Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making

Background: Left ventricular ejection fraction (LVEF) is among the parameters that are usually employed to define surgical timing of severe aortic stenosis (AS). Our hypothesis states that even when their LVEF is preserved, patients with severe symptomatic AS have impaired myocardial structure and function, and such impairment is related to the deleterious progression of left ventricular hypertrophy (LVH) from the compensated to the decompensated stage, as shown by the changes in diastolic function and the increase in left ventricular end-diastolic pressure (LVEDP). Methods and Results: A total of 26 patients with severe AS and LVEF > 50% referred for aortic valve replacement underwent catheterization, echocardiography and an intraoperative biopsy. Patients with severe symptomatic AS were classified as: group 1 (G1; compensated LVH, LVEDP < 15 mm Hg without coronary artery disease [CAD], n = 7), group 2a (G2a, decom­pensated LVH, without CAD, n = 7), and group 2b (G2b, decompensated LVH with CAD, n = 12). Differences were seen in the following: myocyte area [μm2]: G1: 328 ± 66, G2a: 376 ± 22, G2b: 385 ± 13, p < 0.01; collagen volume [%]: G1: 4.77 ± 1.27, G2a: 8.40 ± 1.27, G2b: 11.05 ± 3.08, p < 0.01; LVEDP normalized by diastolic diameter [mm Hg/mm]: G1: 0.27 ± 0.01, G2a: 0.39 ± 0.06, G2b: 0.44 ± 0.11, p < 0.02; +dP/dtmax/LVEDP [mm Hg/s/mm Hg]: G1: 176 ± 45, G2a: 89.6 ± 20, G2b: 113.1 ± 41, p < 0.01; two-dimensional peak systolic longitudinal strain [%]: G1: –17.7 ± 4.75, G2a: –13.4 ± 3.04, G2b: –13.5 ± 3.13, p < 0.05. Conclusions: Patients with severe symptomatic AS and preserved ejection fraction who de­velop decompensated LVH characterized by increased LVEDP, exhibit an abnormal myocardial structure and diastolic and systolic impairment

Arterial Stiffness: Its Relation with Prediabetes and Metabolic Syndrome and Possible Pathogenesis

Aims: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis. Materials and methods: Pulse wave velocity (PWV) was measured in 208 people with FINDRISC ≥ 13 (57 ± 8 years old, 68.7% women) and thereafter divided into those having either normal glucose tolerance (NGT) or PreD. In each subgroup we also identified those with/out insulin resistance (IR) measured by the triglyceride/HDL-c ratio (normal cut off values previously established in our population). Clinical and metabolic data were collected for all participants. PWV was compared between subgroups using independent t test. Results: Women and men had comparable clinical and metabolic characteristics with obesity (BMI ≥ 30) and antihypertensive-statin treatment, almost half with either NGT or PreD. Whereas 48% of NGT people presented IR (abnormally high TG/HDL-c ratio), 52% had PreD. PWV was significantly higher only in those with a complete picture of metabolic syndrome (MS). Conclusions: Since PWV was significantly impaired in people with a complete picture of MS, clinicians must carefully search for early diagnosis of this condition and prescribe a healthy life-style to prevent development/progression of CVD. This proactive attitude would provide a cost-effective preventive strategy to avoid CVD’s negative impact on patients’ quality of life and on health systems due to their higher care costs.Centro de Endocrinología Experimental y AplicadaFacultad de Ciencias Médica

Pre diabetes and arterial stiffness: its identification and posible pathogenesis

Introducción: antecedentes: en el estadio de prediabetes (PreD) aparecen marcadores de lesión vascular que indican la necesidad de identificación precoz y tratamiento oportuno. Objetivos: evaluar los indicadores de rigidez arterial en personas con PreD y su posible patogenia.Introduction: background: in the prediabetes stage (PreD), vascular lesion markers appear indicating the need for early identification and timely treatment. Aims: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis.Publicado en Revista de la Sociedad Argentina de Diabetes, vol. 54, no. 3, Sup.Centro de Endocrinología Experimental y Aplicad

Donantes de tejidos valvulares cardíacos: modelo de selección

La selección de homoinjertos valvulares cardíacos (HV) para su procesamiento en banco de tejidos se realiza con criterios relacionados con antecedentes de los donantes. Es necesario el desarrollo de un modelo que determine el riesgo epidemiológico de alteración estructural de donantes de HV en nuestra población. Un modelo multivariado fue desarrollado en el presente trabajo para la optimización en la selección de donantes de HV aórticos en base a los factores de riesgo cardiovasculares y la anatomía de válvulas cardíacas, procesadas en Bancos de tejidos cardiovasculares en base a los datos registrados en el Servicio de Procuración de Organos y Tejidos del Centro Unico Coordinador de Ablación e Implante de la Provincia de Buenos Aires (CUCAIBA). Las frecuencias de categorías de HV fueron: C2, n = 41 (25,8%); C1, n= 79 (49,7%) Y C0, n = 39 (24,5%). La variable dependiente fue la alteración estructural hallada por disección en el HV (C1+C0); observando predominio de ateromatosis (C1: 75, 95%). Las independientes seleccionadas por análisis multivariado fueron: sexo, antecedente de hipertensión arterial y causa de muerte por accidente cerebrovascular. Se desarrolló un puntaje de riesgo para donantes con alta probabilidad de alteraciones estructurales de sus válvulas aórticas, calculando por curva ROC sensibilidad de 57,3% y especificidad de 92,9%. El modelo de selección calculado aporta información predictiva, evitando procesamiento de tejidos con alteraciones estructurales de tejido vascular y valvular, logrando una mejor selección de sus donantes. La mejor calidad anatómica de los HV obtenidos y almacenados en Banco de tejidos cardiovasculares proveen un potencial beneficio para el pronóstico post implante.Facultad de Ciencias Médica

Adherence to antihypertensive drug treatment in Argentina: a multicenter study.Adherence to antihypertensive drugs in Argentina.

Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence—MMAS score of 8; medium adherence—MMAS scores of 6 to <8; and low adherence—MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.Fil: Espeche, Walter. Hospital San Martin de la Plata; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Salazar, Martin. Universidad Nacional de La Plata; Argentina. Hospital San Martin de la Plata; ArgentinaFil: Sabio, Rodrigo. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Diaz, Alberto Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; ArgentinaFil: Leiva Sisnieguez, Carlos Enrique. Universidad Nacional de La Plata; Argentina. Hospital San Martin de la Plata; ArgentinaFil: Olano, Daniel. Hospital San Martin de la Plata; ArgentinaFil: Balbin, Eduardo. Hospital San Martin de la Plata; ArgentinaFil: Renna, Nicolas Federico. Universidad Nacional de Cuyo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Grosse, Pedro. No especifíca;Fil: Flores, Roberto A.. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Medicas.; ArgentinaFil: Lagos, Ana C.. No especifíca;Fil: Ferrero, Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Poppe, Silvia. Hospital Nacional Profesor Alejandro Posadas.; ArgentinaFil: Risso Patron, Facundo. No especifíca;Fil: Sotnieczuk Stasiuk, Victor D.. No especifíca;Fil: Valentini, Elina. No especifíca;Fil: Cardozo, Jose Ricardo. Hospital Justo Pereyra Aristóbulo del Valle; ArgentinaFil: Romano, Jose R.. Hospital de Formosa; ArgentinaFil: Parodi, Roberto. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Carbajal, Horacio. Universidad Nacional de La Plata; Argentin