Carlos D. Tajer

Conflict of interest policies and disclosure requirements among European Society of Cardiology National Cardiovascular Journals

Disclosure of potential conflicts of interest (COIs) is used by biomedical journals to guarantee credibility and transparency of the scientific process. Conflict of interest disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into the current COI policies and practices among European Society of Cardiology National Cardiovascular Journals, as derived from a cross-sectional survey using a standardized questionnaire, are discussed.

Accuracy of low-dose prospectively gated axial coronary CT angiography for the assessment of coronary artery stenosis in patients with stable heart rate

BACKGROUND Desirable methods for cardiac CT angiography would both reduce radiation exposure from cardiac CT angiography and preserve accuracy. OBJECTIVES We assessed image quality, radiation dose, and diagnostic accuracy of a low-dose, prospectively gated axial cardiac CT angiography protocol for the evaluation of patients with suspected coronary artery disease (CAD). METHODS Fifty consecutive patients referred for diagnostic invasive coronary angiography (ICA) and with a stable heart rate < 60 beats/min after beta-blocker administration were prospectively enrolled in a single center study. Subjects underwent CT angiography with a 64-row multidetector CT scanner with a prospectively gated axial imaging protocol. If the examination was determined to be nondiagnostic, then a retrospectively gated helical scan was performed. Two reviewers independently assessed image quality and the presence of significant coronary artery stenosis (>50%). RESULTS Prospectively gated CT angiography was successfully performed in 46 of 50 patients. Of 794 coronary segments, 777 were determined to be of diagnostic image quality. The overall patient-based sensitivity (95% CI), specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of significant coronary stenosis were 100% (87%-100%), 75% (53%-90%), 81% (64%-93%), 100% (81%-100%), and 88% (81%-95%), respectively. The mean effective radiation dose for CT angiography and ICA were 3.4 +/- 0.4 mSv and 6.9 +/- 0.8 mSv, respectively. CONCLUSIONS Cardiac CT angiography performed in a prospectively gated axial mode with 64-row multidetector CT provides an accurate, low-dose alternative for the detection of CAD.

Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease

PURPOSE We sought to explore the diagnostic performance of dual energy computed tomography (DECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease (CAD). MATERIALS AND METHODS Consecutive patients with known or suspected CAD referred for myocardial perfusion imaging by single-photon emission computed tomography (SPECT) constituted the study population and were scanned using a DECT scanner equipped with gemstone detectors for spectral imaging, and a SPECT. The same pharmacological stress was used for both scans. RESULTS Twenty-five patients were prospectively included in the study protocol. The mean age was 63.4±10.6 years. The total mean effective radiation dose was 7.5±1.2 mSv with DECT and 8.2±1.7 mSv with SPECT (p=0.007). A total of 425 left ventricular segments were evaluated by DECT, showing a reliable accuracy for the detection of reversible perfusion defects [area under ROC curve (AUC) 0.84 (0.80-0.87)]. Furthermore, adding stress myocardial perfusion provided a significant incremental value over anatomical evaluation alone by computed tomography coronary angiography [AUC 0.70 (0.65-0.74), p=0.003]. CONCLUSIONS In this pilot investigation, stress myocardial perfusion by DECT demonstrated a significant incremental value over anatomical evaluation alone by CTCA for the detection of reversible perfusion defects.

Ibero-American Cardiovascular Journals. Proposals for Much-Needed Collaboration

Ibero-American Cardiovascular Journals. Proposals for Much-Needed Collaboration Fernando Alfonso,a Katihurca Almonte,b Kaduo Arai,c Fernando Bacal,d Jose M. Drago Silva,e Javier Galeano Figueredo,f Eduardo Guarda,g Oswaldo Gutierrez Sotelo,h Luis Guzman,i Jorge Leon Galindo,j Bey Mario Lombana,k Manlio F. Marquez,l Francisco Luis Moreno Martinez,m Jose Navarro Robles,n Fausto Pinto,o Carlos Romero,p Carlos D. Tajer,q Hugo Villarroel,r and Fernando S. Wyss Quintanas

Comparison of Myocardial Perfusion Evaluation with Single Versus Dual-Energy CT and Effect of Beam-Hardening Artifacts

RATIONALE AND OBJECTIVES We sought to explore the feasibility and diagnostic performance of dual-energy computed tomography (DECT) versus single-energy computed tomography (SECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease. MATERIALS AND METHODS The present prospective study involved patients with known or suspected coronary artery disease referred for myocardial perfusion imaging by single-photon emission computed tomography. Forty patients were included in the study protocol and scanned using DECT imaging (n = 20) or SECT imaging (n = 20). The same pharmacologic stress was used for DECT, SECT, and single-photon emission computed tomography scans. RESULTS A total of 1360 left ventricular segments were evaluated by DECT and SECT. The contrast-to-noise ratio was similar between groups (DECT 8.8 ± 2.9 vs. SECT 7.7 ± 4.2; P = .22). The diagnostic performance of DECT was greater than that of SECT in identifying perfusion defects (area under the receiver operating characteristic curve of DECT 0.90 [0.86-0.94] vs SECT 0.80 [0.76-0.84]; P = .0004) and remained unaffected when including only segments affected by beam-hardening artifacts (area under the receiver operating characteristic curve = DECT 0.90 [0.84-0.96) vs. SECT 0.77 [0.69-0.84]; P = .007). CONCLUSIONS Our results suggest that myocardial perfusion by DECT imaging is feasible and might have improved diagnostic performance compared to SECT imaging for the assessment of myocardial CT perfusion. Furthermore, the diagnostic performance of DECT remained unaffected by the presence of beam-hardening artifacts.

Feasibility of 64-slice gadolinium-enhanced cardiac CT for the evaluation of obstructive coronary artery disease

Objective To assess the feasibility of gadolinium-enhanced 64-slice cardiac CT (CCT) for the diagnosis of obstructive coronary artery disease. Design Comparative prospective study. Setting Outpatient Imaging Diagnostic Centre, Diagnóstico Maipú, Buenos Aires, Argentina. Patients Twenty patients with suspected coronary artery disease. Interventions Gadolinium-enhanced 64-slice CCT was performed before invasive coronary angiography (ICA). Main outcome measures The feasibility of gadolinium-enhanced 64-slice CCT for detection of obstructive coronary artery disease (>50% diameter reduction) was evaluated, using ICA as the ‘gold standard’. Mean lumen attenuation, non-calcified and calcified plaques densities were correlated between gadolinium-enhanced CCT studies and iodine-enhanced CCT studies of a control group. Renal function was strictly monitored. Results Gadolinium-enhanced CCT demonstrated adequate visualisation of 283/289 coronary segments that were evaluable by ICA, 31 of which had >50% luminal stenosis. In per-segment analysis, gadolinium-enhanced CCT showed a sensitivity of 90.3%, specificity of 96.8%, positive predictive value of 77.8% and negative predictive value of 98.8%. The agreement of coronary stenosis between multidetector CT (MDCT) and ICA was 94.1% (272/289). The mean lumen attenuation, non-calcified and calcified plaques densities in gadolinium-enhanced CCT studies were 140.1 Hounsfield units (HU), 51.1 HU and 523.6 HU, whereas in iodine-enhanced CCT studies the values were 354.1 HU, 101.0 HU and 778.5 HU, respectively (p < 0.001). Conclusion Gadolinium-enhanced CCT is a feasible alternative for patients with severe contraindications to iodinated contrast agents referred for MDCT coronary angiography.

Multivessel versus Single Vessel Angioplasty in Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Metaanalysis

Background Multivessel disease is common in acute coronary syndrome patients. However, if multivessel percutaneous coronary intervention is superior to culprit-vessel angioplasty has not been systematically addressed. Methods A metaanalysis was conducted including studies that compared multivessel angioplasty with culprit-vessel angioplasty among non-ST elevation ACS patients. Since all studies were observational adjusted estimates of effects were used. Pooled estimates of effects were computed using the generic inverse of variance with a random effects model. Results Twelve studies were included (n = 117,685). Median age was 64.1 years, most patients were male, 29.3% were diabetic and 36,9% had previous myocardial infarction. Median follow-up was 12 months. There were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to 1.09; I2 67.9%), with moderate inconsistency. Also, there were no significant differences in the risk of death or MI (HR 0.90; 95% CI 0.69 to 1.17; I2 62.3%), revascularization (HR 0.76; 95% CI 0.55 to 1.05; I2 49.9%) or in the combined incidence of death, myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03; I2 70.8%). All analyses exhibited a moderate degree of inconsistency. Subgroup analyses by design reduced the inconsistency of the analyses on death or myocardial infarction, revascularization and death, myocardial infarction or revascularization. There was evidence of publication bias (Egger’s test p = 0.097). Conclusion Routine multivessel angioplasty in non-ST elevation acute coronary syndrome patients with multivessel disease was not superior to culprit-vessel angioplasty. Randomized controlled trials comparing safety and effectiveness of both strategies in this setting are needed.

Mobile phone text messaging to improve adherence to cardiovascular disease secondary prevention interventions

Fil: Mariani, J. Hospital de Alta Complejidad en Red El Cruce Dr. Nestor C. Kirchner. Servicio de Cardiologia. Florencio Varela, Argentina.

Revistas cardiovasculares iberoamericanas: propuestas para una colaboración necesaria

aEditor Jefe. Revista Española de Cardiología. Madrid. España. bEditora Jefe. Archivos Dominicanos de Cardiología. Santo Domingo. República Dominicana. cEditor Jefe. Avances Cardiológicos. Caracas. Venezuela. dEditor Jefe. Arquivos Brasileiros de Cardiologia. Río de Janeiro. Brasil. eEditor Jefe. Revista Peruana de Cardiología. Lima. Perú. fEditor Jefe. Revista Paraguaya de Cardiología. Asunción. Paraguay. gEditor Jefe. Revista Chilena de Cardiología. Santiago de Chile. Chile. hEditor Jefe. Revista Costarricense de Cardiología. San José. Costa Rica. iEditor Jefe. Revista de la Federación Argentina de Cardiología. Buenos Aires. Argentina. jEditor Jefe. Revista Colombiana de Cardiología. Bogotá. Colombia. kEditor Jefe. Revista de Cardiología. Revista Panameña de Cardiología. Panamá. lEditor Jefe. Archivos de Cardiología de México. México DF. México. mEditor Jefe. CorSalud. La Habana. Cuba. nEditor Jefe. Revista Mexicana de Cardiología. México DF. México. oEditor Jefe. Revista Portuguesa de Cardiologia. Lisboa. Portugal. pEditor Jefe. Revista Uruguaya de Cardiología. Montevideo. Uruguay. qEditor Jefe. Revista Argentina de Cardiología. Buenos Aires. Argentina. rEditor Jefe*. Revista de la Asociación Salvadoreña de Cardiología. San Salvador. El Salvador. sEditor Jefe. Revista de la Asociación Guatemalteca de Cardiología. Ciudad de Guatemala. Guatemala.Fernando Alfonso1, Katihurca Almonte2, Kaduo Arai3, Fernando Bacal4, José M. Drago Silva5, Javier Galeano Figueredo6, Eduardo Guarda7, Oswaldo Gutiérrez Sotelo8, Luis Guzmán9, Jorge León Galindo10, Bey Mario Lombana11, Manlio F. Márquez12, Francisco Luis Moreno Martínez13, José Navarro Robles14, Fausto Pinto15, Carlos Romero16, Carlos D. Tajer17, Hugo Villarroel18 y Fernando S. Wyss Quintana19 Chief Editor Revista Española de Cardiología, Madrid Spain1; Chief Editor Archivos Dominicanos de Cardiología, Santo Domingo Dominican Republic2; Chief Editor Avances Cardiológicos, Caracas Venezuela3; Chief Editor Arquivos Brasileiros de Cardiologia, Rio de Janeiro Brazil4; Chief Editor Revista Peruana de Cardiología, Lima Peru5; Chief Editor Revista Paraguaya de Cardiología, Assuncion Paraguay6; Chief Editor Revista Chilena de Cardiología, Santiago de Chile Chile7; Chief Editor Revista Costarricense de Cardiología, San Jose Costa Rica8; Chief Editor Revista de la Federación Argentina de Cardiología, Buenos Aires Argentina9; Chief Editor Revista Colombiana de Cardiología, Bogota Colombia10; Chief Editor Revista de Cardiología, Revista Panameña de Cardiología Panama11; Chief Editor Archivos de Cardiología de México, Mexico DF. Mexico12; Chief Editor CorSalud, HavanaCuba13; Chief Editor Revista Mexicana de Cardiología, Mexico DF. Mexico14; Chief Editor Revista Portuguesa de Cardiologia, Lisboa Portugal15; Chief Editor Revista Uruguaya de Cardiología, Montevideo Uruguay16; Chief Editor Revista Argentina de Cardiología, Buenos Aires Argentina.17; Chief Editor* Revista de la Asociación Salvadoreña de Cardiología, San Salvador El Salvador.18; Chief Editor Revista de la Asociación Guatemalteca de Cardiología, Guatemala City Guatemala19 *The Revista de la Asociación Salvadoreña de Cardiología was edited in the period between 2003 and 2005

Initial Results and Long-Term Follow-up of Percutaneous Mitral Valvuloplasty in Patients with Pulmonary Hypertension

BACKGROUND Percutaneous balloon mitral valvuloplasty (PMV) is an attractive therapeutic approach in patients with mitral stenosis. The aim of this study was to assess the immediate and long-term clinical, echocardiographic and haemodynamic outcomes of PMV in patients with severe pulmonary hypertension (PAH). METHODS Percutaneous balloon mitral valvuloplasty was performed in 157 consecutive patients; 60 patients (38.2%) had significant PAH defined as baseline pulmonary artery mean pressure (PAMP) ≥ 30mm Hg (Group 1) and 97 patients (61.8%) had PAMP ≤ 30mmHg (Group 2). Pulmonary artery systolic pressure (PASP), mortality, need for mitral valve replacement or new PMV, and valve restenosis were evaluated during follow-up. RESULTS Mean age was 44.2 years and 88.5% (139 patients) were women. Primary success was achieved in 79.6% of the patients (125 patients) without differences between the groups. Mitral valve area increased from 0.90cm2 to 1.76cm2, PASP fell from 57mmHg to 35mmHg in Group 1 and from 38mmHg to 30mmHg in Group 2. Median PASP in Group 1 was 35, 32, 36, 38 and 34mmHg at 12, 24, 36, 48 and 60 months. There were no significant differences in mitral valve area, PASP and clinical status between the groups. CONCLUSION Percutaneous balloon mitral valvuloplasty is a safe and effective technique for the treatment of patients with mitral stenosis and PAH. A significant decrease in pulmonary pressure was observed after valvuloplasty. Although there was a gradual decrease of MVA at long-term follow-up, most patients remained asymptomatic and PASP was stable.