Isabel Diaz-Buschmann

Comentarios a la guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST

The European Society of Cardiology (ESC) guidelines are endorsed by the Spanish Society of Cardiology (SEC) and translated into Spanish for their publication in the Revista Española de Cardiología. Under the policy introduced in 2011, each new guideline is accompanied by an article that formulates comments in accordance with the objectives and methodology recommended in the article that established the Guidelines Committee of the SEC.1 In the present article, we discuss the new European guidelines for ST-segment elevation acute myocardial infarction (STEMI).2 The Guidelines Committee established a work group composed of members proposed by the Ischemic Heart Disease, Hemodynamics, Clinical Cardiology, Heart Failure, and Geriatric Cardiology work groups. As a general comment, we consider that the present guidelines introduce highly interesting developments and that the topics are dealt with clearly and in detail. However, we should also point out that it contains 157 recommendations, 69 (44%) of which are accompanied by level C evidence (expert consensus), predominantly in the sections on in-hospital management, heart failure, and complications, fields in which there thus remains ample room for individualization and progress in clinical research. In applying them, we should not forget that the guidelines themselves remind us that the level A and B recommendations are based on clinical trials, and that even these results are open to interpretation. The different therapeutic options could be influenced by the available resources. Thus, it will be increasingly necessary to perform cost-efficiency studies that aid us in choosing among the different strategies. For the purpose of making the article more readable and to highlight the most relevant or novel aspects, as well as those that are not made clear or are not addressed, we have summarized them in Tables 1 and 2, respectively.

Comentarios a la guía de práctica clínica de la ESC sobre prevención de la enfermedad cardiovascular (versión 2012). Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

As proposed by the SEC clinical practice guidelines committee, the Hypertension and Preventive Cardiology and Rehabilitation sections selected a group of CVD prevention experts to review the ESC guidelines published in 2012 and translated in REVISTA ESPAÑOLA DE CARDIOLOGÍA. Their objective was to discuss the contents and appropriacy of the guidelines, analyze the method and highlight issues considered innovative, positive or questionable, as well as any left with no comment. The guidelines were divided into 5 parts and each was independently commented on by 2 experts. Based on their opinions, a document was prepared and, in turn, reviewed and approved by a group of experts designated by the SEC sections involved. All the experts have declared their conflicts of interest, which are stated in detail at the end of this article.

Comentarios a la guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica 2012. Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

El Comite de Guias de Practica Clinica de la SEC formo un grupo de trabajo integrado por cardiologos clinicos, electrofisiologos, cirujanos cardiacos y personal de enfermeria, expertos en los diversos aparta-dos de la IC que cubre la guia de la ESC, propuestos por la Seccion de Insuficiencia Cardiaca y Trasplante y el Grupo de Trabajo sobre Resin-cronizacion Cardiaca de la SEC y por la Asociacion Espanola de Enfer-meria Cardiovascular, con el objetivo general de revisar las evidencias y recomendaciones aportadas por la guia europea sobre IC antes citada

Programming exercise intensity in patients on beta-blocker treatment: the importance of choosing an appropriate method:

Aim To verify the usefulness of current recommended level of target exercise heart rate (HR) and of different HR-based methods for calculating target HR in patients with and without beta-blocker treatment. Methods We studied 53 patients not treated with beta-blocker and 159 patients on beta-blocker treatment. All patients underwent a maximal exercise test with gas analysis, and first ventilatory threshold (VT1 or aerobic threshold), second ventilatory threshold (VT2 or anaerobic threshold), time of exercise, maximum load, metabolic parameters, HR at rest (HRrest), HRpeak, HR at VT1 (HRVT1) and at VT2 (HRVT2), and 75, 80, and 85% of HRmax (HR75%, HR80%, HR85%) were calculated. Exercise HR was also determined using the Karvonen formula, applying 60, 70, and 80% of the heart rate reserve (HRR) (HRKarv0.6, HRKarv0.7, and HRKarv0.8). Results This study included 102 patients on a beta-blocker and 39 not treated with negative cronotropic effect drugs. Maximum load, metabolic parameters, HRrest, HRpeak, HRVT1, and HRVT2 were significantly lower in patients on beta-blocker treatment. The proportion of patients with a HR75%, HR80%, HR85%, HRKarv0.6, HRKarv0.7, and HRKarv0.8 VT2 was very high and depended on whether patients were on beta-blocker treatment. Conclusions Prescribed exercise intensity should be within VT1 and VT2, so that the efficacy and safety is guaranteed. If determining VT1 and VT2 is not possible, HR-based methods can be used, but with caution. In fact, there will be always a proportion of patients training below VT1 or above VT2. On the other hand, recommendations for patients on a beta-blocker should be different from patients not receiving a beta-blocker. Patients not treated with a beta-blocker should exercise at HRKarv0.7 or at HR85%. In patients on a beta-blocker, we recommend preferentially a target HR of HRKarv0.6 or HR80%.

Valor de la troponina I cardíaca como prueba diagnóstica en el estudio del dolor torácico

Introduccion y objetivos La troponina I cardiacaes un marcador muy sensible y especifico de lesionmiocardica. Hemos analizado si la determinacionde cifras de troponina I cardiaca puede ser util enel diagnostico de cardiopatia isquemica, en pacientespreviamente sanos con clinica de dolor toracicosin que el resto de analitica ni el ECG sean suficientementediagnosticos. Pacientes, material y metodos Se estudiarontransversal y consecutivamente durante un ano untotal de 37 pacientes sin cardiopatia previa conocida,ingresados en la unidad coronaria por dolor toracicosupuestamente anginoso, con enzimas cardiacasy ECG normales. Se consideraron como patologicascifras de troponina I cardiaca al ingreso ≥ 0,4 ng/ml, contrastandose con los resultados de lacoronariografia o de una ergometria concluyente yrelacionandose tambien con la duracion del cuadroy el tiempo de demora entre los sintomas y la extraccionde la muestra. Resultados Fueron estudiados 33 de los 37 pacientesinicialmente incluidos. En 22 se diagnosticocardiopatia isquemica elevandose la troponina I en15 de ellos; se obtuvo una sensibilidad del 68% (48-84%), con una especificidad del 82% (53-97%). Enel subgrupo de pacientes con dolor ≥ 30 min de duracionla sensibilidad ascendio al 85% (59-97%),con una especificidad del 83% (42-99%). No huboresultados significativamente diferentes en funciondel tiempo de demora. Conclusiones La troponina I cardiaca resultamuy util en el estudio de dolores toracicos supuestamenteanginosos sin enzimas ni ECG concluyentes,ya que posee una elevada sensibilidad y especificidadpara la deteccion de lesion isquemica. Estacapacidad diagnostica se acentua en el caso de doloresprolongados.

Comments on the ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012. A Report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology

In line with the policy on clinical practice guidelines established by the Executive Committee of the Spanish Society of Cardiology,1 the present article aims to discuss the most salient and novel features of the European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure (HF).2 These guidelines update the recommendations of the prior version published 4 years ago in 20083 and include the new evidence that has emerged since then in the field of HF.

Comments on the ESC guidelines on the management of valvular heart disease (version 2012). A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology.

A task force was formed consisting of experts from different fields. Members of the task force were proposed by the SEC Clinical Cardiology, Cardiac Catheterization, and Cardiac Imaging sections and by the SECTCV (Spanish Society of Thoracic and Cardiovascular Surgery). The Task Force was coordinated by 2 representatives of the CGPC. The guidelines were divided into blocks and sent to members of the Task Force, who analyzed the most novel and important aspects in terms of clinical practice. They also gave their opinion on the methodology used, possible areas of conflict, and limitations with regard to other guidelines. In addition, they were asked to describe the implications for actual practice in the Spanish setting. The information received was used to produce a first draft of the document, which the original committee evaluated before referring it to a second group of 11 reviewers also proposed by sections of the SEC and the SECTCV. All authors and reviewers were asked to disclose any conflicts of interest, details of which are provided at the end of the article.