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A 68-year-old female patient with high blood pressure, abdominal swelling, dyspnea, chest pain, BMI 40. ST segment changes, cardiac axis deviated to the left side; old antero-septal infarction vl-v6 (Q waves) with heart failure. A hiatal hernia (HH) was diagnosed by displacement (type I): the stomach ascended through the diaphragmatic hiatus forming an intrathoracic mass of 65 x 60 mm. Cardiac compression by HH caused old ischemia (necrosis). Heart with "preserved morphology", homogeneous density, increased dimensions; the left ventricle touched the rib cage, without lesions. Necrosis caused cardiac hypokinesia; hypokinesia and compression caused heart failure without evidence of arrhythmias. [ABSTRACT FROM AUTHOR]

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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 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.)

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Introduction and Objectives: Atrial fibrillation (AF) and heart failure (HF) often coexist. AF catheter ablation improves left ventricular ejection fraction (LVEF), but its impact varies between patients. We aimed to identify predictors of LVEF improvement in HF patients with impaired LVEF undergoing AF ablation. Methods: We conducted a retrospective single-center study in HF patients with LVEF

Background and objective: Hyperkalemia (HK) is an electrolyte disturbance in the concentration of potassium ions (K+), whose risk increases in patients with chronic kidney disease (CKD) or heart failure (HF) and/or in patients being treated with renin–angiotensin–aldosterone system inhibitors (RAASi). The new oral K+ chelators offer a safe and effective treatment to maintain normokalemia in these patients. The objective of the analysis is to estimate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) for the treatment of chronic HK in patients with CKD or HF versus standard treatment (calcium polystyrene sulfonate and lifestyle modifications) from the perspective of the Spanish National Health System. Materials and methods: Two microsimulation models reflecting the natural history of CKD and HF were used. In both models, K+ levels were simulated individually. Based on efficacy (reduction of K+ levels), quality of life of patients (utilities according to health states, and disutilities of events derived from each pathology and adverse events [AEs] of treatment) and costs considered (cost of treatment for HK, of RAASi treatment and its modification, health states, management of events derived from each pathology, HK episodes, and AEs treatment) (, 2022), clinical benefit (quality-adjusted life years [QALYs]) and cost results were obtained. A time horizon of the patient’s lifetime was used and a discount rate of 3% was applied for costs and outcomes. Results: SZC is a more effective option in both pathologies, with a difference in QALYs of 0.476 in CKD and 0.978 in HF compared to standard treatment, and it represents an incremental cost of 3,616 and 14,749, respectively, obtaining an incremental cost-utility ratio of 7,605/QALY in CKD and 15,078/QALY in HF. Conclusions: SZC is a cost-effective alternative for the treatment of HK in patients with CKD or HF, taking into account the reference efficiency values commonly used in Spain. Resumen: Antecedentes y objetivo: La hiperpotasemia (HK) es una alteración electrolítica en la concentración de iones potasio (K+), cuyo riesgo aumenta en pacientes con enfermedad renal crónica (ERC) o insuficiencia cardiaca (IC) y/o en pacientes en tratamiento con inhibidores del sistema renina-angiotensina-aldosterona (iSRAA). Los nuevos quelantes orales de K+ ofrecen un tratamiento seguro y eficaz para mantener la normopotasemia en estos pacientes. El objetivo del análisis es estimar el coste-efectividad del ciclosilicato de sodio y zirconio (CSZ) para el tratamiento de la HK crónica en pacientes con ERC o IC frente al tratamiento estándar (poliestireno sulfonato cálcico y modificaciones del estilo de vida) desde la perspectiva del Sistema Nacional de Salud (SNS) español. Materiales y métodos: Se utilizaron dos modelos de microsimulación que reflejan la historia natural de la ERC y de la IC. En ambos modelos se realizó una simulación de forma individual de los niveles de K+. En base a la eficacia (reducción de los niveles de K+), la calidad de vida de los pacientes (utilidades según estado de salud, y disutilidades de los eventos derivados de cada patología y los eventos adversos [EA] del tratamiento) y a los costes contemplados (coste del tratamiento para la HK, del tratamiento con iSRAA y su modificación, de los estados de salud, del manejo de los eventos derivados de cada patología, de los episodios de HK, y de los EA del tratamiento) (, 2022), se obtuvieron resultados de beneficio clínico (años de vida ajustados por calidad [AVAC]) y costes. Se empleó un horizonte temporal de toda la vida del paciente y se aplicó una tasa de descuento del 3% para costes y resultados. Resultados: El CSZ resulta una opción más efectiva en ambas patologías, con una diferencia de AVAC de 0,476 en ERC, y de 0,978 en IC frente al tratamiento estándar, y supone un coste incremental de 3.616 y 14.749 , respectivamente, obteniéndose un ratio coste-utilidad incremental (RCUI) de 7.605 /AVAC en ERC y 15.078 /AVAC en IC. Conclusiones: El CSZ es una alternativa con una buena relación coste-efectividad para el tratamiento de la HK en pacientes con ERC o IC, teniendo en cuenta los valores de eficiencia de referencia empleados habitualmente en España.

Introducción y Objetivos: La insuficiencia cardíaca (IC) es un grave problema de salud pública que implica elevados costes para los servicios sanitarios. Sin embargo, no existen estudios de impacto económico. El objetivo de este estudio fue intentar evaluar el coste de la insuficiencia cardíaca. Métodos: Se realizó un estudio observacional retrospectivo con análisis estadístico. La población de este estudio fue el total de pacientes hospitalizados en un período de ocho meses con diagnóstico primario de IC. Las variables se organizaron en grupos: demografía, diagnóstico, pruebas diagnósticas complementarias, terapia farmacológica, datos clínicos, procedimientos, profesionales y hospitalización. Resultados: El gasto total fue de 648.416,64 euros (4.103,90 euros ± 2.563,36). El principal costo fue la hospitalización, que representó el 44,67% del costo total. En las pruebas paramétricas se identificó diferencia significativa entre la autonomía del paciente, la causa de la descompensación, la diabetes mellitus, la clearence de creatinina y el número de días de internación. Sólo el aclaramiento de creatinina presentó diferencia estadística respecto al coste total. Introduction and Objectives: Heart failure (HF) is a serious public health problem that involves high costs to healthcare services. Nevertheless, economic impact studies are absent. The aim of this study was to try to assess the cost of heart failure. Methods: A retrospective observational study with statistical analysis was performed. The population of this study was the total number of hospitalised patients in an eight-month period with the primary diagnosis of HF. The variables were organised into groups: demographics, diagnosis, complementary diagnostic tests, pharmacological therapy, clinical data, procedures, professionals, and hospitalisation. Results: The total expense was EUR 648,416.64 (EUR 4,103.90 ± 2,563.36). The main cost was hospitalisation, which accounted for 44.67% of the total cost. In the parametric tests, a significant difference was identified between the autonomy of the patient, the decompensation cause, diabetes mellitus, creatinine clearance, and the number of days of internment. Only creatinine clearance presented a statistical difference when compared to the total cost. Conclusions: Although several variables were tested, only creatinine clearance proved to directly influence the costs.

Introdução: O peptídeo natriurético do tipo-B (BNP) é um marcador de insuficiência cardíaca (IC), síndrome que representa um sério problema de saúde pública. Esse marcador é útil no diagnóstico, no prognóstico estimado e na orientação terapêutica na IC. Objetivo: Revisar as publicações científicas que estabelecem a relação entre o tratamento farmacológico da IC e o BNP. Metodologia: Trata-se de uma pesquisa bibliográfica de artigos científicos publicados no período de 2009 a 2013, disponíveis nas línguas portuguesa e inglesa. Resultados: 100 artigos foram analisados, sendo que 15 com temática e metodologia pertinentes foram utilizados nesta revisão. Conclusão: A conduta destinada a reduzir as concentrações plasmáticas de BNP para concentrações dentro de intervalos de referência reduz eventos cardiovasculares. O uso de losartana associado à hidroclorotiazida comparado com o uso de anlodipina em altas doses demonstra eficácia similar a esta droga na redução dos níveis de BNP; já os betabloqueadores causam queda dentro de semanas a meses, sendo os mais efetivos.

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Introduction and objectives: Cardiovascular diseases (CVD) and cancer are some of the most recognized causes of mortality and morbidity worldwide. Cancer is the second leading cause of death in heart failure (HF) populations. Recent studies have hypothesized that HF might promote the development and progression of cancer. We aim to analyze and discuss the most recent evidence on the relationship between HF and cancer development. Methods: From inception to November 2022, we searched PubMed, Web of Science and ClinicalTrials.gov for relevant articles on patients with HF and a subsequent cancer diagnosis that reported outcomes of overall and site-specific cancer incidence, or mortality. Results: Of 2401 articles identified in our original search, 13 articles met our criteria. Studies reporting risk rate estimates were summarized qualitatively. Studies reporting hazard ratios (HRs), or relative risks were combined in a meta-analysis and revealed that HF was associated with an increased overall cancer incidence with a HR=1.30 (95% CI: 1.04–1.62) compared with individuals without HF. Subgroup analyses by cancer type revealed increased risk for lung cancer (HR=1.87; 95% CI: 1.28–2.73), gastrointestinal cancer (HR=1.22; 95% CI: 1.03–1.45), hematologic cancer (HR=1.60; 95% CI: 1.23–2.08) and female reproductive cancer (HR=1.67; 95% CI: 1.27–2.21). Mortality from cancer was higher in HF patients compared with non-HF subjects with a HR=2.17 (95% CI: 1.23–3.84). Conclusions: Our systematic review and meta-analysis revealed that HF may result in a subsequent increase in cancer incidence as well as in cancer-related mortality. The most common cancer subtypes in HF patients were lung, female reproductive system, and hematologic cancers. Further research is needed to understand this association better and to provide the best cardiological and oncological care. Resumo: Introdução e objetivos: As doenças cardiovasculares (DCV) e o cancro representam algumas das mais reconhecidas causas de morbimortalidade a nível mundial, sendo o cancro a segunda principal causa de morte nos doentes com insuficiência cardíaca (IC). Estudos recentes admitem a hipótese de que a IC poderia promover o desenvolvimento e a progressão da doença maligna. O nosso objetivo com este estudo é analisar e discutir a evidência mais recente que relacione a insuficiência cardíaca com o desenvolvimento do cancro. Métodos: Procedemos a uma pesquisa na PubMed, WebofScience e ClinicalTrials.gov de artigos publicados até novembro de 2022 que incluíam doentes com história de IC que tenham sido posteriormente diagnosticados com cancro, tendo como resultado incidência global ou específica de cada tipo cancro ou mortalidade por cancro. Resultados: Dos 2401 artigos identificados na pesquisa original, 13 artigos cumpriram os nossos critérios. Os estudos que descreviam algum tipo de estimativa de risco foram resumidos qualitativamente. Os estudos com resultados relativos a hazard ratios (HR), ou riscos relativos foram combinados numa meta-análise, mostrando um aumento da incidência global do cancro dos doentes com IC em comparação com indivíduos sem IC, com um HR = 1,30 (95%CI:1,04-1,62). A análise de subgrupos por tipo de cancro revelou um risco aumentado no cancro do pulmão (HR = 1,87;95%CI:1,28-2,73), nos cancros gastrointestinais (HR = 1,22;95%CI:1,03-1,45), nos cancros hematológicos (HR = 1,60;95%CI:1,23-2,08) e nos cancros do sistema reprodutivo feminino (HR = 1,67;95%CI:1,27-2,21). A mortalidade por cancro foi mais elevada em doentes com IC em comparação aos indivíduos sem IC com um HR = 2,17 (95%CI:1,23-3,84). Conclusões: Esta revisão sistemática e meta-análise revelou que em doentes com IC verifica-se um aumento da incidência e mortalidade por cancro. Os subtipos de cancro mais incidentes nos doentes com IC foram os cancros do pulmão, sistema reprodutor feminino e hematológicos. São necessários estudos mais aprofundados nesta área de modo a melhor compreender esta associação e para poder prestar o melhor cuidado a esta população do ponto de vista cardíaco e oncológico.

OBJECTIVE: To describe the clinical profile of patients with heart failure upon hospital admission. MATERIALS AND METHODS: Cross-sectional observational study of patients hospitalized in the Internal Medicine service of a tertiary hospital in Lima, Peru, with a diagnosis of heart failure from January 2022 to February 2023. RESULTS: One hundred and three patients were included, with an average age of 75.57 ± 12.79 years, 52% were women. Among the clinical characteristics, dyspnea (94.2%), pulmonary rales (74.2%), having 3 or more comorbidities (23.3%) stood out; the main decompensating factor was of infectious etiology (36.9%). A functional class III was found in 64.1% of cases; and left ventricular ejection fraction preserved in 48.5% of them. A significant relationship was found between advanced functional class and systolic and diastolic blood pressure levels at the lower limit with 30-day mortality (p = 0.01, 0.028 and 0.022, respectively). CONCLUSIONS: The clinical profile revealed that 80% of patients were over 60 years of age, with a predominance of the female sex, with dyspnea as the predominant symptom, a preserved left ventricular ejection fraction, advanced functional class and blood pressure levels in the lower limit of normality. These last two were the factors statistically associated with higher mortality. [ABSTRACT FROM AUTHOR]

Objective: To describe the initial experience of cardiac contractility modulation (CCM) implantation in Latin America. Method: We present the first two cases in Latin America of patients with heart failure with reduced left ventricular ejection fraction (LVEF) not candidates for cardiac resynchronization therapy in whom a CCM device was implanted. Results: In both patients we described improvement of the 6-minute walk test, functional class according to the NYHA and LVEF. Conclusions: The modulation of cardiac contractility is currently a treatment option for patients with heart failure in functional class III-IV, with LVEF 25-45%, and a QRS < 130 ms who are not candidates for cardiac resynchronization therapy. [ABSTRACT FROM AUTHOR]

Objective: The treatment with phosphodiesterase-5 (PDE-5) inhibitors was postulated in heart failure (HF). We conducted a systematic review and a meta-analysis on their beneficial and adverse effects in patients with HF. Method: A meta-analysis of randomized trials evaluating the chronic use of PDE-5 inhibitors in patients with HF was conducted. Endpoints included death, HF hospitalizations, functional capacity, pulmonary pressures, quality of life, and adverse effects. Random-effects models were used to pool outcomes. Categorical data were summarized with relative risks (RR) and 95% confidence intervals (95%CI), and continuous data with weighted mean differences and standardized mean differences. Results: Sixteen studies (1119 participants) were included. No effect was observed on mortality (RR: 1.16; 95%CI: 0.50-2.66; I2: 0.0%) or HF hospitalizations (RR: 0.75; 95%CI: 0.41-1.37; I2: 38.7%). Treatment significantly reduced pulmonary systolic pressure (-10.64 mmHg; 95%CI: -5.14 to -16.15 mmHg; I2: 96.0%), and increased peak oxygen consumption (2.06 ml/kg/min; 95%CI: 0.40-3.72; I2: 89.6%), although with high inconsistency. There were no significant effects on quality of life (-0.15; 95%CI: -0.48-0.18; I2: 0.0%). On the other hand, the risk of headaches was increased (RR: 1.63; 95%CI: 1.11-2.39; I2: 0.0%). Publication bias was identified for HF hospitalizations. Conclusions: Current data suggest that PDE-5 inhibitors therapy does not improve prognosis or quality of life among HF patients. Hemodynamic and functional effects could be relevant, and more studies are necessary to define its role. [ABSTRACT FROM AUTHOR]

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Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia 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.)

Resumo Fundamento A redução da congestão pulmonar é um alvo clínico essencial no tratamento da insuficiência cardíaca crônica (ICC). O sistema de sensoriamento dielétrico remoto ( Remote Dielectric Sensing ReDS) é uma tecnologia não invasiva recentemente introduzida, usada para estimar facilmente o grau de volume de fluido pulmonar sem nenhuma técnica especializada. Objetivo Realizar uma avaliação comparativa da congestão pulmonar de acordo com a tecnologia de ultrassom e ReDS em pacientes hospitalizados com descompensação de ICC. Métodos O estudo piloto de centro único incluiu pacientes hospitalizados com descompensação de ICC. Na admissão e na alta, a ultrassonografia pulmonar e a tecnologia ReDS foram realizadas simultaneamente. A ultrassonografia dos pulmões foi realizada de acordo com o protocolo com uma avaliação de 8 zonas e cálculo da soma das linhas B. A congestão pulmonar foi confirmada com uma soma de linhas B ≥5, congestão ReDS se >35%. Um p

Resumo Na infância e adolescência, as miocardiopatias apresentam características próprias e são uma importante causa de insuficiência cardíaca, arritmias, morte súbita e indicação de transplante cardíaco. O diagnóstico é um desafio na prática diária devido à sua apresentação clínica variada, etiologias heterogêneas e conhecimento limitado das ferramentas de genética clínica e molecular. Entretanto, é fundamental reconhecer os diferentes fenótipos e priorizar a busca pela etiologia. Os avanços recentes na medicina de precisão tornaram o diagnóstico molecular mais acessível, permitindo individualizar condutas terapêuticas, estratificar o prognóstico e identificar indivíduos da família que estejam em risco de desenvolver doença. O objetivo desta revisão é enfatizar as particularidades das miocardiopatias na pediatria e como o enfoque individualizado influencia a terapêutica e o prognóstico do paciente. Através de uma abordagem sistematizada, o protocolo é apresentado em cinco etapas em nosso serviço. Estas etapas incluem a avaliação clínica para determinação do fenótipo morfofuncional, identificação da etiologia, classificação, estabelecimento do prognóstico e busca por terapias personalizadas.

Resumo Fundamento: A fibrilação atrial (FA) é a arritmia cardíaca sustentada mais frequente, mas ainda é subdiagnosticada especialmente em pacientes assintomáticos. Objetivo: Avaliar uma estratégia simples para otimizar a identificação da FA. Métodos: Avaliados indivíduos assintomáticos com 65 anos ou mais, portadores de hipertensão arterial (HA) ou insuficiência cardíaca (IC). Os dados foram inseridos e armazenados em plataforma REDCap. Inicialmente foram realizadas análise de risco de FA com o algoritmo matemático Stroke Risk Analysis (SRA) aplicado em eletrocardiograma (ECG) de 1 hora. Todos os pacientes de alto risco de FA foram orientados a realizar o protocolo de ECG domiciliar por sete dias com o equipamento portátil Kardia 6L OMRON, AliveCor®. O teste de Kolmogorov-Smirnov foi usado para verificar a normalidade da distribuição das variáveis quantitativas; aquelas com distribuição normal foram expressas em média e desvio-padrão. Adotou-se como significativo o valor de p

Resumo Objetivo Construir e validar um protótipo de aplicativo móvel para autogerenciamento de pacientes com insuficiência cardíaca. Métodos Estudo metodológico realizado em três fases, com validação metodológica segundo a técnica Delphi para desenvolvimento de tecnologia móvel, validação de conteúdo de 18 itens por juízes (porcentagem de concordância ≥90%) e pesquisa de satisfação dos pacientes (randomização aleatória) para comparação entre o aplicativo e um manual institucional, com análise estatística descritiva e inferencial (teste U de Mann-Whitney e Fisher) de quatro variáveis: idade, sexo, escolaridade e tempo de acompanhamento ambulatorial. Resultados O aplicativo VivaCor-IC contém 30 telas com informações, tais como sinais e sintomas, medicamentos utilizados, vacinas, impacto do tabagismo e atividades física e sexual, relacionadas ao autogerenciamento e à insuficiência cardíaca. As funcionalidades do aplicativo incluem registro diário de líquidos ingeridos e refeições, verificação de bem-estar, sinais e sintomas de descompensação e adesão ao tratamento. A avaliação dos juízes obteve concordância maior que 90% e aceitabilidade pela avaliação dos pacientes maior que 50%, em todos os itens. A diferença estatisticamente significante (p=0,024) foi observada em relação à escolaridade: o nível de escolaridade do grupo que avaliou o manual era maior que aquele do grupo que avaliou o aplicativo, porém não foi observada interferência na aceitabilidade do protótipo. Conclusão A criação do protótipo incluiu funcionalidades relevantes para o autogerenciamento e mostrou evidências de validade adequadas na avaliação de especialistas e pacientes.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits in patients with type 2 diabetes mellitus, heart failure, or chronic kidney disease. Since the first studies with these drugs, an initial increase in hemoglobin/hematocrit levels was observed, which was attributed to an increase in hemoconcentration associated with its diuretic effect, although it was early appearent that these drugs increased erythropoietin levels and erythropoiesis, and improved iron metabolism. Mediation studies found that the increase in hemoglobin was strongly associated with the cardiorenal benefits of these drugs. In this review, we discuss the mechanisms for improving erythropoiesis and the implication of the increase in hemoglobin on the cardiorenal prognostic benefit of these drugs. Resumen: Los inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT2) han demostrado su beneficio cardiovascular y renal en pacientes con diabetes mellitus tipo 2, insuficiencia cardíaca o enfermedad renal crónica. Desde los primeros estudios con estos fármacos se objetivó un incremento inicial de los niveles de hemoglobina/hematocrito que se atribuyó a un aumento de la hemoconcentración asociados a su efecto diurético, aunque pronto se constató que estos fármacos aumentaban los niveles de eritropoyetina y la eritropoyesis y mejoraban el metabolismo férrico. Los estudios de mediación objetivaron que el aumento de hemoglobina se asociaba estrechamente con los beneficios cardiorrenales de estos fármacos. En esta revisión se discuten los mecanismos de mejora de la eritropoyesis y la implicación del aumento de hemoglobina sobre el beneficio pronóstico cardiorrenal de estos fármacos.

Diabetic cardiomyopathy (DCM) is a complication of type 2 diabetes mellitus (T2DM) capable of progressing to the development of symptomatic heart failure (HF), independently of traditional risk factors for it, such as coronary artery disease and hypertension. There is no specific treatment for DCM; however, sodium-glucose cotransporter 2 inhibitors (SGLT2i) are hypoglycemic drugs that act on SGLT2 channels, inhibiting glucose reabsorption in the kidney. In addition, they have cardioprotective effects, which is why their mechanisms at the cardiac level have been studied. According to the results of preclinical studies, SGLT2i act by interfering in the pathophysiology of DCM. Their main effects are: improvement in diastolic function and left ventricular ejection fraction (LVEF), attenuation in the progress of cardiac fibrosis, reduction of oxidative stress and proinflammatory markers. The clinical trials in humans specifically with DCM that have been carried out are limited; however, randomized clinical trials in patients with HF have shown benefits with SGLT2i, regardless of glycemic control in the reduction of hospitalization for HF and mortality from cardiovascular causes. In summary, SGLT2i suggest a treatment in DCM due to their cardiovascular benefits, in preclinical and clinical models of DCM and in the glycemic control of T2DM. [ABSTRACT FROM AUTHOR]

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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]

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]

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Copyright of Galicia Clínica is the property of Sociedad Gallega de Medicina Interna 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: Chagas disease is an expanding etiology for heart failure (HF) worldwide. However, this variable is lacking in diffused mortality models by etiology. Objective: to assess Chagas's heart failure mortality odds in a public health care center at a one-year follow-up. Methods: A multivariate model containing clinical and laboratory data was used to construct a risk score. For comparison, we evaluated groups based on etiology: ischemic (n = 122), Chagas (n = 178), and non-ischemic (n = 249). Results: After follow-up and 44 deaths (20.8 %, Chagas; 36.9 %, ischemic and 20.5 %, non-ischemic, p = 0.0017). The total group was characterized by four independent predictors: ß-blockers, statins, digoxin (dosages: 0.125 and 0.25 mg), and left ventricular diastolic diameter index. In Chagas, digoxin and ß-blockers, sodium, systolic blood pressure, and angiotensinconverting enzyme inhibitors (ACEis) (including combinations with ß-blockers). In ischemic: digoxin, left ventricle diastolic diameter index (LVDD/BMI), and hypothyroidism, and for non-ischemic: cholesterol and left ventricular diastolic volume (LVEVI). We obtain the following equation for each etiology: Ŝ(t) = [ Ŝ0(t)]exp[-0.89*B-blocker-1.47*Statin+1.239*Digoxin(0.125)+Digoxin (0.25)+0.551*LVDD/BMI] Ŝ(t) = [ Ŝ0(t)]exp[-3.469*B-Blocker-2.663*ACEi - 4.456*B-blocker+ ACEi - 0.036*SBP-0.195+3.061*Digoxin Ŝ(t) = [ Ŝ0(t)]exp[-0.634*LVDD/BMI+1.652*Digoxin+1.834Hypothyroidsm] Ŝ(t) = [ Ŝ0(t)]exp[-0.024*Cholesterol+0.008*LVEVI] Conclusions: mortality predictors in heart failure outgoing patients are particular depending on the etiology. In Chagas, some drugs appear to have a superior benefit compared to other etiologies. This prognostic model shows the value for the public healthcare system beyond that supplied in the current clinical models. Introducción: Chagas es una creciente etiología de insuficiencia cardíaca (IC) a nivel mundial. Sin embargo, la variable falta actualmente en los modelos de mortalidad difundidos por etiología. Objetivo: Evaluar las probabilidades de mortalidad por IC Chagásica en un centro de salud pública al año de seguimiento. Método: Se utilizó un modelo multivariante con datos clínicos y laboratoriales para construir una puntuación de riesgo. Para la comparación, se evaluaron grupos según la etiología: isquémica (n = 122), chagásica (n = 178) y no isquémica (n = 249). Resultados: Tras el seguimiento y 44 muertes (20,8 %, chagásicas; 36,9 %, isquémicas y 20,5 %, no isquémicas, p = 0,0017). Se identificaron cuatro predictores independientes en la población general: ß-bloqueadores, estatinas, digoxina (en las dosis: 0,125 y 0,25 mg) e índice de diámetro diastólico ventricular izquierdo. En Chagas, digoxina y ß-bloqueadores, sodio, presión arterial sistólica e inhibidores de la enzima convertidora de angiotensina (IECA), (incluyendo combinaciones con ß-bloqueadores). En isquémicos: digoxina, índice de diámetro diastólico del ventrículo izquierdo DdVI/IMC) e hipotiroidismo y en no isquémicos: colesterol y volumen telediastólico ventrícular izquierdo (VTdVI). Obteniéndose las siguientes ecuaciones por etiología: Ŝ(t) = [ Ŝ0(t)]exp[-0.89*B-bloqueador-1.47*Estatina+1.239*Digoxina (0.125)+Digoxina(0.25)+0.551*DdVI/IMC] Ŝ(t) = [ Ŝ0(t)]exp[-3.469*B-bloqueador-2.663*IECA - 4.456*B-bloqueador+ IECA - 0.036*SBP-0.195+3.061*Digoxina Ŝ(t) = [ Ŝ0(t)]exp[-0.634* DdVI/IMC+1.652*Digoxina+1.834Hipotiroidismo] Ŝ(t) = [ Ŝ0(t)]exp[-0.024*Colesterol+0.008*VTdVI] Conclusiones: los predictores de mortalidad, en pacientes ambulatoriales con IC, son particulares según la etiología. En Chagas, algunos fármacos parecen tener un beneficio superior en comparación con otras etiologías. Este modelo de pronóstico muestra un valor al sistema sanitario público más allá del que aportan los modelos clínicos actuales. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical manifestations in patients infected with coxsackievirus B are highly variable, with most cases being asymptomatic or mild, and fewer cases presenting with symptoms of severe disease. Multiorgan involvement associated with coxsackievirus B5 is very rare. CLINICAL CASE: A 20-year-old male patient admitted to the emergency department with jaundice, high fever, abdominal pain, and sepsis; initially treated as leptospirosis. His clinical status rapidly deteriorated to circulatory shock, pancreatitis, and acute renal failure with proteinuria. He subsequently developed acute respiratory failure, possibly due to cardiac failure secondary to viral myocarditis. He required vasoactive support, noninvasive mechanical ventilation, and admission to the intensive care unit. Coxsackie B5 virus was the most likely cause, diagnosed by IgM antibody titer nine days after admission. CONCLUSIONS: The reported case is rare because of multiorgan involvement by Coxsackie B5 virus, which is a common cause of myocarditis and pericarditis and other organ involvement. It is a multiorgan failure of unknown cause; viral infection should be suspected. Coxsackievirus has a wide clinical variability, ranging from asymptomatic infection to life-threatening disease requiring intensive supportive care to sustain life. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular diseases represent an important cause of morbidity and mortality during pregnancy, cardiomyopathy is notable as a syndrome of heart failure. Objective: To characterize patients with peripartum cardiomyopathy according to clinical and epidemiological variables of interest for the investigation. Methods: A descriptive and cross-sectional study of 18 patients with diagnosis of peripartum cardiomyopathy was carried out. They were assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from October, 2015 to December, 2022. Results: In the series there was a prevalence of patients over 35 years (32.6 average age), besides African descendant (50.0 %), chronic hypertension (44.4 %) and multiparity (8.9 %) as risk factors and the left ventricle failure as clinical manifestation. The ejection fraction of this ventricle was regularly diminished and the pharmacological treatment response was satisfactory in all the sample. Conclusions: Peripartum cardiomyopathy is of low incidence in this center; however, due to its seriousness, the early diagnosis and the specialized staff intervention are necessary to avoid complications. [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 Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo 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.)

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Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

Resumo Fundamento A insuficiência cardíaca é uma das principais causas de hospitalização e mortalidade em todo o mundo e representa um grande fardo económico para os sistemas de saúde. A identificação de fatores prognósticos em pacientes com IC é de grande importância para estabelecer estratégias de manejo ideais e evitar procedimentos invasivos e dispendiosos desnecessários em pacientes em estágio terminal. Objetivos No presente estudo, nosso objetivo foi investigar a associação entre parâmetros de strain diastólico, incluindo E/e’ SR, e resultados de curto prazo em pacientes com IC avançada. Métodos O estudo populacional incluiu 116 pacientes com insuficiência cardíaca avançada com fração de ejeção reduzida (ICFEr) avançada. Avaliações clínicas, laboratoriais e ecocardiográficas dos pacientes foram realizadas nas primeiras 24 horas de internação. Os pacientes foram acompanhados por um mês e qualquer reinternação por piora dos sintomas de IC e qualquer mortalidade foi registrada. O nível de significância adotado na análise estatística foi de 5%. Resultados A E/e’ SR foi significativamente maior no grupo de pacientes em comparação ao grupo controle (p=0,001). Durante o acompanhamento de um mês, 13,8% dos pacientes morreram e 37,1% dos pacientes foram reinternados. NT-ProBNP sérico (p=0,034) e E/e’ SR (p=0,033) foram considerados preditores independentes de mortalidade e o uso de IECA (p=0,027) e strain 3C apical (p=0,011) foram considerados independentes preditores de reinternação no grupo de pacientes. Conclusão Os resultados do presente estudo prospectivo demonstram que a E/e’ SR medida pela ecocardiografia com speckle tracking é um preditor independente e sensível de mortalidade em curto prazo em pacientes com ICFEr avançada e pode ter um papel na identificação de pacientes com ICFEr em estágio terminal.

Resumo Fundamento A frequência cardíaca (FC) na insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e ritmo sinusal apresenta valor prognóstico. Entretanto, o método de mensuração é debatido na literatura. Objetivos Comparar em pacientes com ICFEr e ritmo sinusal a FC no Holter com três eletrocardiogramas de repouso: ECG1, ECG2 e ECG3. Metodologia Estudo transversal com 135 pacientes portadores de insuficiência cardíaca com fração de ejeção ≤ 40% e ritmo sinusal. A FC foi avaliada por ECG e Holter. Análises incluíram o coeficiente de correlação intraclasse (CCI), regressão robusta, raiz do erro quadrático médio, Bland-Altman e a área sobre a curva ROC. Adotou-se nível de significância de 0,05 e o ajuste de Bonferroni-Holm para minimizar erros tipo I. Resultados As medianas [intervalo interquartil] de idade e fração de ejeção foram de 65 anos [16] e 30% [11], respectivamente. O CCI dos 3 ECG foi de 0,922 (intervalo de confiança de 95%: 0,892; 0,942). Os coeficientes de regressão robusta para ECG1 e ECG3 foram 0,20 (intervalo de confiança de 95%: 0,12; 0,29) e 0,21 (intervalo de confiança de 95%: 0,06; 0,36). O R2 robusto foi de 0,711 (intervalo de confiança de 95%: 0,628; 0,76). Na análise de concordância de Bland-Altman, os limites de concordância foram de −17,0 (intervalo de confiança de 95%: −19,0; −15,0) e 32,0 (intervalo de confiança de 95%: 30,0; 34,0). A área sob a curva ROC foi de 0,896 (intervalo de confiança de 95%: 0,865; 0,923). Conclusão A FC do ECG mostrou alta concordância com a FC do Holter, validando seu uso clínico em pacientes com ICFEr e ritmo sinusal. Contudo, a concordância foi subótima em um terço dos pacientes com FC inferior a 70 bpm pelo ECG, devendo ser considerada a realização de Holter neste contexto.

Introducción. La insuficiencia cardiaca es una enfermedad muy frecuente a nivel mundial; se considera una patología progresiva, terminal, extremadamente sintomática y en el cuidado integral es fundamental la atención por cuidado paliativo. Sin embargo, el acceso a esta especialidad es escaso. La investigación tiene el objetivo de determinar con un estudio descriptivo retrospectivo las características sociodemográficas, clínicas y del fallecimiento de un grupo de pacientes con insuficiencia cardiaca en el momento de identificar la necesidad de cuidado paliativo. Metodología. Se incluyeron18 pacientes con una edad media de 81.5 (51-94) años, la mayoría hombres; las principales causas de insuficiencia fueron la isquémica y la valvular y todos tenían una clase funcional NYHA III o IV. Resultados. Los síntomas más frecuentes fueron: inapetencia, disnea y malestar general, los cuales fueron reportados como graves. La mayoría de los pacientes tenían una calificación en la escala de Barthel menor que 35 puntos, mayor deterioro neurológico y fallecieron en los siguientes cinco días de identificar la necesidad de atención por cuidados paliativos, pero solo se podía brindar acompañamiento al final de la vida debido a lo tardío de su identificación. Conclusiones. Es importante detectar a tiempo la necesidad de cuidados paliativos en los pacientes con insuficiencia cardiaca con el fin de tratar a tiempo los múltiples síntomas que deterioran su calidad de vida.