População com risco cardiovascular elevado em uso de medicamento e aconselhamento: a situação do Brasil em relação à meta mundial, 2014-2015 / Población de riesgo cardiovascular elevado en uso de medicamento y asesoramiento: la situación de Brasil en relación al objetivo mundial, 2014-2015 / Population with high cardiovascular risk receiving drug therapy and counseling: Brazil's status regarding the global goal, 2014-2015

Objetivo: Estimar a prevalência de risco cardiovascular (RCV) elevado, a proporção de pessoas com RCV elevado que recebem tratamento e aconselhamento, e investigar os fatores sociodemográficos associados ao desfecho, no Brasil. Métodos: Estudo transversal, com dados de subamostra da Pesquisa Nacional de Saúde, coletados por exames bioquímicos, em 2014-2015. Empregou-se regressão de Poisson. Resultados: A proporção de RCV elevado em homens foi de 11,2% (IC95% 9,6;12,9), e em mulheres, de 10,4% (IC95% 9,2;11,8%). No grupo com RCV elevado, 68,8% (IC95% 63,7;73,4%) receberam aconselhamento; 59,3% (IC95% 54,2;64,3%), medicamento; e 55,6% (IC95% 50,4;60,7%), ambos. Na análise multivariável, receber tratamento e aconselhamento mostrou associação com a idade de 50 anos e mais, e com autoavaliação de saúde ruim/muito ruim (RP=1,26 - IC95% 1,06;1,51). Conclusão: A proporção de pessoas com RCV elevado que receberam tratamento e aconselhamento foi superior a 50%.

Objetivo: Estimar la prevalência de riesgo cardiovascular (RCV) elevado, la proporción de personas con RCV elevado que reciben tratamiento y asesoramiento, e investigar los factores sociodemográficos asociados al resultado, en Brasil. Métodos: Estudio transversal, con datos de la submuestra de la Investigación Nacional de Salud, recolectados por exámenes bioquímicos, en 2014-2015. Se usó la regresión de Poisson. Resultados: La proporción de RCV elevado en hombres fue del 11,2% (IC95% 9,6; 12,9) y en mujeres del 10,4% (IC95% 9,2;11,8%). En el grupo con RCV elevado, 68,8% (IC95% 63,7; 73,4%) recibió asesoramiento, 59,3% (IC95% 54,2;64,3%) medicamento y 55,6% (IC95% 50,4;60,7%) ambos. En el análisis multivariable, recebir tratamiento y asesoramiento se mostró asociado a la edad de 50 años y más, y a autoevaluación de salud mala/muy mala (RP=1,26 - IC95% 1,06;1,51). Conclusión: La proporción de personas con RCV elevado que recibió tratamiento y asesoramiento fue superior a 50%.

Objective: To estimate the prevalence of high cardiovascular risk (CVR), the proportion of people with high CVR who receive treatment and counseling, and to investigate the sociodemographic factors associated with this outcome, in Brazil. Methods: This was a cross-sectional study, using subsample data from the National Health Survey, collected via biochemical tests, in 2014-2015. Poisson regression was used. Results: The proportion of high CVR in men was 11.2% (95%CI 9.6;12.9), and 10.4% (95%CI 9.2;11.8%) in women. In the group with high CVR, 68.8% (95%CI 63.7;73.4%) received counseling, 59.3% (95%CI 54.2;64.3%) received medication, and 55.6% (95%CI 50.4;60.7%) received both. In the multivariate analysis, receiving treatment and counseling was associated with being aged 50 years and over, and poor/very poor self-rated health (PR=1.26 - 95%CI 1.06;1.51). Conclusion: The proportion of people with high CVR who had received treatment and counseling was over 50%.

Bulas de medicamentos cardiovasculares: elas têm informações sobre precauções necessárias aos idosos? / Cardiovascular drug labeling: Do they have information on necessary precautions for older people?

OBJETIVO: Analisar a existência de informações, em bulas destinadas aos profissionais de saúde, sobre precaução de uso de medicamentos cardiovasculares em idosos. METODOLOGIA: Trata-se de estudo documental realizado por meio de análise de dados contidos em bulas de medicamentos. Analisou-se a existência, na bula, de informações sobre precauções no uso de medicamentos para idosos, conforme descrito no Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016. RESULTADOS: Dos 29 medicamentos pertencentes ao grupo do sistema cardiovascular que devem ser evitados por idosos e estão disponíveis no Brasil, 15 independem da condição clínica prévia do paciente para que sejam vetados para os idosos. Desses 15, apenas 3 medicamentos (20%) têm informações explícitas concordantes com o Consenso (metildopa, digoxina e espironolactona); 2 (13,33%) têm informações explícitas ausentes; 4 (26,66%) têm informações explícitas discordantes; e 6 bulas (40%) foram categorizadas como informações não explícitas. Quanto às precauções dos medicamentos de acordo com a condição clínica do paciente, incluíram-se 14 medicamentos que devem ser evitados por idosos e estão disponíveis no Brasil. Destes, 12 (85,71%) têm em suas bulas recomendações concordantes com o Consenso, porém não explícitas, e 2 (14,28%) não têm as contraindicações. CONCLUSÕES: A maioria das bulas carece de informações sobre precauções de uso de medicamentos para a população idosa.

OBJECTIVE: To analyze the existence of information on drug labeling intended for health professionals on the precaution of cardiovascular drugs use in older people. METHODS: This is a documentary study, carried out with the analysis of data contained in drug labelings. The existence of information on precautions in the use of drugs for older people as described in the 2016 Brazilian Consensus on Potentially Inappropriate Drugs for Older People (Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016). RESULTS: Of the 29 drugs belonging to the cardiovascular system group that should be avoided by older people and are available in Brazil, 15 are independent of the clinical condition. Of these fifteen, only three drugs (20%) have explicit information in accordance with the Consensus (methyldopa, digoxin, and spironolactone); two (13.33%) have missing explicit information; four (26.66%) have explicitly discordant information; and six drug labels (40%) were categorized as non-explicit information. Regarding drug precautions according to clinical condition, 14 drugs were included. Of these, 12 (85.71%) have equal contraindications of that of Consensus on their drug labels, however, non-explicit; and two (14.28%) contraindications are missing. CONCLUSION: Most drug labels lack information on the precautions for the use of drugs in older people.

Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado / Proportion of patients with heart failure in a specialized clinic eligible for novel therapies

Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials. Material and Methods: Cross-sectional study on 158 patients aged 62 ± 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined. Results: In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 ± 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril ≥ 20 mg / day or losartan ≥ 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate < 70 / min when receiving a maximal tolerated dose of beta-blockers, were present in 22%. Conclusions: A low percentage of our patients were eligible for these therapies. Among the causes that explain these results were clinical stability, a high percentage of patients in functional class I and being in a disease modifying treatment.

Adherencia farmacológica y prevención secundaria cardiovascular: una de las principales barreras en el tratamiento de la enfermedad ateroesclerótica: posición del Departamento de Prevención Cardiovascular de SOCHICAR en el uso de la polipíldora en prevención secundaria / Adherence to pharmacologic treatment in secondary prevention of cardiovascular disease

This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.

Use of medicines recommended for secondary prevention of acute coronary syndrome / Uso de medicamentos recomendados na prevenção secundária da síndrome coronariana aguda

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

RESUMO OBJETIVO : Analisar se variáveis demográficas e socioeconômicas e intervenção coronária percutânea estão associadas ao uso de medicamentos para prevenção secundária da síndrome coronariana aguda. MÉTODOS : Neste estudo de coorte, foram incluídos 138 pacientes com síndrome coronariana aguda, com idade igual ou superior a 30 anos e de ambos os sexos. Os dados foram coletados no momento da alta hospitalar e após seis e 12 meses da alta. O desfecho do estudo foi o uso simultâneo dos medicamentos recomendados para prevenção secundária da síndrome coronariana aguda: antiagregante plaquetário, betabloqueador, estatina e inibidor da enzima conversora de angiotensina ou bloqueador do receptor de angiotensina. As variáveis independentes foram: sexo, idade, escolaridade em anos de estudo, renda mensal em tercis e intervenção coronária percutânea. Descreveu-se a prevalência do uso de cada grupo de medicamento com respectivos intervalos de confiança de 95%, bem como o uso simultâneo dos quatro, em todos os períodos analisados. Na análise bruta verificou-se a associação do desfecho com as variáveis independentes para cada período por meio do teste Qui-quadrado. A análise ajustada foi realizada por Regressão de Poisson. RESULTADOS : Mais de um terço dos pacientes (36,2%; IC95% 28,2;44,3) recebeu prescrição dos quatro medicamentos, simultaneamente, no momento da alta. Não foram observadas diferenças nas prevalências de uso na comparação com os dois períodos de seguimento. A classe de medicamento mais prescrita na alta foi antiagregante plaquetário (91,3%). Na análise bruta, as variáveis demográficas e socioeconômicas não se associaram ao desfecho em nenhum dos três períodos. CONCLUSÕES : A prevalência de uso simultâneo dos medicamentos na alta e nos seguimentos apontou para a subutilização dessa terapêutica na prática clínica. São necessárias estratégias de intervenção para melhoria da qualidade da atenção dada aos pacientes que se estendam além da alta hospitalar, um ponto crítico de transição no cuidado.

Migration of a sirolimus-eluting stent from the ostium of the left main coronary artery to the right deep femoral artery

No abstract available.

Clinical outcomes between different stent designs with the same polymer and drug: comparison between the Taxus Express and Taxus Liberte stents

BACKGROUND/AIMS: The Taxus Liberte stent (Boston Scientific Co.) evolved from the Taxus Express stent, with enhanced stent deliverability and uniform drug delivery. This study was designed to compare angiographic and clinical outcomes in real-world practice between the Taxus Liberte and Taxus Express stents. METHODS: Between 2006 and 2008, 240 patients receiving the Taxus Liberte stent at three centers were registered and compared to historical control patients who had received the Taxus Express stent (n = 272). After propensity score matching, 173 patients treated with the Taxus Liberte stent and the same number of patients treated with the Taxus Express stent were selected. The primary outcome was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), ischemia driven target vessel revascularization (TVR), and stent thrombosis (ST) at 1 year. An additional angiographic assessment was conducted at 9 to 12 months. RESULTS: The study showed no significant difference between the Taxus Express and Taxus Liberte stents (death, 1.73% vs. 2.31%, p = 1.000; MI, 0% vs. 1.73%, p = 0.2478; TVR, 2.31% vs. 1.16%, p = 0.6848; and ST, 0% vs. 1.16%, p = 0.4986). The total MACE rate at 1 year did not differ between the groups (4.05% in Taxus Express vs. 4.05% in Taxus Liberte, p = 1.000). In addition, the binary restenosis rate did not differ (2.25% in Taxus Express vs. 1.80% in Taxus Liberte, p = 0.6848). CONCLUSIONS: In real-world experience with the two Taxus stent designs, both stents showed similarly good clinical and angiographic outcomes at 1 year. A long-term follow-up study is warranted.

Clinical Characteristics of Coronary Drug-Eluting Stent Fracture: Insights from a Two-Center DES Registry

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.

Clinical Characteristics of Coronary Drug-Eluting Stent Fracture: Insights from a Two-Center DES Registry

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.

Fundamento e desenho do teste randomizado PAINT / Rationale and design for the PAINT randomized trial / Fundamento y diseño del test randomizado PAINT

Fundamento: Descrevemos as bases teóricas e o formato do "Estudo PAINT - Intervenção percutânea com stents com eluição de paclitaxel ou sirolimus em polímero biodegradável comparados com stents sem recobrimento no tratamento de lesões coronárias de novo". Objetivo: Avaliar duas novas formulações de stents com eluição de paclitaxel ou sirolimus em comparação com um stent de estrutura metálica idêntica, porém sem recobrimento polimérico ou eluição de droga. Métodos: O PAINT é um estudo randomizado, multicêntrico, de 3 braços, conduzido em centros terciários brasileiros, que incluiu 275 pacientes alocados para tratamento com os stents InfinniumR (paclitaxel), the SupralimusR (sirolimus) ou Milennium MatrixR (sem recobrimento) na proporção 2:2:1 ratio. Os pacientes apresentavam lesões coronarianas de novo em vasos nativos com um diâmetro entre 2,5 e 3,5 mm, passíveis de tratamento com um único stent com comprimento de 29 mm ou menos. O objetivo primário era comparar a perda tardia aos nove meses de ambos stents com paclitaxel- ou sirolimus versus a perda luminal dos stents convencionais de controle. Objetivos secundários importantes incluíam a comparação angiográfica entre os dois tipos de stents farmacológicos, bem como a análise da ocorrência de eventos clínicos adversos. Resultados e conclusões: O estudo PAINT apresenta um formato peculiar e único que permitiu a avaliação da segurança e eficácia de duas novas formulações de stents farmacológicos, com carreador polimérico biodegradável, e liberação de paclitaxel ou sirolimus, os quais foram comparados contra um stent metálico convencional (objetivo primário). Uma vez que os stents farmacológicos diferiram entre sí somente pela droga, mas eram idênticos nas suas outras características, os estudo também permitiu a comparação do efeito anti-restenótico entre sirolimus e paclitaxel (objetivo secundário).

Background: We describe the rationale and design for the "PercutAneous Intervention with biodegradable-polymer based paclitaxel-eluting or sirolimus-eluting versus bare stents for de novo coronary lesions - PAINT trial". Objectives: To evaluate two novel formulations of paclitaxel-eluting stent and the sirolimus-eluting stent against a stent with the same metallic structure but without polymer coating or drug elution. Methods: The PAINT is a multicenter 3-arm randomized trial, conducted in Brazilian tertiary institutions, which included 275 patients allocated for the InfinniumR paclitaxel-eluting stent, the SupralimusR sirolimus-eluting stent or the Milennium MatrixR bare metal stent in a 2:2:1 ratio. Patients had de novo coronary lesions in native vessels with a diameter between 2.5 and 3.5 mm, amenable for treatment with a single stent of 29 mm or less in length. The primary objetive was to compare the in-stent late loss at 9 months of both paclitaxel- and sirolimus-eluting versus the late loss of control bare metal stents. Important secondary objectives included the comparison in outcomes between sirolimus and paclitaxel stents, as well as the analysis of the incidence of major adverse cardiac events. Results amd conclusions: The PAINT trial had a unique design that allowed for the evaluation of the safety and efficacy profiles of two novel drug-eluting stent formulations, with a biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which were compared against a bare metal stent (primary objective). As the drug-eluting stents differed by the drug, but were identical otherwise, the trial also allowed the comparison of the anti-restenosis effects of sirolimus versus paclitaxel (secondary objective).

Fundamento: Describimos las bases teóricas y el formato del "Estudio PAINT - Intervención percutánea con stents recubiertos de paclitaxel o sirolimus en polímero biodegradable comparados con stents no recubiertos en el tratamiento de lesiones coronarias de novo". Objetivo: Evaluar dos nuevas formulaciones de stents con liberación de paclitaxel o sirolimus en comparación con un stent de estructura metálica idéntica, pero sin recubierto polimérico o liberación de droga. Métodos: El PAINT es un estudio randomizado, multicéntrico, de 3 brazos, llevado a cabo en centros terciaros brasileños, que incluyó a 275 pacientes destinados a tratamiento con los stents InfinniumR (paclitaxel), the SupralimusR (sirolimus) o Milennium MatrixR (no recubierto) en la proporción 2:2:1. Los pacientes presentaban lesiones coronarias de novo en vasos nativos con un diámetro entre 2,5 y 3,5 mm, pasibles de tratamiento con un único stent de hasta 29 mm de longitud. El objetivo primario era comparar la pérdida luminal tardía a los nueve meses de ambos stents con paclitaxel- o sirolimus versus la pérdida luminal de los stents convencionales de control. Los objetivos secundarios importantes incluían la comparación angiográfica entre los dos tipos de stents farmacológicos, así como el análisis de la ocurrencia de eventos clínicos adversos. Resultados y conclusiones: El estudio PAINT presenta un formato peculiar y único que permitió la evaluación de la seguridad y eficacia de dos nuevas formulaciones de stents farmacológicos, con transportador polimérico biodegradable, y liberación de paclitaxel o sirolimus, los que fueron comparados con un stent metálico convencional (objetivo primario). Dado que los stents farmacológicos diferían entre sí solamente por la droga, pero eran idénticos en sus otras características, el estudio también permitió la comparación del efecto antireestenótico entre sirolimus y paclitaxel (objetivo secundario).

Administration of aqueous extract of Desmodium gangeticum (L) root protects rat heart against ischemic reperfusion injury induced oxidative stress.

Myocardial reperfusion is believed to be associated with free radical injury. The present study evaluates the effect of aqueous extract of D. gangeticum (DG) on lipid peroxides and antioxidants in ischemic reperfused (IR) Wistar albino male rats. Significant elevation in lipid peroxide products (thiobarbituric acid reactive substances) and decreased activity of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase) were observed in the rat hearts during ischemia reperfusion phase. Pre treatment of rats with aqueous extract of DG orally for 30 days showed significantly improved preservation of antioxidant enzymes and subsequent reduction in lipid peroxidation. But 2,3,5 triphenyl tetrazolium chloride (TTC) stained rat heart did not show much significant antioxidant enzyme activities and lipid peroxidation. On the other hand, TTC unstained rat heart showed significant improvement in the antioxidant activities indicating cardio protective effect of aqueous extract of DG in myocardium affected by ischemia reperfusion insult. The administration of DG to normal rats did not have any significant effect on any of the parameter studied. These results indicate that DG improves the antioxidant capacity of heart and attenuate the degree of lipid peroxidation after IR.

Aldosterone receptor antagonists induce favorable cardiac remodeling in diastolic heart failure patients / Antagonistas de receptores de aldosterona inducen remodelación cardiaca favorable en pacientes con insuficiencia cardiaca diastólica

Background. Serum levels of aldosterone in heart failure are increased up to 20 times compared to normal subjects. After an acute myocardial infarction, aldosterone increases progressively as well as interstitial fibrosis and collagen synthesis from cardiac fibroblasts, forming a patchy heterogeneous interstitial collagen matrix that affects ventricular function. Even if angiotensine converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) can reduce aldosterone levels early during treatment, they increase again after a 12 week treatment. The aim of this study was to evaluate the changes in structure and function of the left ventricle in symptomatic (NYHA I-III) diastolic heart failure patients receiving an aldosterone receptor antagonist. Methods. Twenty-eight subjects with diastolic heart failure, on BB, ACEI and/or ARA were randomized to receive spironolactone (group A) on a mean dose of 37.5 mg once a day (n =14, age 63.7 ± 21.6 years and body mass index, BMI 27.5 ± 9.4), or not (group B, n = 14, Age 64.8 ± 11.9, BMI 26.9 ± 4.7). All patients were followed-up for a mean of 13.79 ± 0.99 months. Results. Group A showed a 42.8% ischemic origin of heart failure, while in group B was 55% (p = 0.2). No other co-morbidities were significativelly different among both groups. Mean percentage of changes by echocardiogram was as follows: Interventricular septum (IVS) -12.2 ± 11% vs. 1.3 ± 15.2 (p = 0.03), pulmonary systolic artery pressure (PSAP was 0.99 ± 3.8% vs. 10.5 ± 9.1, p = 0.05). Other parameters did not show statistically significant differences. Conclusion. Aldosterone receptor antagonists reduce or avoid increasing of PSAP and inducing a favorable remodeling of the left ventricle, especially in the IVS in diastolic heart failure patients.

Antecedentes. En pacientes con insuficiencia cardiaca existen aumentos de aldosterona hasta 20 veces mayores que en sujetos control. Después de un infarto miocárdico la aldosterona aumenta progresivamente, así como la fibrosis intersticial y la síntesis de colágena por fibroblastos cardiacos, provocando parches intersticiales heterogéneos en la matriz de colágena que afecta la función ventricular. El tratamiento inicial con inhibidores de enzima convertidora de angiotensina (IECA) y/o antagonistas de receptores de angiotensina II (ARA) puede reducir estos niveles; sin embargo, aumentan nuevamente después de 12 semanas de tratamiento. El propósito de este estudio fue evaluar los cambios estructurales y funcionales en el ventrículo izquierdo en pacientes con insuficiencia diastólica tratados con ARA angiotensina (NYHAI-III). Métodos. Veintiocho pacientes con insuficiencia cardiaca diastólica en tratamiento con BB, IECA y/o ARA se aleatorizaron a recibir una dosis media de 37.5 mg una vez al día de espironolactona (grupo A) (n - 14, edad 63.7 ± 0 21.6 años e índice masa corporal IMC 27.5 ± 9.4), o no (grupo B, n =14, edad 64.8 ± 11.9, IMC 26.9 ± 4.7). Todos los pacientes fueron seguidos por 13.79 ± 0.99 meses. Resultados. De los pacientes del grupo A, 42.8% y el 55 del grupo B (p = 0.2), tenían cardiopatía isquémica. No se encontraron diferencias significativas en otras comorbilidades. El porcentaje promedio de cambios en el ecocardiograma se observó en septum interventricular (SIV) -12.2 ± 11% vs. 1.3 ± 15.3% (p = 0.02), y la presión sistólica de la arteria pulmonar (PSAP, 0.99 ± 3.8% vs. 10.5 ± 9.1, p = 0.05, para los grupos A y B, respectivamente). Los otros parámetros no mostraron diferencias estadísticamente significativas. Conclusión. El tratamiento con antagonistas de receptores de aldosterona disminuye o limita aumentos de PSAP e inducen una remodelación favorable del ventrículo izquierdo, especialmente del SIV en pacientes con insuficiencia cardiaca diastólica.

Efecto del diltiazem sobre los lípidos séricos y lesiones ateroscleróticas en conejos hipercolesterolemicos / Effect of the diltiazem on the seric lipids and atherosclerotics lesions in hypercholesterolemics rabbits

El propósito de este estudio fue evaluar si la administración de diltiazem (30mg/día(vía oral), disminuye la hipercolesterolemia e inhibe la aterosclerosis en 38 conejos machos hipercolesterolemicos. Control: Conejarina por doce semanas, A: dieta rica con 0,3 por ciento de colesterol (DH) por doce semanas. B: DH por doce semanas y desde la tercera semana hasta la dodécima diltiazem, Grupo C: DH por dos semanas y Conejarina + diltiazem desde la tercera semana hasta la duodécima y D: DH por dos semanas y Conejaría desde la tercera hasta la duodécima semana. Se determinaron Colesterol Total (CT), LDL-colesterol (LDLc) y Triglicéridos (Tg) por métodos enzimáticos. A la duodécima semana, se sacrificaron los conejos y el estudio histológico fue realizado por los siguientes métodos: 1. Hematoxilina Eosina evaluó la presencia de lesiones, 2. Gomori's: evaluó la profundidad de las lesiones 3. Computarizado: midió la extensión de las lesiones. En el grupo A y B aumentaron significativamente el CT, LDLc y Tg en relación al control en todos los periodos, a excepción de los Tg a la duodécima semana. Respectoa las lesiones ateroscleróticas, los grupos A y B presentaron lesiones tipo II, III, IV y V, el porcentaje promedio de área lesionada fue: Grupo A: 47,20 por ciento, Grupo B: 57, 60 por ciento. Estos resultados permiten concluir que el diltiazem ejerce un efecto hipolipidemiante cuando se administra junto con una dieta rica en 0,3 por ciento colesterol, se confirma que una dieta adecuada es una buena estrategia para prevenir las displidemías y que el diltiazem no previno, ni indujo regresión de las lesiones ateroscleróticas.

Clinical profile and management of PDA in neonates.

Patent ductus arteriosus (PDA) is recognised more often with increasing survival of preterm babies. The pharmacological closure of ductus by indomethacin has changed the management of PDA. Twenty neonates admitted over a period of 21 months to Neonatal Intensive Care Unit (NICU) of M.S. Ramaiah Medical College hospital, Bangalore, who were diagnosed to have PDA, were analyzed. The objectives of this retrospective analysis were to study the clinical profile, the efficacy of oral indomethacin and the outcome of PDA. 2-D and Doppler echocardiaography were used to confirm the clinically suspected PDA. These neonates were treated with 3 doses of oral indomethacin (0.2-0.25 mg/kg/dose 12 hourly) along with fluid restriction and oxygen. Echocardiography was repeated to demonstrate the closure of PDA. The incidence of PDA was 2.3% of total NICU admissions. Seventy percent of this cohort were < 32 weeks of gestation, 55% had birth weight of < 1500 gms. Seventy percent (14) neonates had onset of PDA after 48 hrs of life. 81.25% of neonates responded to indomethacin and overall survival rate in treated group was 67%. Drug related complications were noted in 2 newborns. This study illustrates the utility of echocardiography in diagnosing and monitoring PDA in preterm and low birth weight babies with high index of suspicion of this common congenital heart disease. Pharmacological intervention with indomethacin is rewarding with acceptable results.

Low-dose intravenous diltiazem--efficacy and safety in supraventricular tachyarrhythmias.

Intravenous diltiazem has been used to rapidly reduce ventricular rate in patients with supraventricular tachyarrhythmias (SVTs). This study assesses the efficacy and safety of a low-dose (0.1 mg/kg) intravenous bolus of diltiazem on the heart rate and blood pressure. Fifteen consecutive patients were treated for 21 episodes of atrial fibrillation, sinus tachycardia or ectopic atrial tachycardia. The bolus dose reduced the heart rate significantly in all patients with atrial fibrillation within 5 min (173 +/- 21 to 144 +/- 27 beats/min, p < 0.05) with the maximum response seen at 10 min (128 +/- 26.7 beats/min, p < 0.05). However, patients with sinus tachycardia showed a significant decrease in heart rate only at 15 min (147 +/- 12 to 123 +/- 15 beats/min, p < 0.05). One patient with ectopic atrial tachycardia required maintenance infusion of diltiazem. Conversion to sinus rhythm was observed in another patient with atrial fibrillation. The drug was well tolerated with no significant hypotension, bradyarrhythmia or aggravation of pre-existing congestive heart failure. It is concluded that Indian patients require a lower dose of intravenous diltiazem as compared to Western ones (0.1 mg/kg versus 0.25-0.33 mg/kg) which gives a prompt, effective and safe response in patients with SVTs.