Rafael Vázquez García

Coartación de aorta: diferentes formas anatomoclínicas según la edad de presentación

Objetivo Analizar las caracteristicas anatomoclinicasdiferenciales de la coartacion de aorta en susdiferentes edades de presentacion. Pacientes y metodos Se revisaron restrospectivamentelos datos clinicos, angiograficos, hallazgosintraoperatorios y resultados quirurgicos de 82 casosde coartacion de aorta (54 varones y 28 mujeres). La edad media fue de 16, 2 ± 13, 7 anos (rango= 1 mes-63 anos). Los pacientes fueron divididos entres grupos: menores de 1 ano (grupo A; n = 10); de1-12 anos (grupo B; n = 30) y mayores de 12 anos(grupo C; n = 42). Resultados La forma preductal se observo en el 20, 7% de los casos (el 50,0%, el 30,0% y el 7,1% en los grupos A, B y C respectivamente; p = 0,003) y las anomalias asociadas tipo shunt izquierda-dere chaen el 19,5% (el 40,0%, el 16,7% y el 16,7% enlos grupos A, B y C, respectivamente; p = NS). La insuficiencia cardiaca fue la manifestacion predominante en el grupo A (70,0%), mientras que lomas frecuente en el grupo B fue el hallazgo casualen un paciente asintomatico (30,0%). La hipertension arterial o sus complicaciones fueron la presentacionmas habitual en el grupo C (38,0%). Se observo crecimiento ventricular izquierdo en el electrocardiograma en el 0,0%, el 30,0% y el 54,7% de los pacientes de los grupos A, B y C, respectivamente(p = 0,003). Se observaron complicaciones postoperatorias, incluyendo fallecimiento, crisis hipertensivasy recoartacion, respectivamente, en el 90,0%, 33,3% y 21,4% de los casos de los grupos A, B y C (p = 0,01). Conclusiones La edad de presentacion de la coartacionaortica permite establecer grupos con diferentes caracteristicas anatomicas y clinicas, e incluso con diferente evolucion postoperatoria.

Comments on the 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

In accordance with the policy on clinical practice guidelines established by the Executive Committee of the Spanish Society of Cardiology, the current article discusses the most notable and novel aspects of the European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure (HF). The aim of the guidelines is to update our knowledge of the diagnosis and treatment of HF based on the best clinical evidence available.

Comments on the 2016 ESC/EAS Guidelines for the Management of Dyslipidemias☆

In the present article, we discuss the recently published guidelines for the treatment of dyslipidemia developed by the European Society of Cardiology (ESC) in conjunction with the European Atherosclerosis Society and with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation.1 To comment on these guidelines, the Guidelines Committee formed a task force composed of members of the Spanish Society of Cardiology (SEC). Thus, following the same order as the guidelines, the current article reviews the most important aspects of the various sections.

Prognostic Implications of Functional Mitral Regurgitation in Patients With Heart Failure and Reduced Ejection Fraction

1. Jannin J, Villa L. An overview of Chagas disease treatment. Mem Inst Oswaldo Cruz. 2007;102(Suppl 1):95–97. 2. Schmunis GA. Epidemiology of Chagas disease in non-endemic countries: the role of international migration. Mem Inst Oswaldo Cruz. 2007;102(Suppl 1):75– 85. 3. Morillo CA, Marin-Neto JA, Avezum A, et al. Randomized trial of benznidazole for chronic Chagas’ cardiomyopathy. N Engl J Med. 2015;373:1295–1306. 4. Garcia-Alvarez A, Sitges M, Pinazo MJ, et al. Chagas cardiomiopathy: the potential of diastolic dysfunction and brain natriuretic peptide in the early identification of cardiac damage. PLoS Negl Trop Dis. 2010;4:e826.

Valoración pronóstica de pacientes postinfarto mediante la ecocardiografía bidimensional, los potenciales tardíos ventriculares y la sensibilidad barorrefleja

Fundamento Aunque un gran numero de variablesson utiles predictores de muerte postinfarto, su valorpredictivo positivo es debil cuando se aplican de formaindividual. El objetivo del estudio fue determinarel valor pronostico de la combinacion de la fraccionde eyeccion ventricular izquierda, los potenciales tardiosventriculares y la sensibilidad barorrefleja. Pacientes y metodos Se estudiaron 69 pacientespostinfarto consecutivos. A todos se les practicaron,el dia del alta de la unidad coronaria, una ecocardiografiabidimensional, para la determinacionde la fraccion de eyeccion y un electrocardiogramade alta resolucion para detectar potenciales tardios.A 49 pacientes se les determino la sensibilidadbarorrefleja mediante el test de la fenilefrina.Los pacientes fueron seguidos 14 ± 7 meses y seconsideraron los siguientes eventos finales: muertesubita cardiaca, muerte cardiaca no subita y episodiosde taquicardia ventricular sostenida o fibrilacionventricular no fatales. Resultados Hubo 3 muertes subitas, 3 muertesno subitas y 2 taquicardias ventriculares reanimadas.La tasa de fibrinolisis fue del 55%. La fraccionde eyeccion inferior al 45%, la presencia de potencialestardios y la sensibilidad barorrefleja inferiora 3,0 ms/mmHg fueron predictores univariados delos acontecimientos finales (valores predictivospositivos del 33, 24 y 16%, respectivamente). Lacombinacion de las 3 variables anteriores permitioelevar el valor predictivo positivo al 50%. Conclusion La determinacion combinada de lafraccion de eyeccion, los potenciales tardios ventricularesy la sensibilidad barorrefleja permiten definira un subgrupo de pacientes con alta probabilidadde complicaciones cardiacas graves tras uninfarto de miocardio.

Comments on the 2018 ESC Guidelines for the Diagnosis and Management of Syncope

The new syncope guidelines significantly increase the volume of information on how to diagnose and manage this entity, which is of considerable importance not only to cardiologists, but also to all physicians involved. A welcome addition is the incorporation of emergency specialists, neurologists, and geriatricians into the working group. The new document comprises 69 pages and 440 references vs the 41 pages and 213 references of the previous guidelines. The increase is even greater if one considers the new online section of additional material called ‘‘Practical Instructions’’. This material includes an extensive glossary that establishes a general vocabulary, a definition of criteria, and a description of techniques and management instructions. This hugely valuable supplement comprises 38 pages and 192 references. The recommendations continue to operate in an environment of pervasive uncertainty. Quantitatively, the number of recommendations has increased by 7%; however, 40% are level I (49% in 2009) and only 3% are level III (14% in 2009). Neither has the level of evidence changed substantially: only 5% of recommendations are level A (3% in 2009) and most–50%–are level C (52% in 2009). In addition to specific novel aspects, which are addressed in each section, the role of syncope units (SUs) is emphasized in a commitment to improved patient-focused safety and efficiency. This same commitment is reflected in the definition of the initial evaluation and risk stratification in the emergency department. Beyond the specific novelties (Figure 1), we also highlight the conceptual aspects that have been updated and describe them in the same order as the headings of the original document (Figure 2).

Comments on the 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases.

Since 2011, the Spanish Society of Cardiology (SEC) has had a policy of endorsing all the clinical practice guidelines published by the European Society of Cardiology (ESC). In an effort to increase awareness of the guidelines, they are translated into Spanish and published in Revista Española de Cardiología along with comments from a group of Spanish experts that highlight the most noteworthy aspects, criticize the limitations, and adapt the recommendations to everyday clinical practice in Spain. This article contains the comments on the recently published ESC guidelines on the diagnosis and treatment of peripheral vascular diseases,1 developed in collaboration with the European Society for Vascular Surgery (ESVS). The Guidelines Committee set up a working group composed of SEC members to comment on the guidelines. These guidelines update the first ESC clinical practice guidelines on peripheral vascular disease (PVD) published in 2011.2 Although PVD may appear to be beyond the scope of cardiology, nothing could be further from the truth. The guidelines stress the importance of increasing cardiologists’, vascular surgeons’ and other physicians’ awareness and knowledge of the common nature of arteriosclerotic disease and the risk factors in the different vascular territories, including extracranial carotid and vertebral disease. For example, they recommend screening for PVD in patients with cardiac or cerebrovascular disease, and vice versa, because these 2 locations are the most common causes of mortality in patients with PVD. The collaboration with the ESVS is also relevant, because vascular surgeons are increasingly more involved in treatment, not only for revascularization, but also epidemiological aspects and the medical treatment of arterial disease. The document contains a table titled “What is new in the 2017 PAD guidelines?” plus some key messages at the start of each chapter, by way of an introduction. Another interesting feature is the “questions and answers” section, only available in the additional online material, which includes 14 short clinical cases that clearly and specifically illustrate the practical application of the guideline recommendations. Below are the comments on the most important aspects, following the same order as the guideline sections.