardiográficos anormales en deportistas amateur: comparación de los criterios de Seattle 2013 con los criterios de Seattle 2017

Introduction: The specificity of the electrocardiogram as a diagnostic method of causes of sudden cardiac death in athletesdepends on the criteria used to discern between physiological and pathological alterations.Objectives: To assess the prevalence of abnormal electrocardiographic findings in amateur athletes when comparing theSeattle 2013 and 2017 Criteria.Material and methods: 853 athletes were evaluated. Gender and age were evaluated as independent predictor variables.Follow-up was carried out by means of complementary diagnostic methods.Results: 29 athletes presented abnormal electrocardiograms according to 2013 criteria, and 17 athletes according to 2017criteria, constituting 3.4% and 2% respectively. No significant differences were found between genders or by age.Conclusions: Of the electrocardiograms considered abnormal according to the 2013 criteria, 41.4% came to be considerednormal when applying the criteria redefined in 2017. Neither gender nor age are independent predictor variables. In none ofthe patients, heart disease could be demonstrated during follow-up.Introducción: La especificidad del electrocardiograma como método diagnóstico de causas de muerte súbita cardíaca en deportistasdepende de los criterios utilizados para discernir entre alteraciones fisiológicas y patológicas.Objetivos: Evaluar la prevalencia de hallazgos electrocardiográficos anormales en deportistas amateur al comparar los Criteriosde Seattle 2013 y 2017.Material y métodos: Fueron evaluados 853 deportistas. Se evaluaron género y edad como variables predictoras independientes.Se realizó un seguimiento mediante métodos complementarios de diagnóstico.Resultados: Presentaron electrocardiogramas anormales según criterios 2013 29 deportistas y 17, según criterios 2017, lo queconstituyó el 3,4% y el 2%, respectivamente. No se encontraron diferencias significativas entre géneros ni por edad.Conclusiones: De los electrocardiogramas considerados anormales según los criterios 2013, el 41,4% pasó a considerarse normalal aplicarse los criterios redefinidos en 2017. Ni el género ni la edad constituyen variables predictoras independientes. Enningún evaluado, se pudo demostrar cardiopatía en el seguimiento

Changes in cardiac Aquaporin expression during aortic valve replacement surgery with cardiopulmonary bypass

OBJECTIVES: Cardiopulmonary bypass (CPB) use is an essential strategy for many cardiovascular surgeries. However, its use and duration have been associated with a higher rate of postoperative complications, such as low cardiac output syndrome due to myocardial oedema and dysfunction. Though Aquaporin water channels have been implicated in myocardial water balance, their specific role in this clinical scenario has not been established. METHODS: In a consecutive study of 17 patients with severe aortic stenosis undergoing aortic valve replacement surgery, 2 myocardial biopsies of the left ventricle were taken: 1 before and 1 after CPB use. Sociodemographic, clinical and laboratory data were collected. Western blot and immunohistochemistry studies were performed. RESULTS: After CPB use, there was a mean increase of ∼62% in Aquaporin 1 protein levels (P = 0.001) and a mean reduction of ∼38% in Aquaporin 4 protein levels (P = 0.030). In immunohistochemistry assays, Aquaporin 1 was found lining small blood vessels, while Aquaporin 4 formed a circular label in cardiomyocytes. There were no changes in the localization of either protein following CPB use. During the observed on-pump time interval, there was a 1.7%/min mean increase in Aquaporin 1 (P = 0.021) and a 2.5%/min mean decrease in Aquaporin 4 (P = 0.018). Myocardial interstitial oedema increased by 42% (95% confidence interval 31-54%) after CPB use. Patients who developed low cardiac output syndrome were in the upper half of the median percentage change of Aquaporin expression. CONCLUSION: Time-dependent changes in cardiac Aquaporin expression may be associated with myocardial oedema and dysfunction related to CPB use.Fil: Politi, María Teresa. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Ochoa, Federico Claudio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Netti, Vanina Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Ferreyra, Raúl. No especifíca;Fil: Bortman, Guillermo. No especifíca;Fil: Sanjuan, Norberto Aníbal. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Morales, Celina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiopatología Cardiovascular; ArgentinaFil: Piazza, Antonio. No especifíca;Fil: Capurro, Claudia Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; Argentin