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Background and Objectives: Globally, cardiovascular diseases (CVDs), mainly stroke and ischemic heart disease (IHD) remain the leading and major causes of mortality in addition to being the key contributors to disabilities. The objective of this systematic review entails the evaluation of the global burden and the risk factors associated with CVDs in adolescents and young adults. To attain this objective, the study will examine the various underlying causes of CVD mortality and the associated risk factors. Methodology: The study entailed an in-depth search of various online databases for original studies focusing on the global burden of CVDs and risk factors in adolescents and young adults. The search was conducted on databases that included Embase, PubMed, Google Scholar, SCOPUS, and Web of Science. The identified studies were subjected to evaluation and screening, and the selection of the apt studies was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 15 studies were selected and included in this systematic review Results: CVD prevalence and incidence rates in adolescents and young adults are highest in low and low-middle socio-demographic index (SDI) nations, despite the CVD burden progressively increasing in high and high-middle SDI countries. Male adolescents and young adults have the highest prevalence, incidence, and disability-adjusted life year (DALY), and mortality rates for endocarditis, even as females aged 30 to 39 years have the highest atrial fibrillation and atrial flutter-related DALY and mortality rates. Conclusion: The global CVD burden in adolescents and young adults remains a major global health challenge. Therefore, it is important that factors that include disparities observed in the SDI levels amongst the nations, age and gender attributes of the populaces, the primary CVD types, and the various attributable risk factors are taken into consideration during the formulation and execution of prevention strategies and interventions.

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Background: Ischemic heart disease is a critical global health issue characterized by inadequate blood supply to the myocardium, leading to an imbalance between oxygen supply and demand. This study aimed to analyze the prescription patterns of both cardiovascular and non-cardiovascular drugs among ischemic heart disease patients at a government medical college hospital in Tamil Nadu, India. This observationalMethods and Materials: prospective study was conducted over six months, from April to September 2023, involving 100 patients aged 31 years and above. Data were collected during ward rounds and regular follow-ups and were analysed using Microsoft Excel 2021. Results: The study revealed that the majority of ischemic heart disease patients were aged 51 to 60 years and men had a higher predominance rate than women. The most frequently prescribed drug classes were antiplatelet agents (17.26%), antihypertensives (17%), antihyperlipidemic drugs (8.76%), anticoagulants (7.80%), and nitrates (7.18%). Additionally, non- cardiovascular drugs were widely prescribed, with antacids (8.93%) and benzodiazepines (7.27%) being the most common. The prescription patterns largely adhered to established management guidelines, with a focus on antiplatelets, antihypertensives, and statins. The frequent use of non-cardiovascular drugs indicated the presence of comorbid conditions, such as gastroesophageal reux disease and anxiety. This study highlights the prescription patterns for ischemicConclusion: heart disease and their adherence to standard management practices concluding that antiplatelets were the most commonly prescribed drugs. It also emphasizes the need for future research with larger populations and an assessment of clinical outcomes.

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Background: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality among adults with diabetes. Understanding the prevalence and trends in hospitalizations for CVD complications in this population is crucial for informing healthcare strategies and interventions. Aim: This study aimed to analyze the prevalence and hospitalization rates of CVD complications among adults with diabetes using data from the USDSS database. Methods: This retrospective study analyzed USDSS database data from 2000 to 2020, exploring CVD complications' prevalence and hospitalization patterns in adults with diabetes.The study explored prevalence rates of major CVD complications, including heart disease and stroke, alongside demographic factors like age, gender, race/ethnicity, and education level. Hospitalization rates for ischemic heart disease, heart failure, and stroke were calculated. Temporal trends were analyzed graphically, and statistical tests (chi-square, ANOVA) with a significance level of p<0.05 were conducted. Results: The analysis revealed notable temporal trends in major heart disease prevalence and stroke rates among adults with diabetes. Over the study period, major heart disease incidence increased from 2.7 in 2000 to 4.9 in 2022, with an average of 4.22. Prevalence ranged from its lowest at 18.2% in 2014 to its highest at 23.7% in 2001, with the latest at 17.4% in 2022. Stroke cases rose steadily from 1.1 in 2000 to 2.1 in 2022, with the latest prevalence at 7.4%. Subgroup analysis revealed variations across gender, age, race, and education levels. Hospitalization rates for CVD declined from 78.6 per 1,000 in 2000 to 46 per 1,000 in 2020. Rates for ischemic heart disease decreased from 32.2 per 1,000 to 10.2 per 1,000, heart failure from 20.7 per 1,000 to 15 per 1,000, and stroke from 9.4 per 1,000 to 8.4 per 1,000. Conclusion: This study provides valuable insights into the prevalence and hospitalization trends of cardiovascular disease complications among adults with diabetes in the United States. The findings underscore the importance of targeted interventions to reduce the burden of CVD in this population.

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Background: Endothelial nitric oxide synthase (eNOS) enzyme plays a key role in maintaining optimal cardiovascular health. Furthermore, the literature review suggests the prominence eNOS gene polymorphisms in pathophysiology of ischemic heart disease (IHD). Aim and Objectives: The aim of this study was to evaluate the association of eNOS gene intron 4a/b polymorphism with IHD in smokers. Materials and Methods: Two hundred male patients presenting with IHD and 100 and 27 age-matched healthy males from the same demographic area were recruited for the study. Based on the history of smoking habit (?20 pack years of smoking), the subjects were further categorized into non-smokers and smokers. All the subjects were analyzed for the eNOS gene 4a/b polymorphism and other relevant parameters. Results: While studying the association of “aa” genotype with smoking in the patient group as well as in control group, there was no significant association observed between smoking behavior and genotype frequencies (for aa vs. ab+bb, odds ratio [OR] 1.5682, 95% confidence interval [CI] 0.6119–4.0191, P = 0.3457) in patient smokers versus patient non-smokers, OR 0.59, 95% CI 0.1349–2.581, P = 0.479 in control smokers versus control non-smokers. Conclusion: Although genotype frequencies for eNOS 4 b/b, eNOS 4 a/b and eNOS 4 a/a and “a” allele frequency differed between IHD patients and controls, it was not statistically significant indicating “a” allele of eNOS intron 4 a/b variable number of tandem repeat polymorphism was not an independent predictor of IHD.

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Introducción: La relación entre las enfermedades periodontal y coronaria ha sido estudiada con profundidad en los últimos años y se ha concluido, que los individuos con afección periodontal tienen mayor riesgo de presentar enfermedades cardiovasculares. Objetivo: Identificar la asociación entre la enfermedad periodontal y la cardiopatía isquémica en pacientes ingresados en un servicio de terapia intermedia. Métodos: Se realizó un estudio observacional y descriptivo de los pacientes hospitalizados en la Sala de Terapia Intermedia del Hospital Provincial Vladimir Ilich Lenin de Holguín, desde 2018 hasta 2022. La muestra se dividió en 2 grupos: enfermos y sanos con 50 y 75 integrantes, respectivamente. Las variables analizadas fueron edad, sexo, forma de presentación de la cardiopatía isquémica, factores de riesgo periodontales y coronarios, así como estado periodontal según el índice periodontal de Russel. Se emplearon métodos teóricos, empíricos y de la estadística descriptiva. Resultados: Existió un predominio del sexo masculino en ambos grupos (enfermos y sanos) con 27 y 41 pacientes, respectivamente, así como del grupo etario de 60-79 años con 54,4 %. El infarto agudo de miocardio afectó a 72,0 % de los enfermos. El consumo de café y la presencia de hipertensión arterial fueron los factores de riesgo más representativos; la mayor incidencia de pérdidas óseas avanzadas se presentó en los enfermos. Conclusiones: Se pudo constatar que existe asociación entre la enfermedad periodontal y la cardiopatía isquémica, con resultados estadísticamente significativos.

Introduction: The relationship between the periodontal and coronary diseases has been deeply studied in the last years and it has been concluded that individuals with periodontal affection have a higher risk of suffering from cardiovascular diseases. Objective: To identify the association between periodontal disease and ischemic heart disease in patients admitted to an intermediate therapy service. Methods: An observational and descriptive study of the patients hospitalized in the Intermediate Therapy Room of Vladimir Ilich Lenin Provincial Hospital was carried out in Holguín, from 2018 to 2022. The sample was divided into 2 groups: sick and healthy with 50 and 75 members, respectively. The analyzed variables were age, sex, form of presentation of the ischemic heart disease, periodontal and coronary risk factors, as well as periodontal state according to the Russel periodontal index. Theoretical, empiric and descriptive statistic methods were used. Results: There was a prevalence of the male sex in both groups (sick and healthy) with 27 and 41 patients, respectively, as well as the 60-79 age groups with 54.4 %. Acute heart attack affected 72.0 % of the sick patients. Coffee consumption and the presence of hypertension were the most representative risk factors; the highest incidence of advanced bony loss was presented in sick patients. Conclusions: The association between periodontal disease and ischemic heart disease could be verified, with statistically significant results.

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Background: The current study aimed to investigate the efficacy of the Ischemia Reversal program (IRP) as an Ayurveda based therapy to standard anti-ischemic therapy in patients with ischemic heart disease (IHD). Methods: A retrospective, single centre, observational study was conducted from January 2022 to May 2023. A total of 39 patients diagnosed with ischemic heart disease and global longitudinal strain (GLS) <15, regardless of underlying co-morbidities such as diabetes mellitus, hypertension, obesity, hyperlipidemia, low ejection fraction, history of myocardial infarction were included in this study. The primary endpoint was improvement in GLS from baseline to the 90-day follow-up in various different categories. Secondary endpoints were improvement in EF, abdominal girth, weight and reduction in dependency on allopathic medication from baseline to the 90-day follow-up. Results: The mean age of the study population was 59.23±9.01 years. Weight (day 1: 67.29±13.16 kg and day 90: 61.39±11.11 kg; p=0.00), body mass index (day 1: 25.75±4.03 and day 90: 23.79±3.50; p=0.00), abdominal girth (day 1: 95.31±10.75 cm and day 90: 85.67±17.02 cm p=0.00), EF (day 1: 40.74±10.30% and day 90: 53.91±11.87%; p=0.00), and GLS (day 1: -10.99±2.72 and day 90: -13.17±3.75; p=0.00) improved at the 90 day follow-up. Conclusions: The study showed notable improvements in weight, body mass index, abdominal girth, EF, and GLS after 90 days. These results suggest that IRP is beneficial treatment for IHD, but more extensive research is needed to confirm its effectiveness.

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Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality globally. In recent years research has increasingly focused on the interplay between the white blood cells and the development and progression of IHD. Neutrophils, lymphocytes, and Monocytes play an important role in the immune system and were found to have dual roles in both protective mechanisms and harmful effects. Neutrophils are traditionally viewed as first responders to tissue injury. Their rapid infiltration aids in the clearance of cellular debris and pathogens, while the release of reactive oxygen species and inflammatory mediators can exacerbate tissue damage. Additionally, neutrophils participate in intercommunication with endothelial cells and platelets, influencing the progression of atherosclerosis and thrombosis. Lymphocytes, a key player in adaptive immune response, similarly exhibit a dual role in IHD. Their involvement extends beyond immune surveillance. Monocytes contribute to phagocytosis and tissue repair while some of their actions cause atherosclerotic plaque instability. This review provides an overview of IHD, covering its prevalence, pathogenesis, risk factors, clinical manifestations, diagnosis, and the involvement of white blood cells, including neutrophils, lymphocytes, and monocytes, in the disease process.

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BACKGROUND:Myocardial infarction is one of the most serious cardiovascular diseases at present,and the existing clinical treatment options such as thrombolytic therapy,percutaneous coronary intervention and coronary artery bypass grafting cannot fully restore the myocardial damage caused by ischemia.Stem cell-derived exosomes for the treatment of myocardial infarction have been a hot research topic in recent years,but the low yield of natural-derived exosomes,the difficulty and time consuming nature of obtaining them,and the poor homing effect have limited their clinical application.In this context,the construction of artificial exosomes as an alternative to natural exosomes has become an effective strategy to solve the above problems. OBJECTIVE:To expound the research status of artificial exosomes in the treatment of myocardial infarction,and classify them into two design modes:semi-artificial and full-artificial,and discuss the research progress and problems of the two modes,finally,make the evaluation and prospect of its clinical application in the future. METHODS:PubMed and CNKI were searched for relevant articles with"artificial exosomes,myocardial infarction,engineering"in Chinese,and"artificial exosome,hybrid exosome,myocardial infarction,nanoparticle,drug delivery system"in English.The focus of the search was from January 2017 to December 2022,and some of the classic forward literature was included.A preliminary selection was conducted through reading titles and abstracts.Repetitive studies,low-quality journals and irrelevant articles were excluded.Finally,73 articles were included for review. RESULTS AND CONCLUSION:(1)By semi-artificially modifying exosomes,whether it is the modification of targeting peptides,hybridization of biofilms or the assistance of magnetic substances,traditional exosome therapies with insufficient targeting and low retention rate and easy to be cleared by the reticuloendothelial system have improved the efficiency of traditional exosome therapy for myocardial infarction.However,these strategies have problems such as unclear modification efficiency,medical ethics,and biotoxicity.(2)Fully artificial bionic exosomes have a higher degree of design freedom compared to exosome modification,which can solve the problems of high extraction and storage difficulties of exosomes of natural origin and limitations of large-scale production;however,this artificial exosome strategy still lacks reliable preclinical data support and biosafety testing,and has not yet formed a standardized process required for large-scale production;therefore,before applying to the clinic,the artificial exosome solution as an alternative to natural exosomes still needs continuous in-depth research by researchers.

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Ischemic cardiovascular and cerebrovascular diseases， encompassing ischemic heart disease and ischemic cerebrovascular disease， possess the features of high prevalence， disability， and mortality rates， thus ranking as the leading cause of global mortality. The shared etiology of ischemic heart disease and ischemic cerebrovascular disease involves local hypoperfusion caused by vascular stenosis， atherosclerosis， and infarction. Their intricate pathological processes involve various mechanisms such as inflammation， pyroptosis， apoptosis， and autophagy. However， interventions targeting individual pathological pathways offer limited therapeutic effects. There is an urgent need to explore novel treatment strategies or medications capable of simultaneously intervening in multiple pathological pathways. Mesenchymal stem cells， through their paracrine effects， play a role in tissue repair， with exosomes playing an important role. Mesenchymal stem cell-derived exosomes exhibit immunomodulatory and reparative properties similar to their parent cells while also reducing the side effects and infusion toxicity associated with the direct application of stem cells. Thus， they hold broad prospects for the treatment of ischemic cardiovascular and cerebrovascular diseases. Traditional Chinese medicine （TCM） and formulations， with their characteristics of multiple components， targets， and multi-level system regulation， can improve the cellular microenvironment by modulating mesenchymal stem cell-derived exosomes， thereby exerting therapeutic effects on ischemic cardiovascular and cerebrovascular diseases. This viewpoint highlights the concept of microscopic pattern differentiation in modern TCM and represents another significant area of TCM modernization. This article provided a comprehensive overview of the therapeutic effects and mechanisms of mesenchymal stem cell-derived exosomes in ischemic cardiovascular and cerebrovascular diseases while discussing the application of TCM in regulating mesenchymal stem cell-derived exosomes in ischemic cardiovascular and cerebrovascular diseases， offering new insights for the prevention and treatment of ischemic cardiovascular and cerebrovascular diseases using TCM.

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ObjectiveTo investigate the effect of Gualou Xiebai Banxiatang on cardiac function and myocardial histopathological changes in rats with ischemic myocardial injury， and to observe the effect of myocardial microvascular density （MVD）， phosphatidylinositol 3-kinase （PI3K）， mammalian target of rapamycin （mTOR）， hypoxia-inducible factor-1 alpha （HIF-1α）， and vascular endothelial growth factor （VEGF） signaling pathways on myocardial microangiogenesis. MethodSeventy male SD rats were randomly selected， with six rats in the normal group. The remaining rats were fed a high-fat diet and injected with isoproterenol hydrochloride （ISO，80 mg·kg-1·d-1， 2 d） to induce a hyperlipidemia-based ischemic heart disease model. After successful modeling， the rats were randomly divided into the model group， high， medium， and low dose groups of Gualou Xiebai Banxiatang， and the metoprolol group. The high， medium， and low dose groups of Gualou Xiebai Banxiatang were given Gualou Xiebai Banxiatang at 10.42， 5.21， 2.61 g·kg-1·d-1， respectively， while the metoprolol group was given metoprolol at 2.6 mg·kg-1·d-1. Both the normal and model groups were given an equivalent volume of physiological saline for 28 days. After the intervention， relevant tests were conducted， and serum was collected to measure heart function-related indicators. Hematoxylin-eosin （HE） and Masson staining were performed on ventricular tissue to observe pathological changes under a light microscope. Immunohistochemistry （IHC） was used to detect the positive expression of platelet endothelial cell adhesion molecule （CD31）. Enzyme-linked immunosorbent assay （ELISA） was used to detect the expression of N-terminal pro-brain natriuretic peptide （NT-proBNP） and VEGF. Western blot was used to detect the protein expression levels of PI3K/mTOR/HIF-1α/VEGF. ResultCompared with the normal group， the model group showed significantly increased serum levels of LDH， CK， CK-MB， NT-proBNP， and VEGF （P<0.01）， significantly increased collagen volume fraction （CVF） （P<0.01）， significantly decreased MVD （P<0.01）， and elevated protein expression levels of PI3K， mTOR， HIF-1α， and VEGF （P<0.05， P<0.01）. Compared with the model group， the metoprolol group had significantly lower serum levels of LDH， CK， CK-MB， and NT-proBNP （P<0.01）， significantly higher VEGF levels （P<0.01）， significantly decreased CVF （P<0.01）， significantly increased MVD （P<0.01）， and significantly increased protein expression levels of PI3K， mTOR， and VEGF （P<0.01）， with no statistically significant change in HIF-1α protein expression. Compared with the model group， the high and medium dose groups of Gualou Xiebai Banxiatang had decreased serum levels of LDH， CK， CK-MB， and NT-proBNP （P<0.05， P<0.01）， increased VEGF levels （P<0.05， P<0.01）， significantly reduced CVF （P<0.01）， increased MVD （P<0.05， P<0.01）， and significantly increased protein levels of PI3K， mTOR， HIF-1α， and VEGF （P<0.01）. In the low dose group of Gualou Xiebai Banxiatang， compared with the model group， serum levels of LDH and NT-proBNP were decreased （P<0.05）， VEGF was increased （P<0.05）. Moreover， CVF was decreased （P<0.05）， and the protein expression levels of PI3K， mTOR， HIF-1α， and VEGF were significantly increased （P<0.01）. ConclusionGualou Xiebai Banxiatang can improve cardiac function， reduce myocardial pathological damage， enhance endothelial cell function， promote myocardial microvascular formation， and upregulate the expression of PI3K， mTOR， HIF-1α， and VEGF proteins in myocardial tissue in rats with ischemic myocardial injury.

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Cardiovascular disease is the leading cause of death among Chinese residents, and non-invasive imaging technology has important value in the diagnosis and treatment of cardiovascular disease. Cardiac magnetic resonance (CMR) can characterize cardiac pathophysiological information from multiple dimensions, including cardiac structure, function, tissue characteristics, and microstructure, through multi parameter and multi sequence " one-stop" imaging. This article will focus on new technologies such as CMRT1 mapping, feature tracking, and diffusion tensor imaging, and explain their applications and progress in the diagnosis, efficacy monitoring, and prognosis prediction of various myocardial lesions such as non ischemic heart disease and ischemic heart disease.

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Objective To understand the trends of the mortality and DALY of ischemic heart disease (IHD) caused by high-salt diets，as well as their age-period-cohort effects among Chinese residents from 1990 to 2019. Methods Using the 2019 Global Burden of Disease Study (GBD 2019) data on IHD deaths and DALY attributed to high-salt diets among Chinese residents from 1990 to 2019, an age-period-cohort (APC) model was applied to explore the age-period-cohort effect. Results Among the 13 major risk factors for ischemic heart disease (IHD) in China in 1990 and 2019, age-standardized mortality and age-standardized DALY rates attributable to risk factors of high-salt diets led the way. Age-standardized mortality and age-standardized DALY rates were attributabled to high-salt diets showed a decreasing trend in both China and globally in 1990-2019, but were consistently higher in China than in the world. The results of the APC model show that from 1990 to 2019, the mortality rate and DALY rate of IHD attributed to a high-salt diet in China showed an increasing trend with age; over time, the risk of death and the risk of DALY for males showed a decreasing trend from 1990-1994 to 1995-1999, and an increasing trend from 1995-1999 to 2010-2014, and reached its peak in 2010-2014 (RR=1.17,95% CI: 1.12-1.21), followed by a decreasing trend. For males with a later birth cohort have a higher risk of death and DALY, while for females with a later birth cohort have a lower risk of death and DALY. Conclusion The burden of IHD disease attributed to a high-salt diet in China is still relatively heavy, and it is necessary to strengthen protection for high-risk populations such as young males and the elderly population to reduce the burden of IHD disease in China.

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Introducción: La homocisteina es considerada como un factor aterogénico en diversas patologías como las enfermedades cardiovasculares y cerebrovasculares. La hiperhomocisteinemia es una condición de causa variable como factor de riesgo en las enfermedades vasculares obstructivas. Objetivo: Estudiar el aumento de los niveles de homocisteina en sangre como indicador de riesgo de las enfermedades vasculares obstructivas. Métodos: Se realizó un estudio prospectivo-analítico de las variaciones de los niveles séricos de hemograma completo en pacientes, con diagnóstico de enfermedades vasculares obstructivas ingresados en el Hospital Hermanos Ameijeiras en el año 2022. La muestra estuvo comprendida por 100 pacientes. La confiabilidad fue un 95 por ciento, el poder estadístico de 80 por ciento y un 25 por ciento de la exposición al factor a evaluar, un odds ratio estimado de 5,00 y una relación de 1:1, (50 casos y 50 controles). Resultados: En el estudio predominaron los pacientes con más de 50 años, pero no se detectó diferencia significativa con respecto al sexo. La cardiopatía isquémica fue la EVO de mayor incidencia. La hiperhomocisteinemia constituyó un excelente marcador de EVO en los pacientes estudiados a diferencia de los controles. Conclusiones: En el estudio se demostró una asociación positiva estadísticamente significativa entre la hiperhomocisteinemia y las enfermedades vasculares obstructivas, lo cual confirma el valor de la Hc como predictor de riesgo de esta enfermedad(AU)

Introduction: Homocysteine is considered an atherogenic factor in various diseases such as cardiovascular and cerebrovascular diseases. Hyperhomocysteinemia is a condition of variable cause as a risk factor in obstructive vascular diseases. Objective: To study the increase in homocysteine levels in the blood as a risk indicator for obstructive vascular diseases. Methods: A prospective-analytical study was carried out on the variations in serum levels of complete blood count in patients, with a diagnosis of obstructive vascular diseases, who were admitted to Hermanos Ameijeiras Hospital in 2022. The sample consisted of 100 patients. The reliability was 95percent, the statistical power was 80percent and 25percent of the exposure to the factor to be evaluated, an estimated odds ratio of 5.00 and a ratio of 1:1, (50 cases and 50 controls). Results: Patients over 50 years of age predominated in the study, but no significant difference was detected with respect to sex. Ischemic heart disease was the OVD with the highest incidence. Hyperhomocysteinemia was an excellent marker of VOD in the patients studied, unlike controls. Conclusions: The study demonstrated a statistically significant positive association between hyperhomocysteinemia and obstructive vascular diseases, confirming the value of Hc as a risk predictor for this disease(AU)

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Las imágenes no invasivas resultan opciones válidas para detectar la cardiopatía isquémica. La evaluación directa de las respuestas microcirculatorias coronarias a estímulos vasodilatadores y la evaluación de los trastornos vasomotores representan ventajas de los procedimientos diagnósticos intervencionistas. La relevancia funcional de las alteraciones en la microcirculación coronaria y los mecanismos independientes del endotelio de la disfunción coronaria microvascular se pueden apreciar durante el estudio de la macrocirculación coronaria. La administración de estímulos inductores de vasorreactividad investiga los mecanismos dependientes del endotelio de la disfunción coronaria microvascular y los trastornos del tono vasomotor epicárdico. Los procedimientos de diagnóstico intervencionista diferencian endotipos subyacentes en cardiopatía isquémica y guían un enfoque de terapia personalizada, según la respuesta fisiológica del paciente. El estudio de la microcirculación coronaria se puede estimar dentro del mismo procedimiento, y su valor diagnóstico sirve para interpretar los resultados de la intervención coronaria percutánea. El presente documento resume el estado actual del conocimiento sobre el estudio de la microcirculación coronaria y sus mecanismos independientes del endotelio en la disfunción coronaria microvascular. Además, expone las ideas básicas para una correcta interpretación de sus resultados en el laboratorio de hemodinámica(AU)

Noninvasive imaging is used to detect ischemic heart disease. Direct assessment of coronary microcirculatory responses to vasodilator stimuli and evaluation of vasomotor disturbances present advantages for interventional diagnostic procedures. The functional relevance of alterations in the coronary microcirculation and the endothelium-independent mechanisms of coronary microvascular dysfunction can be appreciated during the study of the coronary macrocirculation. Administration of vasoreactivity-inducing stimuli investigates endothelium-dependent mechanisms of microvascular coronary dysfunction and disorders of epicardial vasomotor tone. Interventional diagnostic procedures differentiate underlying endotypes in ischemic heart disease and guide a personalized therapy approach according to the patient's physiological response. The study of coronary microcirculation can be estimated within the same procedure, and its diagnostic value serves to interpret the results of percutaneous coronary intervention. The present paper summarizes the current state of knowledge on the study of coronary microcirculation and its endothelium-independent mechanisms in coronary microvascular dysfunction. In addition, it presents the basic ideas for a correct interpretation of its results in the hemodynamics laboratory(AU)

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La presencia de complejos QRS fragmentados (fQRS) en un electrocardiograma (ECG) de 12 derivaciones de rutina es un marcador interesante de anormalidad de la despolarización. El fQRS representa un retraso en la conducción debido a una activación no homogénea de los ventrículos debido a una cicatriz miocárdica. Sin embargo, la fQRS no es específica de la enfermedad de las arterias coronarias y además se encuentra en otras enfermedades del miocardio como la miocardiopatía y la cardiopatía congénita. fQRS también se há descrito en otras entidades como la miocardiopatía arritmogénica del ventrículo derecho y el síndrome de Brugada. La importancia y el valor predictivo del complejo fQRS como marcador ECG de eventos cardiovasculares parecen ser diferentes en diferentes entidades. En pacientes con enfermedad arterial coronaria estable y en pacientes con infarto de miocardio agudo, la fQRS parece ser un buen predictor de eventos cardíacos. En pacientes con miocardiopatía no isquémica, la fQRS estrecho parece correlacionarse con el grado de fibrosis y disincronía, y podría influir en la respuesta a la terapia de resincronización cardíaca. En pacientes con disfunción del VI, no hay evidencia clara de que la presencia de fQRS pueda predecir eventos arrítmicos. Por otro lado, hubo diferencia estadísticamente significativa en la mortalidad asociada a la presencia de fQRS en pacientes con síndrome coronario agudo y necrosis miocárdica. La presencia de fQRS, posee una alta especificidad y un alto valor predictivo positivo debido a la existencia de trastornos segmentarios de la motilidad miocárdica en pacientes con cardiopatía isquémica.

The presence of fragmented QRS complexes (fQRS) on a routine 12-lead electrocardiogram (ECG) is an interesting marker of depolarization abnormality. There is compelling data suggesting that fQRS represents a conduction delay from inhomogeneous activation of the ventricles due to myocardial scar. However, fQRS is not specific for coronary artery disease and it is also found in other myocardial diseases such as cardiomyopathy and congenital heart disease. fQRS has also been described in other entities such as arrhythmogenic right ventricular cardiomyopathy and Brugada syndrome. The importance and predictive value of the fQRS complex as an ECG marker of cardiovascular events appear to be different in different entities. In patients with stable coronary artery disease and in patients with acute myocardial infarction, fQRS appears to be a good predictor of cardiac events. In patients with nonischemic cardiomyopathy, narrow fQRS appears to correlate with the degree of fibrosis and dyssynchrony, and could influence the response to cardiac resynchronization therapy. In patients with LV dysfunction, there is no clear evidence that the presence of fQRS can predict arrhythmic events. On the other hand, there was a statistically significant difference in mortality associated with the presence of fQRS in patients with acute coronary syndrome and myocardial necrosis. The presence of fQRS has a high specificity and a high positive predictive value for the existence of segmental disorders of myocardial motility in patients with ischemic heart disease.

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Introducción: La revascularización mediante intervención coronaria percutánea con colocación de stent, o cirugía de derivación coronaria, alivia la isquemia miocárdica. Sin embargo, las pruebas de estrés no invasivas y la angiografía coronaria no siempre proporcionan la información adecuada sobre la importancia funcional de las estenosis en las arterias coronarias. Objetivo: Describir las recomendaciones actuales de la literatura médica con respecto a la fisiología coronaria en la cardiopatía isquémica. Desarrollo: El índice de reserva fraccional de flujo se considera el estándar de oro para detectar la isquemia miocárdica. Su naturaleza invasiva se equilibra con la resolución espacial inigualable y su relación lineal con el flujo sanguíneo máximo. Los resultados clínicos de pacientes cuya estrategia de revascularización se basa en mediciones de reserva fraccional de flujo son decisivos en varios subconjuntos de diferentes lesiones. En la última década se ha propuesto la evaluación de la gravedad de la estenosis coronaria mediante índices no hiperémicos. Sin embargo, la precisión de estos índices para distinguir correctamente la isquemia miocárdica es solo del 80 por ciento. Conclusiones: Actualmente, la hiperemia máxima se recomienda para una óptima toma de decisiones sobre la revascularización(AU)

Introduction: Revascularization by percutaneous coronary intervention with stenting, or coronary bypass surgery, alleviates myocardial ischemia. However, noninvasive stress testing and angiography do not always provide adequate information on the functional significance of coronary artery stenoses. Objective: To describe the recommendations of the medical literature regarding coronary physiology in ischemic heart disease. Development: The fractional flow reserve index is considered the gold standard for detecting myocardial ischemia. Its invasive nature is balanced by unmatched spatial resolution and its linear relationship to peak blood flow. The clinical outcomes of patients whose revascularization strategy is based on fractional flow reserve measurements are decisive in several subsets of other lesions. In the last decade, assessment of coronary stenosis severity by non-hyperemic indices has been proposed; however, the accuracy of these indices to correctly distinguish myocardial ischemia does not exceed 80 percent. Conclusions: Currently, maximal hyperemia is recommended for optimal revascularization decision making(AU)

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Introducción: Uno de los aspectos que más interés suscita en lo referente a la distribución geográfica de la mortalidad por cáncer es la formación de conglomerados espaciales. Objetivo: Identificar el patrón espacial de la mortalidad por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica mediante la detección y descripción de conglomerados espaciales en la provincia de Santiago de Cuba. Métodos: Se realizó un estudio ecológico exploratorio espacial de los fallecimientos por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica durante el período comprendido desde el 1 de enero hasta el 31 de diciembre de 2019 en la provincia de Santiago de Cuba, para lo cual se procedió a la detección de conglomerados espaciales de elevada y baja mortalidad por las causas antes citadas. Se empleó el método de escaneo espacial estadístico con el programa Satscan y las variables independientes fueron divididas en demográficas y clínicas. Resultados: De los 36 conglomerados espaciales de mortalidad detectados, 23 correspondieron al cáncer (65,8 %), 7 a cardiopatía isquémica (18,4 %) y 6 a enfermedad cerebrovascular isquémica (15,8 %); asimismo, 44,7 % del total eran de elevado riesgo y 55,3 % de bajo riesgo. Conclusiones: El patrón de la distribución espacial de mortalidad por cáncer de próstata, pulmón, mama, colon, esófago, cardiopatía isquémica y enfermedad cerebrovascular isquémica se caracterizó por la formación de conglomerados espaciales de elevada y baja mortalidad.

Introduction: One of the aspects that more interest raises regarding the geographical distribution of mortality due to cancer is the formation of space conglomerates. Objective: To identify the space pattern of mortality due to cancer, ischemic heart disease and ischemic cerebrovascular disease by means of the detection and description of space conglomerates in Santiago de Cuba province. Methods: A space exploratory ecological study of deaths due to cancer, ischemic heart disease and ischemic cerebrovascular disease was carried out during January 1st to December 31, 2019 in Santiago de Cuba province, for which space conglomerates of high and low mortality due to the abovementioned causes were detected. The statistical space escanning method was used with the Satscan program and the independent variables were divided in demographic and clinical. Results: Of the 36 space conglomerates of mortality detected, twenty three corresponded to cancer (65.8%), seven to ischemic heart disease (18.4%) and six to ischemic cerebrovascular disease (15.8%); also, 44.7% of the total was of high risk and 55.3% of low risk. Conclusions: The space distribution pattern of mortality due to prostate, lung, breast, colon, esophagus cancer, ischemic heart disease and ischemic cerebrovascular disease was characterized by the formation of high and low mortality space conglomerates.

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Resumen Objetivo: el síndrome coronario agudo es una importante causa de morbimortalidad en Colombia, con una alta carga en calidad de vida, muertes, impacto social y costos para el sistema. El control subóptimo de las dislipidemias tiene múltiples causas, entre ellas el uso inadecuado de las estatinas, la inercia terapéutica, la baja difusión y la adopción de las guías y protocolos de manejo, adicional a las barreras de acceso a la atención y a los medicamentos, y la falta de trazabilidad en la atención a partir del evento isquémico agudo. El proyecto "Ruta de atención y manejo de los lípidos en el paciente con síndrome coronario agudo" busca identificar las brechas en la atención clínica y el manejo de la dislipidemia en los pacientes con síndrome coronario agudo en Colombia, y plantear soluciones para cerrarlas. Materiales y método: se realizaron 178 encuestas a profesionales médicos en instituciones de todo el país, para conocer las pautas de manejo de los pacientes con dislipidemia en el paciente con síndrome coronario agudo. Un panel de 17 expertos analizó los resultados y definió las brechas entre la práctica clínica, la evidencia disponible y el manejo recomendado, y planteó recomendaciones para cerrarlas. Resultados y Conclusiones: este artículo muestra las principales brechas detectadas en el manejo de la dislipidemia en pacientes con síndrome coronario agudo en Colombia, y emite recomendaciones de manejo de la dislipidemia, coherentes con las necesidades y características del Sistema de Salud colombiano.

Abstract Objective: acute coronary syndrome (ACS) is an important cause of morbidity and mortality in Colombia, imposing a heavy burden in terms of quality of life, deaths, social impact, and costs to the system. Suboptimal control of dyslipidemia, associated with inadequate statin use, therapeutic inertia, and low rate of dissemination and adoption of the management protocols and guidelines are clinical and healthcare-related factors that contribute to this situation. This is compounded by barriers that hinder access to care and medications, and the lack of care traceability after the acute ischemic event. The "Care Pathway and lipid management in patients with Acute Coronary Syndrome" project seeks to identify gaps in clinical care and the management of dyslipidemia in patients with acute coronary syndrome in Colombia and propose solutions to bridge those gaps. Materials and method: to gain insights into the management of dyslipidemia in patients with ACS, 178 surveys were sent to medical professionals working in different institutions throughout the country. A panel of 17 experts analyzed the results and identified gaps in terms of clinical practice, available evidence, recommended management, and proposed recommendations to bridge those gaps. Results and conclusions: this paper describes the main gaps related to the management of dyslipidemia in patients with ACS in Colombia and offers recommendations by the needs and characteristics of the Colombian Health System.

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Abstract Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score ≥ 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse mechanical, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased left ventricular ejection fraction, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusion: The high burden of comorbidities and symptoms in our population alters myocardial function regardless of the level of ischemia.

Resumen Objetivo: La asociación de comorbilidades y síntomas cardíacos que alteran la función miocárdica podría ayudar a los médicos a identificar correctamente a poblaciones de riesgo. Métodos: Se realizó un estudio transversal en población abierta de pacientes referidos a una unidad de PET/CT en la Ciudad de México para evaluación de la función miocárdica, perfusión y circulación coronaria. La isquemia se definió como una suma de diferencia de puntuación (SDS) ≥ 2. La asociación entre las comorbilidades y los síntomas cardíacos se fundamentó mediante modelos de regresión logística y análisis de tendencias. Realizamos un análisis de interacción para evaluar la adición de cualquier síntoma acompañante a condiciones comórbidas en el deterioro de la función miocárdica. Resultados: Se incluyeron 1.273 pacientes, 66,1% del sexo masculino, con una edad media de 62,4 (± 12.7) años, 360 (28,7%) con isquemia, 925 (72,7%) con al menos una comorbilidad y 676 (53,1%) con al menos una menos un síntoma cardíaco asociado. En pacientes sin isquemia, la diabetes mellitus tipo 2, la hipertensión arterial y los síntomas cardíacos adversos se asociaron con parámetros mecánicos, de perfusión y de flujo coronario adversos. Se observó una tendencia con el número acumulado de comorbilidades y síntomas cardíacos con aumento de la isquemia y disminución del flujo coronario. Solo en la disminución de la FEVI se demostró un efecto de interacción entre el aumento de las comorbilidades y los síntomas adversos. Conclusión: La alta carga de comorbilidades y síntomas en nuestra población altera la función miocárdica independientemente del nivel de isquemia.

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Introducción: Las alteraciones provocadas por el nuevo coronavirus, así como otros factores como la edad, sus antecedentes patológicos personales y determinados resultados de laboratorio, contribuyen al estado de choque. Objetivo: Determinar si existe relación entre el estado de choque provocado por la infección por la COVID-19 con los antecedentes patológicos personales, los índices de INL y la escala qSOFA. Material y Método: Estudio de cohorte longitudinal prospectivo en 302 pacientes con el diagnóstico positivo de la COVID-19 que ingresaron en el Hospital Docente Clínico-Quirúrgico Comandante Manuel Fajardo (La Habana, Cuba) entre marzo y octubre de 2021. Resultados: El 27,8 % de los pacientes evolucionó al choque, principalmente el choque séptico (25,2 %), la mediana de edad fue de 69 con RIC (57-77), mientras los antecedentes personales más frecuentes fueron: hipertensión arterial (71,5 %), obesidad (29,5 %) y Diabetes Mellitus (24,8 %), respectivamente. Los análisis de regresión logística identificaron como variables predictoras de choque los antecedentes de cardiopatía con un RR: 2,16; (IC 95 %: 1,15-4,04; p= 0,02) y el valor de la creatinina con un RR: 1,01; (IC 95 %: 1,00-1,01; p= 0,03). Conclusiones: Los antecedentes de cardiopatía isquémica y el valor de la creatinina representan variables predictoras independientes de la ocurrencia de choque; por otro lado, la supervivencia de los pacientes con diagnóstico positivo de la COVID-19 que desarrollan un estado de choque durante su hospitalización, es significativamente menor.

Introduction: The alterations caused by the new coronavirus, as well as other factors such as age, personal pathological history and certain laboratory results, contribute to the state of shock. Objective: To determine if there is a relationship between the state of shock caused by the COVID-19 infection with the personal pathological history, the INL indices and the qSOFA scale. Material and Methods: Prospective longitudinal cohort study conducted on 302 patients with a positive diagnosis of COVID-19 who were admitted to Manuel Fajardo Hospital in Havana, Cuba between March and October 2021. Results: Our results show that 27.8% of the patients evolved to shock, mainly septic shock (25.2%); the median age was 69-years (RIC: 57-77), while the most frequent personal histories were: arterial hypertension (71.5%), obesity (29.5%), and diabetes mellitus (24.8%), respectively. Logistic regression analyses identified the history of heart disease (RR= 2.16; (95 % CI: 1.15-4.04; p= 0.02) and the creatinine value (RR: 1,01: (95 % CI: 1.00-1.01; p= 0,03) as predictive variables for shock. Conclusions: The history of ischemic heart disease and the creatinine value represent independent predictive variables for the occurrence of shock; on the other hand, the survival of patients with a positive diagnosis of COVID-19 who develop a state of shock during their hospitalization is significantly lower.