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Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Atrial fibrillation is the most frequent chronic arrhythmia in patients with chronic kidney disease. Oral anticoagulation with vitamin K antagonists and now direct oral anticoagulants have been and are the fundamental pillars for the prevention of thromboembolic events. However, there are no randomized clinical trials on the risk-benefit profile of oral anticoagulation in patients with chronic kidney disease stage 5 on peritoneal dialysis and there is little evidence in the literature in this population.The objective of our study was to know the prevalence, treatment and professionals involved in the management of atrial fibrillation in peritoneal dialysis patients. For this purpose, we performed a descriptive analysis through a survey sent to different peritoneal dialysis units in Spain. A total of 1,403 patients on peritoneal dialysis were included in the study, of whom 186 (13.2%) had non-valvular atrial fibrillation. In addition, the assessment of the scores of thromboembolic and bleeding risks for the indication of oral anticoagulation was mainly carried out by the cardiologist (60% of the units), as well as its prescription (cardiologist 47% or in consensus with the nephrologist 43%).In summary, patients on peritoneal dialysis have a remarkable prevalence of non-valvular atrial fibrillation. Patients frequently receive oral anticoagulation with vitamin K antagonists, as well as direct oral anticoagulants. The data obtained regarding the scores used for the assessment of thromboembolic and bleeding risk, treatment and involvement by Nephrology indicates that there is a need for training and involvement of the nephrologist in this pathology. Resumen: La fibrilación auricular es la arritmia crónica más frecuente en pacientes con enfermedad renal crónica. La anticoagulación oral con antagonistas de la vitamina K y actualmente los anticoagulantes orales de acción directa han sido y son el pilar fundamental para la prevención de eventos tromboembólicos. Sin embargo, no existen ensayos clínicos aleatorizados de su perfil riesgo-beneficio en pacientes con enfermedad renal crónica estadio 5 en diálisis peritoneal y son pocas evidencias en la literatura en esta población. El objetivo del estudio fue conocer la prevalencia, tratamiento y profesionales implicados en el manejo de la fibrilación auricular en diálisis peritoneal en nuestro entorno mediante el análisis descriptivo de una encuesta enviada a diferentes unidades de diálisis peritoneal de España. Se incluyeron en el estudio 1403 pacientes en programa de diálisis peritoneal, de los cuales 186 (13,2%) presentaban fibrilación auricular no valvular. Además, observamos que la valoración de los scores para el inicio del tratamiento anticoagulante la realizaba mayoritariamente el cardiólogo (60% de los centros), así como la prescripción de anticoagulación (cardiólogo 47% o conjuntamente con nefrólogo 43%).En conclusión, los pacientes en diálisis peritoneal presentan una notable prevalencia de fibrilación auricular no valvular. Reciben frecuentemente anticoagulación oral con antagonistas de la vitamina K, así como con anticoagulantes orales de acción directa. Los datos obtenidos respecto a las escalas utilizadas para la valoración de riesgo tromboembólico y de sangrado, tratamiento e implicación por parte de Nefrología indica que existe una necesidad de formación e implicación del nefrólogo en esta patología.

Geriatric Cardiology was born as a need for the comprehensive, individualized, holistic, strategic evaluation of the elderly, in itself heterogeneous; in conjunction with their geriatric syndromes such as frailty, cognitive impairment, sarcopenia, physical dysfunction, falls; in addition to its multimorbidity, its polypharmacy; with respect to cardiovascular diseases such as heart failure, atrial fibrillation, coronary disease, valvular disorders; ethereal population, which in many clinical trials have been excluded, and do not have a representativeness in the development of the current clinical guidelines for the correct diagnosis, evaluation and treatment of said cardiovascular diseases; Geriatric cardiology is therefore collaborative, it is multidisciplinary, it prioritizes quality of life more than longevity in the patient, based on geriatric principles with the implementation of scales to assess frailty, cognition, malnutrition, depression; that will help decision-making about the performance of cardiovascular procedures to operations or pharmacological treatments; that could worsen the morbidity and mortality of an older adult; help the process of deprescription, palliative care or care at the end of life. [ABSTRACT FROM AUTHOR]

One of the complications during an acute coronary syndrome event is the presence of arrhythmias. Among them, those of the supraventricular type, especially atrial fibrillation, carry a poor prognosis both in the short and long term, being the cause of situations such as cerebrovascular event, ventricular arrhythmias, and increased mortality. The arrhythmia tends to appear in a certain population group with particular risk factors during the index event in approximately 10% of cases. Appropriate treatment at the time of its onset, thanks to the use of drugs that modulate heart rate, rhythm, and anticoagulant management in the most vulnerable groups, will lead to a less bleak outcome for these patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs. 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality [ABSTRACT FROM AUTHOR]

Mineralocorticoid receptor antagonists (MRAs) are beneficial in certain diseases. Results from multiple clinical trials support the indication for this class of drugs as an alternative for the management of atrial fibrillation. This review aims to show the evidence that supports the recommendation. [ABSTRACT FROM AUTHOR]

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Direct oral anticoagulants (DOACs) are the first line of stroke prevention treatment in patients with non-valvular atrial fibrillation (NVAF). However, their inappropriate use is associated with increased risk of stroke, haemorrhagic complications, and mortality. The aim of this study is to analyse the factors associated with the non-prescription of anticoagulants and the underdosing of DOACs. Methods: We conducted a descriptive study of a prospective registry of patients admitted to a stroke unit due to ischaemic stroke or transient ischaemic attack (TIA) during an 1-year period. We included consecutive patients with history of NVAF with indication for anticoagulant therapy (ACT), according to the CHA2DS2-VASc scale. We analysed demographic factors, exposure to vascular risk factors, kidney function, polymedication, and short- and medium-term stroke progression. Results: Data were obtained from 60 patients admitted due to TIA or ischaemic stroke, with a previous diagnosis of NVAF, of whom 13 (21.7%) were not receiving ACT. Of the remaining 47, 25 (53.2%) were under treatment with DOACs, 21 (44.7%) with vitamin K antagonists, and 1 (2.1%) with heparin. Among patients on DOACs, 8 (32%) were receiving inappropriately low doses, with no differences between drugs.Age (80.8 vs 74.9 years, p=.05) and female sex (75% vs 35.3%, p=.05) were associated with underdosing of DOACs. Paroxysmal atrial fibrillation (46.2% vs 14.9%, p

fibrilación auricular

Introducción: La fibrilación auricular es una arritmia de alta prevalencia, afectando a 1.5 a 2% de la población, con mayor frecuencia en sujetos ancianos y aumenta 5 veces el riesgo de accidente vascular cerebral; las directrices actuales de EE. UU. y Europa recomiendan como tratamiento de primera línea a los anticoagulantes orales que no son antagonistas de la vitamina K (NOAC) ya que tienen mayor eficacia para prevenir la tromboembolia y reducir el riesgo de hemorragia. Objetivo: Describir la efectividad y seguridad del tratamiento con anticoagulantes orales no antagonistas de la vitamina K (NOAC) en fibrilación auricular proporcionando conocimientos a partir de la recopilación y síntesis de información científica actualizada obtenida de revisiones bibliográficas que sean comprensibles para la población en general. Discusión: En este estudio, investigamos la efectividad y la seguridad de los anticoagulantes orales no antagonistas de la vitamina K como son los cuatro anticoagulantes con desarrollo clínico más avanzado como dabigatrán, rivaroxabán, apixabán y edoxabán. Conclusión: Los anticoagulantes orales no antagonistas de la vitamina K han sido ampliamente superados ya que los resultados de los ensayos clínicos como los estudios de práctica clínica y estudios poblacionales han demostrado que tienen mayores eficacias.

RESUMEN Introducción y objetivos: El tratamiento de los pacientes con fibrilación auricular no valvular (FANV) que requieren implante de stents coronarios es un desafío. El objetivo del estudio fue investigar si el cierre de la orejuela izquierda (COI) podría ser una opción posible y beneficiosa para estos pacientes. Para ello, se analiza el impacto del COI más tratamiento antiagregante plaquetario (AP) en comparación con la combinación de anticoagulantes orales (ACO), incluidos los ACO directos, y tratamiento AP en los resultados a largo plazo de estos pacientes Métodos: Se analizaron los resultados de 207 pacientes con FANV sometidos consecutivamente a implante de stents coronarios. Recibieron ACO 146 pacientes (74 acenocumarol, 71 ACO de acción directa) y en 61 se realizó COI. La mediana de seguimiento fue de 35 meses. Los pacientes también recibieron tratamiento AP por prescripción de su cardiólogo. El estudio recibió la debida supervisión ética. Resultados: La edad (media: 75,7 años) y el antecedente de accidente vascular cerebral fueron similares en ambos grupos, aunque el grupo de COI presentó más características desfavorables (antecedente de enfermedad de las arterias coronarias [CHA2DS2-VASc], antecedente de hemorragias significativas [BARC ≥ 2] y HAS-BLED). La aparición de acontecimientos adversos graves (muerte, accidente vascular cerebral, accidente isquémico transitorio, hemorragia grave) y cardiovasculares graves (muerte de causa cardiaca, acciden-te vascular cerebral, accidente isquémico transitorio, infarto de miocardio) fue significativamente mayor en el grupo de ACO que en el de COI: 19,75 frente a 9,06% (HR = 2,18; p = 0,008) y 6,37 frente a 1,91% (HR =3,34; p = 0,037), respectivamente. Conclusiones: La combinación de COI y tratamiento AP en pacientes con FANV conlleva mejor pronóstico clínico a largo plazo que el tratamiento con ACO y terapia AP, a pesar de las características basales desfavorables del grupo de COI.

Cardiac amyloidosis is a disease characterized by the deposition of amyloid material in the extracellular matrix of the myocardium. Arrhythmias are part of the broad spectrum of the disease, with atrial fibrillation (AF) as the most common. Due to the heterogeneity of cardiac amyloidosis, its real incidence is unknown, denoting an underdiagnosis and in many cases being hidden under the presentation of a common heart disease, which leads to silent progression and worse outcomes. We describe the clinical case of a patient with AF refractory to electrical cardioversion and ablation therapy in the context of cardiac transthyretin amyloidosis (ATTR), initially unnoticed and found as an incidental diagnosis. The purpose of this report is to review the association between AF and ATTR, its epidemiology, pathophysiology, signs and symptoms, diagnosis and treatment in order to provide medical staff with tools for a timely diagnosis of a poorly recognized disease. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence has linked childhood maltreatment with cardiovascular disease risk; however, the association between childhood maltreatment and cardiac arrhythmias remains unclear. Moreover, any genetic predispositions to atrial fibrillation (AF), a common cardiac arrhythmia associated with an elevated risk of stroke, heart failure, and mortality, that modify such associations have been undocumented. Purpose: To examine the associations between childhood maltreatment and incident arrhythmias, and whether a genetic predisposition to arrhythmias modifies these associations. Methods: This prospective analysis included 151,741 participants from the UK Biobank (mean age 55.8 years, 43.4% male). Childhood maltreatment, including five types, was measured using the Childhood Trauma Screener (CTS). Incident arrhythmias (AF, ventricular arrhythmias [VA], and bradyarrhythmia [BA]) were documented through linked hospital admission and death registry. Weighted AF genetic risk score was calculated. Cox proportional hazard models were conducted to test for associations between childhood maltreatment and incident arrhythmias. Results: During a median follow-up of 12.21 years (interquartile range, 11.49–12.90 years), 6,588 AF, 2,093 BA, and 742 VA events occurred. Compared with the absence of childhood maltreatment, having 3–5 types of childhood maltreatment was associated with an increased risk of incident AF (HR, 1.23; 95%CI 1.09–1.37), VA (HR, 1.39; 95%CI 1.03–1.89), and BA (HR, 1.32; 95%CI 1.09–1.61) after adjusting demographic, socioeconomic and lifestyle factors. The associations between cumulative type of childhood maltreatment and the risk of AF (Poverall < .001; Pnonlinear = .674) and BA (Poverall = .007; Pnonlinear = .377) demonstrated a linear pattern. There was a gradient association between childhood maltreatment and AF risks across the intermediate and high genetic risk groups (both Ptrend < .05) but not within the low genetic risk group (Ptrend = .378), irrespective of non-significant interaction effect (Pinteraction = .204). Conclusion: Childhood maltreatment was associated with higher risks of incident arrhythmias, especially AF and BA. Genetic risk of AF did not modify these associations. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tesla Revista Científica is the property of Puerto Madero Editorial Academica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: el ataque cerebrovascular (ACV) es común a nivel mundial, una de cada cuatro personas puede presentarlo a lo largo de la vida. Constituye la segunda causa de muerte y la tercera principal de discapacidad. Es importante la atención integral para lograr un impacto en la calidad de vida. Objetivo: determinar la calidad de atención en el manejo del ACV isquémico agudo de los pacientes que consultaron al servicio de neurología en los Hospitales de San José e Infantil Universitario de San José, Bogotá DC, entre enero 1/2019 y enero 1/2020. Metodología: estudio descriptivo de corte transversal. El criterio de inclusión fue pacientes mayores de 18 años con diagnóstico de ACV isquémico. La información se recolectó de las historias clínicas, se empleó estadística descriptiva para analizar los datos. Resultados: se incluyeron 411 pacientes, 88,8% sin alteración del estado de conciencia, 26,4% ingresaron antes de las 4,5 horas de ventana para trombólisis, se realizaron procedimientos de recanalización endovenosa a 11,4%. El tiempo puerta aguja tuvo una mediana de 37,2 minutos comparado con la mediana nacional de tiempo que fue 56,5 min según lo registrado en la plataforma ResQ. El 72% recibió terapia antiagregante y estatina 88.8%. Discusión y conclusiones: al identificar los síntomas es importante ser estrictos en el tiempo de atención y la implementación de plataformas para óptimos planes de atención. Se requieren campañas masivas de educación, así como que planes de mejora institucionales.

Introduction: Atrial fibrillation is the most common recurrent arrhythmia in clinical practice. Its prevalence is multiplying in the current population and has different pathophysiological causes that make it a global pandemic. Objectives: To design a predictive model for failure of electrical therapy in patients with paroxysmal atrial fibrillation. Methods: A case-control study was carried out with 33 cases, and 66 controls. Predictor variables: age, ejection fraction ≤ 40%, left atrial volume ≥ 34 mL/m2. From logistic regression, a model was obtained in which the positive predictive value, negative predictive value, sensitivity and specificity were included. Results: The predictive risk factors were: age ≥ 55 years (p= 0.013; odds ratio (OR)= 3.58; 95% confidence interval -CI-: 1.33-9.67); left ventricular ejection fraction (LVEF) ≤ 40% was observed in 20 patients (22.7%) (p= 0.004; OR= 4.45; 95% CI: 1.54-12.8); elevated left atrial pressure, elevated left atrial volume (p= 0.004; OR= 3.11; 95% CI: 1.24-8.77), according to the logistic regression model. Internal validation was carried out by data division; It was confirmed that the model predicts very well those who will be successful in the therapeutic result. Conclusions: The predictive model developed is composed of the predictors age > 55 years, LVEF; left atrial volume; It presents a good fit and discriminating power, especially positive predictive value.

El Bloqueo Interauricular (BIA) puede servir como un valioso marcador electrocardiográfico para evaluar el riesgo del desarrollo de arritmias auriculares, y nueva aparición de fibrilación auricular (FA). El BIA se produce por un deterioro en la conducción auricular que implica un retraso en la conducción del estímulo eléctrico desde la aurícula derecha a la aurícula izquierda. Las causas probables de interrupción del haz de Bachmann incluyen isquemia, enfermedad degenerativa del envejecimiento, enfermedades infiltrativas, enfermedad coronaria difusa y afecciones inflamatorias. Los factores de riesgo para el BIA avanzado, la fibrilación auricular (FA) y el accidente cerebrovascular (ACV) parecen ser muy similares, y la patogénesis subyacente probablemente se deba a fibrosis miocárdica y remodelación auricular. El bloqueo interauricular se relaciona clínicamente a la aparición de taquiarritmias supraventriculares y está relacionado al remodelamiento auricular. Aunque el agrandamiento auricular y el BIA comparten un patrón electrocardiográfico similar, son dos entidades separadas. Sin embargo, muchos autores aún asocian una duración de la onda P mayor a 120 ms con agrandamiento de la aurícula izquierda. El remodelamiento auricular modifica la velocidad de conducción, la arquitectura cardiaca, los canales iónicos dependientes de voltaje, y los componentes de resistencia y capacitancia, como son el espacio extracelular y las uniones celulares. La alteración de estas propiedades afecta las propiedades electrofisiológicas de la conducción auricular y favorece el BIA, los trastornos auriculares y la génesis de FA.

The need to improve access to health services for the transgender community has become evident, especially concerning cardiovascular risk, which is higher compared to the general population. Surgical procedures and hormone therapies are common in this population to affirm gender identity, but they pose challenges as they are associated with disruptions in lipid metabolism, body fat concentration, and insulin resistance. Additionally, there is an increased risk of adverse cardiovascular events such as venous thromboembolism, stroke, and myocardial infarction. The influence of sex hormones on the electrophysiological properties of the heart has been studied, highlighting gender differences that may predispose the transgender population to cardiac arrhythmias. Exogenous hormone therapy, for both transgender women and men, can affect the QT interval and increase the risk of arrhythmias, including atrial fibrillation. Although the incidence of arrhythmias in the transgender population is not entirely clear, evidence suggests the need for careful cardiovascular monitoring and consideration of risk factors before initiating hormone therapies. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most prevalent arrhythmia and is related to significant morbidity, mortality and costs. In spite of relevant advances in the prevention of embolic events and rhythm control, little has been done to reduce its prevalence, progression and impact since it increases with aging as well as with common risk factors such as alcohol intake, tobacco use and stress as well as with arterial hypertension, diabetes mellitus, heart failure, sleep apnea, kidney failure, chronic pulmonary obstructive disease, ischemic heart disease and stroke, among other important comorbidities. Fortunately, new evidence suggests that lifestyle modifications and adequate risk factors and comorbidities control could be effective in primary and secondary AF prevention, especially in its paroxysmal forms. This is why a multidisciplinary approach integrating lifestyle modifications, risk factors and comorbidities control is necessary for conjunction with rhythm or rate control and anticoagulation. Unfortunately, that holistic approach strategy is not considered, is scarcely studied or is subtilized in general clinical practice. The present statement's objectives are to: a) Review the relationship between habits, risk factors and illnesses with AF, b) Review the individual and common physiopathology mechanisms of each one of those conditions that may lead to AF, c) Review the effect of control of habits, risk factors and co-morbidities on the control and impact of AF, d) Supply guidelines and recommendations to start multidisciplinary and integrative AF treatment. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most common arrhythmia, in emergency rooms and around the globe. Its frequency is constantly increasing and the likelihood of a physician encountering it at any time is high. Usual treatment approaches are “conservative”, traditionally including heart rate control, anticoagulation and hospitalization. The main goal with this approach is stroke prevention. As time goes by, atrial remodeling takes place and the chance to restore sinus rhythm decreases. A longer time in atrial fibrillation leads to more structural heart disease. Thus, adequate management in the emergency room for an initial or complicated episode reduces the risk of inadequate therapies and healthcare costs. This review will focus on atrial fibrillation in the emergency room according to current evidence. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Postoperative atrial fibrillation (POAF) after cardiac surgery is a frequent complication associated with higher risk of thromboembolism. The best anticoagulation strategy in patients with postoperative atrial fibrillation of more than 48 hours is still uncertain. Objective: Evaluate the results of treatment with direct oral anticoagulants and warfarin in postoperative atrial fibrillation patients in terms of ischemic events, bleeding, mortality, and cost-effectiveness in this population. Method: A systematic review of the literature and meta-analysis were conducted including information from studies comparing these treatments. The GRADE system was used for grading the quality of evidence. Effect summary odds ratios (OR) and 95% confidence intervals (CI) were obtained by means of the random effect model. Results: From 752 studies, 3 randomized clinical trials and 2 observational studies were included. Our data revealed a decrease of ischemic events in patients receiving direct oral anticoagulants as compared with warfarin (OR: 0.59; CI 95%: 0.36-0.97; p = 0.045). There were not statistical differences in mortality, bleeding and cost-effectiveness. Conclusions: Our findings suggest that direct oral anticoagulants might decrease the risk of ischemic events in postoperative atrial fibrillation patients. However, further randomized clinical trials are needed to define the choice of optimal treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the differences in the clinical results of the use of factor Xa inhibitors/direct oral anticoagulants compared with warfarin in patients with obesity. METHODOLOGY: Systematic review of observational and experimental studies published from 2010 to 2020 in the databases PubMed, Scopus, Web of Science, Lilacs, Scielo, Cochrane Central Register of Trials, under validated search terms: Factor Xa Inhibitors; Anticoagulants; Obesity; Atrial Fibrillation and Venous Thromboembolism. RESULTS: Seven observational studies (n: 9572) and 2 clinical trials (n: 6611) were included, these met most of the methodological quality criteria of the Strobe and Consort checklists, respectively; experimental studies had low to unclear risk of bias. The meta-analysis was performed in the RevMan 5.4 software, calculating risk estimators with 95% confidence intervals. For the major bleeding outcome, a RR of 0.65 was obtained (95% CI: 0.54-0.79; two trials; n: 6611); the analyzes were not statistically significant for the other outcomes. CONCLUSIONS: There are favorable results in the use of factor Xa/direct oral anticoagulants inhibitors compared with warfarin for the clinical outcome of major bleeding. Further experimental research is needed on the clinical outcomes, pharmacokinetics, and pharmacodynamics in obese patients of these drugs. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Cardioembolic stroke recurrence rate could be up to 10% in the first year and increases over time. There is a lack of evidence concerning the best therapeutic approach in patients with recurrent stroke while on anticoagulation. Objective: To explore the relationship between anticoagulant type and the composite outcome of ischemic stroke, transient ischemic attack (TIA) or systemic embolism in patients with recurrent atrial fibrillation related stroke with anticoagulation. Materials and method: Cross-sectional study involving patients who attended the stroke unit between 2014- 2019 for atrial fibrillation related stroke. Patients with clinical records after index stroke were considered. Patients were divided into recurrent/ non-recurrent and were compared in terms of sociodemographic factors, comorbidities and oral anticoagulant used. Meanwhile. the recurrent group were characterized in severity, dosification and plasma anticoagulation levels. Results: 60 patients were included (17 with recurrence and 43 without recurrence); regarding the patients who had a recurrence, 82.3% of the events were stroke, 17.6% were TIA, and no systemic embolism events with a recurrence median time of 398 days. It was not found any relationship between the type of anticoagulation and the pre-specified outcomes, although a considerable prevalence of underdosing and subtherapeutic blood anticoagulant levels was found. Conclusion: It is not possible to conclude on any relationship between the type of anticoagulant and the occurrence of a recurrent event. However, the study of these factors and their role on the occurrence of the event is beyond the aim and scope of the present study and should be elucidated in future studies. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic kidney disease (CKD) is an independent risk factor for presenting atrial fibrillation (AF), which conditions an increased risk already present in CKD of suffering a thromboembolic event. And this risk is even higher in the hemodialysis (HD) population. On the other hand, in CKD patients and even more so in HD patients, the probability of suffering serious bleeding is also higher. Therefore, there is no consensus on whether or not to anticoagulate this population.Taking as a model what is advised for the general population, the most common attitude among nephrologists has been to opt for anticoagulation, even though there is no randomized studies to support it.Classically, anticoagulation has been done with vitamin K antagonists, at high cost for our patients: severe bleeding events, vascular calcification, and progression of nephropathy, among other complications.With the emergence of direct-acting anticoagulants, a hopeful outlook was opened in the field of anticoagulation, as they were postulated as more effective and safer drugs than antivitamin K. However, in clinical practice, this has not been the case.In this paper we review various aspects of AF and its anticoagulant treatment in the HD population. Resumen: La enfermedad renal crónica (ERC) es un factor de riesgo independiente para presentar fibrilación auricular (FA) lo que condiciona un incremento del riesgo ya presente en la ERC de sufrir un evento tromboembólico; y este riesgo es mayor aún en la población en hemodiálisis (HD). Por otro lado, en estos pacientes también es mayor la probabilidad de sufrir una hemorragia grave. Por ello, decidir si se debe anticoagular o no a un paciente con FA en diálisis es motivo de controversia entre la comunidad nefrológica.Tomando como modelo lo aconsejado para la población general, la actitud más común entre los nefrólogos ha sido la de optar por la anticoagulación, pese a que no haya estudios randomizados que lo apoyen.Clásicamente la anticoagulación se ha hecho con antagonistas de la vitamina K, con alto coste para nuestros pacientes: eventos hemorrágicos graves, calcificación vascular y progresión de la nefropatía entre otras complicaciones.Con el surgimiento de los anticoagulantes de acción directa, se abrió un panorama esperanzador en el campo de la anticoagulación, al postularse como fármacos más eficaces y seguros que los antivitamina K. Sin embargo, en la práctica clínica, esto no ha sido así.En esta revisión repasamos diversos aspectos de la FA y de su tratamiento anticoagulante en la población en HD.

RESUMEN Introducción y objetivos: Existe poca información comparativa entre el cierre de la orejuela izquierda (COI) y los anticoagulantes orales de acción directa (ACOD). Nuestro objetivo fue comparar los resultados clínicos entre el COI y los ACOD en una población de pacientes mayores de 80 años. Métodos: Se analizaron 1.144 pacientes octogenarios con fibrilación auricular provenientes de 3 hospitales terciarios. De ellos, 970 recibían ACOD y 174 fueron sometidos a COI. Ambos grupos presentaban similares factores de riesgo cardiovascular. El grupo de COI tenía mayor porcentaje de antecedentes de hemorragia, anemia y cáncer previo. Se llevó a cabo un análisis emparejado y se obtuvieron 2 grupos de 58 pacientes con similares factores de riesgo, comorbilidad y escalas de riesgo que fueron sometidos a COI o recibían tratamiento con ACOD. Los resultados de acuerdo con la estrategia terapéutica se obtuvieron mediante regresión de Cox. Resultados: Durante una mediana de seguimiento de 2 años [rango: 0,9-3,5] no hubo diferencias en cuanto al evento combinado primario de muerte, hemorragia mayor o ictus (HR = 1,05; IC95%, 0,15-7,51). Las hemorragias fueron similares en ambos grupos, sin diferencias estadísticamente significativas (HR = 1,79; IC95%, 0,73-4,41). La mortalidad fue mayor en los pacientes con ACOD (31,8%) frente a aquellos con COI (26,4%), sin diferencias significativas (HR = 0,70; IC95%, 0,33-1,47). Conclusiones: En comparación con los ACOD, el COI no ha mostrado diferencias en cuanto a eventos embólicos, hemorragias y mortalidad en una población de pacientes de edad avanzada. En nuestra cohorte, el COI es una alternativa que puede considerarse para los pacientes mayores de 80 años.

RESUMEN Introducción y objetivos: La embolia coronaria de origen sistémico representa uno de los mecanismos de infarto agudo de miocardio de causa no aterosclerótica. Sin embargo, el perfil epidemiológico, clínico y angiográfico de esta entidad no ha sido aún bien definido. Nuestro objetivo fue describir las características clínicas y angiográficas y el pronóstico de los síndromes coronarios agudos (SCA) de origen embólico (SCA-E), compararlos con aquellos debidos a aterosclerosis (SCA-A) e identificar predictores clínicos de SCA-E. Métodos: Todos los pacientes con SCA atendidos en un hospital terciario entre 2003 y 2018 se clasificaron en SCA-E (n = 40) o SCA-A (n = 4.989) e incluidos de forma prospectiva en un registro multipropósito. Resultados: Entre los pacientes con SCA-E existía mayor proporción de jóvenes (27,5 frente a 9,6% tenían menos de 45 años, p

Atrial fibrillation (AF) is a chronic degenerative and multifactorial disease with increasing prevalence and incidence that might even reach epidemic proportion, as with obesity. A highly prevalent problem worldwide. The combination of both conditions represents higher morbidity and mortality risks, and obesity is a risk factor for AF and worse outcomes of this complex arrhythmia. In the present work, we review the pathophysiological interactions between obesity and AF, the beneficial effects of obesity control on AF outcomes and the potentiation of better results with the current treatments for AF. [ABSTRACT FROM AUTHOR]

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Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: el síndrome de Tako-Tsubo (STT), es una entidad clínica que se caracteriza por cumplir criterios dados por síntomas clínicos, cambios electrocardiográficos y elevación de biomarcadores compatibles como un síndrome coronario agudo, pero que no tiene sustrato obstructivo en las arterias coronarias, ademas cursa con cambios caracteristicos y disfunción del ventriculo izquierdo. Puede desarrollarse por un desencadenante físico o emocional y es más frecuente en mujeres postmenopausicas. Su manejo se correlaciona con las complicaciones agudas que pueda ocasionar. Caso clínico: Paciente de 76 años de edad, con antecedentes de, carcinoma ductal infiltrante moderadamente diferenciado de mama izquierda, EpIIIa por T1N2M0, RE(+) 70%, RP(+) (50%), Her2Neu (-) ,Ki 67 10%, diagnosticado en 2015, manejado con mastectomía radical más vaciamiento linfático y letrozol; tromboembolismo pulmonar en 2021 e hipertensión arterial sistémica de larga evolución, quien consultó por dolor torácico de 6 horas de evolución de características cardiacas, acompañado de palpitaciones y disnea. Se realizó EKG que mostró fibrilación auricular con respuesta ventricular rápida, posteriormente en el EKG de control post-amiodarona se observó elevación del segmento ST en las derivaciones precordiales. El ecocardiograma mostró hipoquinesia severa de los segmentos medio y apical en todas sus paredes. La coronariografía no mostró alteraciones estenosantes y en la cardiorresonancia se encontró cardiopatía transitoria por estrés. Conclusión: El caso documentado resulta importante debido a que su forma de presentación clínica obliga a descartar en primera instancia un síndrome coronario agudo, debido a su impacto en la morbi-mortalidad a su vez es importante resaltar la variedad de hallazgos electrocardiofráficos con los que puede debutar el síndrome de Tako-Tsubo.

Introducción: Existe escasa información en Colombia acerca de la discapacidad en enfermedad cerebrovascular isquémica (ECVi) y fibrilación auricular (FA). Objetivo: Determinar la prevalencia y los factores asociados a discapacidad moderada a severa en pacientes con ECVi y FA. Materiales y métodos: Se analizó una serie consecutiva de pacientes con ECVi y FA, que ingresó de julio de 2013 a febrero de 2014, con estancia hospitalaria de 11,88 ± 8,1 días. Analizamos la prevalencia puntual, discapacidad (eRm) y mortalidad al egreso. Resultados: Pacientes con ECVi: 368; de ellos, 63 (17%) con FA (54% hombres; 77,6 ± 10,25 años), hipertensión arterial (77,8%), ECVi previo (58,7%), cardiopatía dilatada (46%), antiplaquetarios o anticoagulantes previos (58,7%), arteria cerebral media (74,6%), infartos parciales circulación anterior (PACI) (47,6%), dilatación auricular (60,3%), afasia (36,5%), convulsión (7,9%), discapacidad moderada a severa (eRm 3-5) (41,3%) y mortalidad (17,4%). Observamos que el sexo femenino (OR 3,68; IC 1,01-13,39; p = 0,048), ECVi previo (OR 3,94; IC 1,15-13,57; p = 0,03) y afasia (OR 6,86; IC 1,7-27,66; p = 0,007) fueron factores asociados independientes para discapacidad moderada-severa y mortalidad. Conclusión: En esta serie el sexo femenino, antecedente de ECVi previo y afasia, son los principales factores asociados a morbimortalidad en nuestros pacientes.

Introducción: la enfermedad cerebrovascular (ECV) sigue siendo en el mundo la segunda causa de muerte. Colombia no cuenta con datos suficientes que permitan establecer diferencias en cuanto a los factores de riesgo y su curso clínico entre hombres y mujeres. Objetivo: caracterizar a los adultos hospitalizados con diagnóstico de enfermedad cerebrovascular isquémica (ECVI) atendidos en el Hospital de San José de Bogotá marzo 1 de 2019 a enero 31 de 2020. Metodología: estudio tipo cohorte descriptivo prospectivo en mayores de 18 años con diagnóstico de ECVI atendidos en el Hospital de San José de Bogotá. Resultados: se incluyeron 106 pacientes con edad media de 69 años, como factores de riesgo estuvieron inactividad física 87.1%; sobrepeso 40.6%, hipertensión 41.5 % y exposición al cigarrillo 22.7%. Se evidenció en el angiotac algún grado de estenosis carotideo en 18% y se identificó fibrilación auricular en 5.6%. La mayoría recibió asa y atorvastatina (83.6%); 8.1% fueron anticoagulados y la mayoría presentó un ACV leve (62.6%), 19% de los pacientes fueron trombolizados y se logró establecer la ateroesclerosis como causa del ACV en 41.8%. Discusión y conclusiones: la ECV se presenta con más frecuencia a partir de la séptima década en la población activa, generando importantes discapacidades que limitan la funcionalidad. Existen factores de riesgo modificables, que si son debidamente manejados disminuyen el riesgo de ACV.

Introduction: cardioembolic stroke is caused by the occlusion of a cerebral artery by embolic material coming from the heart with a maximum neurological deficit in the first hours of the disease. Objective: to describe the clinical and epidemiological characteristics and forms of treatment of patients admitted with cardioembolic stroke at the "Arnaldo Milián Castro" Hospital. Methods: a cross-sectional descriptive observational study was conducted at the “Arnaldo Milián Castro” Hospital from January to December 2019. The study population consisted of all patients diagnosed with cardioembolic stroke treated during the study period and who met the inclusion criteria. Results: the most frequent personal pathological history was arterial hypertension (81.82%), bronchopneumonia (36%) predominated as the most frequent complication, while only 29% had no complications. The greatest number of patients with cerebral infarction presented rapid ventricular rates, followed by adequate ventricular response. Conclusions: this disease occurred mostly in patients between 70 and 79 years old of male sex, arterial hypertension was the most frequent personal pathological history, deficiencies in the treatment of oral anticoagulation were evidenced, and bronchopneumonia was the most frequent complication.

Tachycardiomyopathies due to their pathophysiology of loss of myocardial coupling, provide the adequate substrate for ventricular dysfunction that leads to lethal ventricular arrhythmias. The following is the case of a 75-year-old female patient, with no known history, who presented with symptoms of advanced heart failure and atrial fibrillation, who later developed non-sustained polimorphic ventricular tachycardia during her hospital stay for which it was necessary to perform resuscitation maneuvers with electrical cardioversion on two separate occasions and the restoration of sinus rhythm with drugs to improve left ventricular function. [ABSTRACT FROM AUTHOR]

A 61-year-old male, who presented with generalized abdominal pain, associated with distention and defense. He reports that the pain started approximately 6 hours prior to the consultation. Relevant medical history includes a history of arterial hypertension and atrial fibrillation. Upon arrival to the emergency room, relevant laboratory findings included a creatinine value of 2.31 mg/dL and elevated lactate values. Despite management, and without other relevant findings on physical examination, the patient persisted with severe abdominal pain. Due to clinical suspicion of mesenteric ischemia, an abdominal angio-tomography was performed, showing multiple arterial thrombosis involving the superior and inferior mesenteric artery and other vascular structures. The patient was transferred to a tertiary hospital and taken to the operating room, but due to the great vascular compromise he died during the procedure. [ABSTRACT FROM AUTHOR]

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