ABSTRACT
RESUMEN Introducción: Diferentes registros argentinos de insuficiencia cardíaca crónica (ICC) fueron generados en los últimos 25 años, en forma individual por la Sociedad Argentina de Cardiología (SAC) y la Federación Argentina de Cardiología (FAC), con diversa representatividad. Los últimos datos conocidos datan de 2013. El Registro OFFICE IC AR fue encarado en forma conjunta por la SAC y la FAC para conocer la realidad de la ICC en Argentina. Objetivos: Describir en forma amplia y comprensiva las características salientes de la ICC en Argentina, incluyendo las características de los pacientes, el uso de recursos diagnósticos y terapéuticos, la adherencia a las guías de práctica y el pronóstico a mediano y largo plazo. Material y Métodos: Estudio prospectivo de cohorte, de pacientes con ICC de al menos 6 meses de evolución, alejados de una internación por al menos 3 meses. Se recabaron datos clínicos y paraclínicos. Los pacientes fueron categorizados, de acuerdo a la fracción de eyección ventricular izquierda (FEVI), en IC con FE reducida, ICFER (≤40%); IC con FE en el rango medio, ICFErm, ahora denominada IC con FE levemente reducida, ICFElr (41%-49%), e IC con FE preservada, ICFEP (≥50%). En seguimiento de al menos 1 año se registró la incidencia de hospitalización por insuficiencia cardíaca (HIC), muerte cardiovascular (MCV) y muerte de todas las causas (MTC) Resultados: Entre noviembre de 2017 y enero de 2020, 100 cardiólogos de todo el país incluyeron 1004 pacientes con ICC; edad media 65,8 ± 12,4 años, 74,6% hombres, FEVI conocida en el 93,8%. El 68,4% tenía ICFER, el 16% ICFElr y el 15,6% ICFEP. Hubo alta prevalencia de comorbilidades, incluyendo diabetes y anemia en el 30%, e insuficiencia renal crónica en el 22%. Fue elevada la utilización de antagonistas neurohormonales (ANH): 89,5% betabloqueantes; 57,3% inhibidores o antagonistas del sistema renina angiotensina, 28,9% sacubitril valsartán y 78,6% antialdosterónicos. En 69% se utilizó triple terapia. Su empleo fue mayor en la ICFER, pero elevado incluso en la ICFEP. En una mediana de seguimiento de 1,7 años la incidencia anual de MCV/HIC fue 12,8%, la de MCV 6,6% y la de MTC 8,4%, sin diferencia entre las distintas categorías de FEVI. Conclusiones: En el primer registro conjunto de ICC SAC-FAC se verificó elevada prevalencia de ICFER, alta prevalencia de comorbilidades, uso frecuente de ANH y pronóstico acorde a los registros internacionales.
ABSTRACT Background: Several Argentine registries on chronic heart failure (CHF) have been generated over the past 25 years, either individually by the Argentine Society of Cardiology (SAC) or the Argentine Federation of Cardiology (FAC), with different representativeness. The last known data are from 2013. The OFFICE IC AR registry was jointly undertaken by the SAC and FAC to know the reality of CHF in Argentina. Objective: The aim of this registry was to extensively and comprehensively describe the outstanding characteristics of CHF in Argentina, including patient characteristics, use of diagnostic and therapeutic resources, adherence to practice guidelines and mid-and long-term prognosis. Methods: This was a prospective cohort study of patients with at least 6-month evolution CHF and not hospitalized for at least the past 3 months. Clinical and paraclinical data were collected. Patients were categorized according to left ventricular ejection fraction (LVEF), into HF with reduced EF, HFrEF (≤40 %), HF with midrange EF, now termed HF with mildly reduced EF, HFmrEF (41%-49%), and HF with preserved EF, HFpEF (≥50%). The incidence of hospitalization for HF (HHF), cardiovascular mortality (CVM) and all-cause mortality (ACM) was recorded for at least 1-year follow-up. Results: Between November 2017 and January 2020, 100 cardiologists from all over the country included 1004 patients with CHF. Mean age was 65.8 ± 12.4 years, 74.6% were men, and 93.8% had known LVEF. In 68.4% of cases, patients had HFrEF, 16% HFmrEF and 15.6% HFpEF. A high prevalence of comorbidities was found, including diabetes and anemia in 30% of cases, and chronic renal failure in 22%. There was high use of neurohormonal antagonists (NHA): 89.5% betablockers, 57.3% renin-angiotensin system inhibitors or antagonists, 28.9% sacubitril-valsartan and 78.6% aldosterone antagonists. Triple therapy was used in 69% of patients, with higher prescription in HFrEF, but elevated even on HFpEF. At a median follow-up of 1.7 years, the annual incidence of CVM/HHF was 12.8%, CVM 6.6% and ACM 8.4%, without statistical differences between the different LVEF categories. Conclusions: This first SAC-FAC joint CHF registry verified a high prevalence of HFrEF, a high prevalence of comorbidities, frequent use of NHA and prognosis according to international registries.
ABSTRACT
Con la finalidad de "saber qué hacer" en el ámbito de la urgencia de una insuficiencia cardíaca aguda y con el objetivo de optimizar las estrategias de diagnóstico y tratamiento en el primer contacto con un paciente que podría estar cursando esta patología, se presentan en este artículo, conceptos fundamentales sobre definiciones de esta patología, clasificaciones clínicas y hemodinámicas, manejos iniciales en diferentes escenarios (etapa pre hospitalaria, departamento de emergencia, ingreso a unidad coronaria) y finalmente, un algoritmo diagnóstico y terapéutico para la rápida toma de decisiones. Es nuestro objetivo que médicos generalistas, clínicos, internistas y/o cardiólogos, puedan en una forma organizada y eficiente optimizar el diagnóstico y manejo precoz de esta condición clínica que amenaza la calidad de vida y supervivencia.
Algorithm of acute heart failure Initial management: prehospital stage, emergency department, admission to coronary unit In order to "know what to do" in the area of acute heart failure and with the objective of optimizing diagnostic and treatment strategies in the first contact with a patient who might be attending this pathology, article, fundamental concepts on definitions of this pathology, clinical and hemodynamic classifications, initial management in different scenarios (prehospital stage, emergency department, coronary unit admission) and, finally, a diagnostic and therapeutic algorithm for rapid decision making. It is our goal that general practitioners, clinicians, internists and / or cardiologists, in an organized and efficient way, can optimize the diagnosis and early management of this life-threatening clinical condition.
Algoritmo de insuficiência cardíaca aguda Manejo inicial: estágio pré-hospitalar, departamento de emergências, admissão à unidade coronária Para "saber o que fazer" na área de insuficiência cardíaca aguda e com o objetivo de otimizar estratégias de diagnóstico e tratamento no primeiro contato com um paciente que possa estar atendendo a esta patologia, artigo, conceitos fundamentais sobre definições desta patologia, classificações clínicas e hemodinâmicas, gerenciamento inicial em diferentes cenários (estágio pré-hospitalar, departamento de emergência, admissão da unidade coronária) e, finalmente, um algoritmo diagnóstico e terapêutico para a tomada de decisões rápidas. Nosso objetivo é que clínicos gerais, clínicos, internistas e / ou cardiologistas, de forma organizada e eficiente, possam otimizar o diagnóstico e o gerenciamento precoce desta condição clínica que ameaça a vida.
ABSTRACT
BACKGROUND: endovascular aneurysm repair (EVAR) reduces morbidity and hospital stay compaired with open surgical repair. Endoleak is a common complication of the procedure. The resulting increase of pressure within the sac may expand the aneurysm with the following risk of rupture. The aim of this study was to recognize the incidence of endoleak in tomographic controls of the patients who underwent endovascular repair at our hospital as well as identify the risk factors associated with this complication. METHODS: all consecutive patients who underwent endovascular aneurysm repair at our hospital between 2008, February until 2012, February were restrospectively enrolled in the study, excluding those who were lost at follow-up. 43 patients were included, aged 70.5 ± 6 (men: 88
). The endpoint was endoleak incidence at 1, 6, 12th months after the intervention in the control tomography, and its association with underlying risk factors: hypertension, Smoking, chronic obstructive pulmonary desease and the diameter of the aneurysm. RESULTS: eleven (11
). All were infrarrenal aortic aneurysms. The anteroposterior diameter of the aneurysm (more than 60 mm) showed a trend toward statistical significance as a risk factor (30
; p:0.073). No relationship was found with gender, age, COPD, smoking or hypertension. CONCLUSION: endoleak after endovascular aneurysm repair is a common complication. The size of the aneurysm might be a risk factor of the event.