Insuficiencia cardíaca con función sistólica preservada de etiología infiltrativa. El enemigo silencioso

Heart failure with preserved ejection fraction still remains being one of the paradigms of modern Cardiology. Reaching the correct diagnosis and identifying the etiology is a diffi cult challenge, where the new techniques of strain rate may develop an important role. In therms of medical therapies, there is a lack of specific measures in order to improve the prognosis of these patients. Our clinical report tries to show the clinical situation and echocardiographic patterns that must establish the suspicion of cardiac amyloidosis.La insuficiencia cardíaca con función sistólica preservada continúa siendo uno de los grandes cuadros clínicos de la cardiología actual, tanto desde el punto de vista del diagnóstico, donde identificar la etiología concreta resulta un reto frente al que las novedosas técnicas de strain rate comienzan a aportar luz, como del tratamiento, dada la ausencia de medidas específicas que mejoren el pronóstico de estos pacientes. Este caso clínico trata de mostrar la situación clínica y los patrones ecocardiográficos que deben establecer la sospecha de amiloidosis cardíaca

Imagen multimodal en la endocarditis infecciosa: el dilema del huevo o la gallina

In medicine the clinical context is essential to carry out a differential diagnosis, and thus it is important for the interpretation of the findings in the imaging techniques to be aware of the clinical history of the patient we are evaluating. We present a case of a patient derived to our hospital for the suspicious of endocarditis on the native mitral valve. However, in our hospital we found no compatible images with endocarditis, but a dissection in the ascending aorta with no signs of infection. Due to the chronology of the clinical case we concluded that the most likely diagnosis was a pseudoaneurysm secondary of an endocarditis.En medicina el contexto clínico es esencial para llevar a cabo un diagnóstico diferencial, y por este motivo es importante que los hallazgos de las pruebas de imagen vayan acompañados de la historia clínica del paciente para poderse interpretar. A continuación, se presenta el caso de una sospecha de endocarditis sobre válvula mitral que se remitió a nuestro centro; sin embargo, el equipo no encontró signos compatibles con endocarditis, más bien una disección en la aorta ascendente. Debido a la cronología de la historia clínica se concluyó que el diagnóstico más plausible era un pseudoaneurisma secundario a endocarditis

Patología pericárdica. Reto diagnóstico y terapéutico en la era de la imagen cardíaca multimodal a propósito de un caso

The pericardium consists of two layers, the visceral pericardium consisting of a single layer of mesothelial cells, elastin and collagen, attached to the epicardial surface of the heart, and an avascular parietal layer with an extensive network of collagen fibers. In humans, this fine structure normally reaches up to 2 mm thick. Its function is basically mechanical adapting to the volume changes of the cardiac cavities, although important variations of these or affectation of its tissue, makes it more rigid conditioning a restrictive behavior. There are many pathologies that can affect it, from inflammation, trauma, radiation to tumor infiltration.El pericardio está formado por dos capas: el pericardio visceral, constituido por una sola capa de células mesoteliales, elastina y colágeno, adherido a la superficie epicárdica del corazón, y una capa parietal avascular y con amplia red de fibras de colágeno. En el ser humano esta fina estructura llega a medir normalmente hasta 2 mm de espesor. Su función es fundamentalmente mecánica adaptándose a los cambios de volumen de las cavidades cardíacas, aunque variaciones importantes de éstas o la afectación de su tejido, lo hace más rígido condicionando un comportamiento constrictivo. Son múltiples las patologías que pueden afectarlo, desde inflamación, trauma, radiación hasta infiltración tumoral

¿Viable o no viable? El problema del manejo de la enfermedad coronaria muy avanzada

Patients with very advanced coronary disease are a hard challenge for the clinician. This clinical report is a good example, with a patient with very extensive and severe arteriosclerosis in several vascular territories that debuted as acute leg arterial ischemia but in which the coronary disease became the worst problem. Despite myocardial viability demonstration, the extent and complexity of coronary lesions made it impossible treat them. In this kind of cases, although we know what the ideal treatment should be, the trip ends without reaching the goal of the revascularization.Los pacientes con enfermedad coronaria muy avanzada son todo un reto para el clínico. Este caso clínico es un buen ejemplo de ello, con un paciente con arterioesclerosis muy extensa y grave en varios territorios vasculares que debuta con isquemia arterial aguda, pero en el que la evolución predomina la disfunción ventricular por enfermedad coronaria. A pesar de demostrar viabilidad miocárdica en las pruebas de imagen, la extensión y complejidad de las lesiones hizo que no fuera posible tratarlas. En casos como éste, a pesar de que se conoce cuál es el tratamiento ideal, el viaje termina sin alcanzar la orilla de la revascularización

Distortion of the QRS in elderly patients with myocardial infarction

Background: Distortion of the terminal portion of the QRS in the initial electrocardiogram (ECG) is a strong predictor of adverse outcome in myocardial infarction. Our purpose is to assess the relationship of distortion of QRS and other ECG characteristics with older age. Methods and results: We analysed 634 consecutive patients (age 62.6 &#177; 13.7, 77% male) admitted in the first 12 hours of ST-elevation myocardial infarction. Two groups of age were defined: < 75 years-old and &#8805; 75 years-old. Additionally, we defined two ECG groups according to the presence of ST segment elevation with distortion of the terminal portion of the QRS in two or more adjacent leads (QRS+) or the absence of this pattern (QRS&#8211;). Older people had more often QRS+ (30% vs. 20%, p = 0.023). The older group with QRS+ had an in-hospital mortality of 18%, vs. 7% with QRS&#8211; (p = 0.04), and an incidence of major adverse events of 40% vs. 14% (p = 0.002). In the multivariate analysis, age &#8805; 75 years was an independent predictor of distortion of the QRS (odds ratio 2.1, 1.2&#8211;4.9, p = 0.016). Conclusions: The distortion of the terminal portion of the QRS in myocardial infarction is more frequent in elderly people, and is significantly related to adverse prognosis. This ECG finding can be helpful to promptly stratify the risk in elderly patient

Eco-fusión. Aplicación en el intervencionismo estructural cardíaco

The evolution in percutaneous structural intervention has generated a parallel development in advanced imaging techniques. Echocardiography plays a key role in structural intervention in patient selection, assessment during the fluoroscopy and immediate analysis of outcomes and early detection of complications; echo-fusion images appear as a complementary tool in which two techniques with dynamic images are complemented in a single image in order to guide, decrease intervention time and reduce complications.La evolución en el intervencionismo estructural percutáneo ha generado un desarrollo paralelo en las técnicas de imagen avanzada. La ecocardiografía en el intervencionismo estructural juega un papel básico en la selección de los pacientes, en la valoración durante el procedimiento y en el análisis inmediato de los resultados y la detección precoz de complicaciones. Las imágenes de fusión eco/fluoroscopia aparecen como una herramienta complementaria en la que dos técnicas con imágenes dinámicas se complementan en una sola imagen con el fin de orientar, disminuir el tiempo de intervención y disminuir las complicaciones

TIMES TO ACT. Italian-Spanish-Polish-Uzbek Expert Forum Position Paper 2022. Dyslipidemia and arterial hypertension: The two most important and modifiable risk factors in clinical practice

Hypertension and lipid disorders are two of the main cardiovascular risk factors. Both risk factors — if detected early enough — can be controlled and treated with modern, effective drugs, devoid of significant side effects, available in four countries as different as Italy, Spain, Poland, and Uzbekistan. The aim herein, was to develop this TIMES TO ACT consensus to raise the awareness of the available options of the modern and intensified dyslipidemia and arterial hypertension treatments. The subsequent paragraphs involves consensus and discussion of the deleterious effects of COVID-19 in the cardiovascular field, the high prevalence of hypertension and lipid disorders in our countries and the most important reasons for poor control of these two factors. Subsequently proposed, are currently the most efficient and safe therapeutic options in treating dyslipidemia and arterial hypertension, focusing on the benefits of single-pill combination (SPCs) in both conditions. An accelerated algorithm is proposed to start the treatment with a PCSK9 inhibitor, if the target low-density-lipoprotein values have not been reached. As most patients with hypertension and lipid disorders present with multiple comorbidities, discussed are the possibilities of using new SPCs, combining modern drugs from different therapeutic groups, which mode of action does not confirm the “class effect”. We believe our consensus strongly advocates the need to search for patients with cardiovascular risk factors and intensify their lipid-lowering and antihypertensive treatment based on SPCs will improve the control of these two basic cardiovascular risk factors in Italy, Spain, Poland and Uzbekistan