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Resumen: La necesidad de distanciamiento social impuesta por la actual pandemia por coronavirus obligó a las diferentes sociedades científicas a realizar sus actividades en formato completamente virtual. La Sociedad Europea de Cardiología no ha sido la excepción. Desde el 29 de agosto al 1 de septiembre de 2020 se celebró este evento sin precedentes que, además de contar con 125.000 profesionales de 213 países, permitió el acceso gratuito a todos los cibernautas. De esta manera, la actualidad en cardiología pudo llegar a todos los rincones del mundo, pese a las circunstancias tan complejas. Como ya es tradición de la revista, realizamos un resumen de los principales ensayos presentados durante el congreso: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)
Summary The need for social distancing imposed by the current coronavirus pandemic, forced the different scientific societies to carry out their activities in a completely virtual format. And the European Society of Cardiology has not been the exception. From August 29 to September 1 of 2020, this unprecedented event was held which, in addition to having 125,000 health professionals from 213 countries, allowed free access to all netizens. In this way, current affairs in cardiology could reach all corners of the world, despite such complex circumstances. As is the tradition of the magazine, we present a summary of the main essays presented during the congress: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)
Resumo A necessidade de distanciamento social imposto pela atual pandemia do coronavírus, obrigou as diferentes sociedades científicas a desenvolverem suas atividades de forma totalmente virtual. E a Sociedade Europeia de Cardiologia não foi exceção. De 29 de agosto a 1º de setembro 2020, foi realizado esse evento inédito que, além de contar com 125.000 profissionais de saúde de 213 países, possibilitou o acesso gratuito a todos os internautas. Dessa forma, a atualidade da cardiologia pode atingir todos os cantos do mundo, apesar de circunstâncias tão complexas. Como é tradição da revista, apresentamos um resumo dos principais ensaios apresentados durante o congresso: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)
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Resumen: Del 16 al 18 de noviembre de 2019 se celebró en la ciudad de Philadelphia una nueva reunión del congreso anual del American College of Cardiology. Es uno de los eventos más relevantes de la cardiología mundial, y contó en esta oportunidad con la participación de destacados profesionales que presentaron los últimos ensayos clínicos en las sesiones de Late Breaking Science, abordando diferentes aspectos de la especialidad: estrategias innovadoras para reducir el riesgo cardiovascular, resultados de los ensayos de isquemia, controversias en el manejo contemporáneo de la estenosis aórtica, estado del arte del manejo de pacientes con síndromes coronarios agudos, desafíos en insuficiencia cardíaca y nuevas fronteras en la terapia lipídica. A continuación presentamos un resumen de los principales trabajos presentados: - The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF). - The COLchicine Cardiovascular Outcomes Trial (COLCOT). - Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcathether Aortic Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results. - RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes (ISCHEMIA).
Summary: A new meeting of the annual congress of the American College of Cardiology, was held from November 16 to 18 last year; located in the city of Philadelphia. As one of the most important events in global cardiology, it was attended by leading professionals who were the last clinical trials in the Late Breaking Science sessions, which addressed different aspects of the specialty: innovative strategies to reduce cardiovascular risk, results of the trials of ischemia, controversies in the contemporary management of aortic stenosis, state of the art of the management of patients with acute coronary syndromes, challenges in heart failure and new frontiers in lipid therapy. We will make a brief summary of the main presented trials: - The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF). - The COLchicine Cardiovascular Outcomes Trial (COLCOT). - Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcathether Aortic Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results. - RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes (ISCHEMIA).
Resumo: Uma nova reunião do congresso anual do Colégio Americano de Cardiologia, foi realizada de 16 a 18 de novembro do ano passado; localizado na cidade de Filadélfia. Como um dos eventos mais importantes da cardiologia global, contou com a presença de profissionais líderes que apresentaram os últimos ensaios clínicos nas sessões de Late Breaking Science, que abordaram diferentes aspectos da especialidade: estratégias inovadoras para reduzir o risco cardiovascular, resultados dos ensaios de isquemia, controvérsias no tratamento contemporâneo da estenose aórtica, estado da arte do tratamento de pacientes com síndromes coronárias agudas, desafios na insuficiência cardíaca e novas fronteiras na terapia lipídica. Faremos um breve resumo dos principais trabalhos apresentados: - The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF). - The COLchicine Cardiovascular Outcomes Trial (COLCOT). - Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcathether Aortic Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results. - RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes (ISCHEMIA).
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Resumen: El 35° Congreso Uruguayo de Cardiología tuvo lugar en Punta del Este, del 7 al 9 de noviembre. Como cada año, constituyó una oportunidad de actualización en diferentes áreas de la cardiología, contando con la participación de invitados nacionales e internacionales. Asimismo, se dio a conocer la actividad científica desarrollada por diferentes autores mediante la exposición de temas libres. A continuación, comentamos los siete artículos premiados por el Comité Científico. - Prevención de muerte súbita (PREMUDE) en jugadores de fútbol: 10 años de valoración precompetitiva. - Perfil clínico de la fibrilación auricular en el posoperatorio de cirugía cardíaca. - Protocolo de cardio-oncología para el seguimiento de pacientes con riesgo de disfunción ventricular por quimioterapia. - Implicancia del uso del score de calcio coronario en la re-estratificación del riesgo cardiovascular en prevención primaria. - Análisis de la morbimortalidad asociada a implante percutáneo de válvula aórtica: valor de variables clínicas y scores de riesgo a mediano plazo. - Anticoagulación en bioprótesis valvular aórtica. Ensayo clínico randomizado multicéntrico. - Strain global longitudinal del ventrículo izquierdo permite predecir mejoría funcional y sobrevida en pacientes con insuficiencia mitral severa asintomática y función normal. Metaanálisis.
Summary: The 35th Uruguayan Congress of Cardiology was held in Punta del Este in November 7th to 9th. As every year, it was an opportunity to update in different cardiovascular areas with participation of national and international guests. Scientific activity of different authors was also announced, through exposition of several articles. We will comment the seven awarded abstracts. - Sudden death prevention (PREMUDE) in soccer players: 10 years of pre-competitive assessment. - Clinical profile of atrial fibrillation in the postoperative period of cardiac surgery. - Cardio-oncology protocol for the follow-up of patients at risk of ventricular dysfunction due to chemotherapy. - Implication of the use of coronary calcium score in the re-stratification of cardiovascular risk in primary prevention. - Analysis of morbidity and mortality associated with percutaneous aortic valve implantation: value of clinical variables and medium-term risk scores. - Anticoagulation in aortic valve bioprosthesis. Multicenter randomized clinical trial. - Longitudinal global left ventricular strain allows prediction of functional improvement and survival in patients with severe asymptomatic mitral regurgitation and normal function. Meta-analysis.
Resumo: O 35º Congresso Uruguaio de Cardiologia, aconteceu em Punta del Este, de 7 a 9 de novembro. Como todos os anos, foi uma oportunidade de atualização em diferentes áreas cardiológicas, graças à experiência de convidados nacionais e internacionais. Também foi anunciada a atividade científica de diferentes serviços, através da exposição de vários artigos. Propomos comentar os sete artigos premiados. - Prevenção de morte súbita (PREMUDE) em jogadores de futebol: 10 anos de avaliação pré-competitiva. - Perfil clínico da fibrilação atrial no pós-operatório de cirurgia cardíaca. - Protocolo cardio-oncológico para acompanhamento de pacientes com risco de disfunção ventricular devido à quimioterapia. - Implicação do uso do escore de cálcio coronariano na ré estratificação do risco cardiovascular na prevenção primária. - Análise da morbimortalidade associada ao implante valvar aórtico percutâneo: valor de variáveis clínicas e escores de risco a médio prazo. - Anticoagulação na bioprótese valvar aórtica. Ensaio clínico randomizado multicêntrico. - O strain global longitudinal do ventrículo esquerdo permite predizer melhora funcional e sobrevida em pacientes com insuficiência mitral assintomática grave e função normal. Meta-análise.
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Resumen: La pandemia generada por el SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) ha constituido un desafío mundial. En momentos de dificultad como los que se han presentado recientemente, es aún más necesaria la investigación para avanzar en el diagnóstico y tratamiento de las diferentes patologías. Utilizando el amplio desarrollo de los medios de comunicación, este año el Congreso del Colegio Americano de Cardiología (ACC por su sigla en inglés) se celebró del 28 al 30 de marzo en un formato virtual, permitiendo a profesionales de todo el mundo acceder a múltiples actividades científicas con el mismo nivel de excelencia que en las sesiones presenciales. Realizaremos un breve resumen de alguno de los principales trabajos científicos presentados: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR-PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.
Summary The SARS-CoV-2 pandemic has been a global challenge. In times of difficulty such as those that have recently arisen, research is even more necessary to advance in the diagnosis and treatment of different pathologies. Using the extensive development of the media, this year the American Congress of Cardiology was held from March 28 to 30 in a virtual format, allowing professionals from around the world to access multiple scientific activities with the same level of excellence as in face-to-face sessions. We will make a brief summary of some of the main scientific papers presented: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR-PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial:. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial. - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.
Resumo: A pandemia de SARS-CoV-2 tem sido um desafio global. Em tempos de dificuldade como os que surgiram recentemente, a pesquisa é ainda mais necessária para avançar no diagnóstico e tratamento de diferentes patologias. Utilizando o amplo desenvolvimento da mídia, este ano o Congresso Americano de Cardiologia foi realizado de 28 ao 30 de março em um formato virtual, permitindo que profissionais de todo o mundo acessassem diversas atividades científicas com o mesmo nível de excelência que nas sessões presenciais. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR - PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial. - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.
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Resumen: La pandemia actual generada por el nuevo coronavirus (SARS-CoV-2) ha constituido desde su aparición, el foco de preocupación sanitaria a nivel mundial. Su elevada transmisibilidad asociada a la ausencia de un tratamiento eficaz, implica un duro impacto en el área de investigación. Los reportes sobre formas de presentación atípicas, factores de riesgo asociados y fármacos ensayados para disminuir su morbimortalidad, saturan los medios de comunicación. La comunidad cardiológica se encuentra activamente presente, ya que las manifestaciones cardiovasculares son frecuentes y variadas, así como también se ha observado un aumento del riesgo de mala evolución en aquellos individuos con enfermedad cardiovascular previa. El objetivo de la revisión es aportar la evidencia disponible en este tópico, haciendo la salvedad del carácter dinámico de la información.
Summary: The current pandemic caused by the new coronavirus (SARS-CoV-2) has been the focus of global health concern since its appearance. Its high transmissibility associated with the absence of an effective treatment implies a hard impact in the research area. Reports of atypical presentation forms, associated risk factors, and drugs tested to decrease morbidity and mortality saturate the media. The cardiology community is actively present since cardiovascular manifestations are frequent and varied, as well as an increased risk has been observed in those patients with previous cardiovascular disease. The objective of this review is to contribute the available evidence on this particular topic, making the caveat, of the dynamic nature of the information.
Resumo: A atual pandemia causada pelo coronavírus (SARS-CoV-2) tem sido o foco de preocupações globais com a saúde desde o seu surgimento. Sua alta transmissibilidade associada à ausência de um tratamento efetivo implica forte impacto na área de pesquisa. Relatos de formas de apresentação atípicas, fatores de risco associados e medicamentos testados para diminuir a morbimortalidade saturam a mídia. A comunidade de cardiologia está ativamente presente, pois as manifestações cardiovasculares são frequentes e variadas, bem como um risco aumentado foi observado nos pacientes com doença cardiovascular anterior. O objetivo desta revisão é contribuir com as evidências disponíveis sobre esse tópico em particular, tornando a advertência da natureza dinâmica das informações.
RESUMO
Resumen: La insuficiencia mitral aguda por rotura de músculo papilar, como complicación del infarto agudo de miocardio (IAM), ha disminuido su incidencia con las estrategias de reperfusión miocárdica coronaria. La actual pandemia (COVID-19) ha generado alerta en la comunidad cardiológica por el riesgo de consultas tardías en pacientes con síndrome coronario agudo, con las consecuencias derivadas de una reperfusión tardía. Presentamos el caso de una paciente con IAM que en la evolución padece esta complicación.
Summary: Acute mitral regurgitation from ruptured papillary muscle such, as complication of acute myocardial infarction, has decreased its incidence with myocardial coronary reperfusion strategies. The current pandemic (COVID-19) has generated an alert in the cardiology community due to the risk of late consultations in patients with acute coronary syndrome, with the consequences derived from a late reperfusion. We present the case of a patient with acute myocardial infarction who in evolution suffers this complication.
Sumário: Regurgitação mitral aguda do músculo papilar rompido, como complicação do infarto agudo do miocárdio, sua incidência diminuiu com estratégias de reperfusão miocárdica coronário. A pandemia atual (COVID-19) gerou um alerta na comunidade de cardiologia devido ao risco de consultas tardias em pacientes com síndrome coronariana aguda, com as consequências derivado de uma reperfusão tardia. Apresentamos o caso de uma paciente com infarto agudo do miocárdio que na evolução sofre essa complicação.
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Resumen: Como todos los años, en esta oportunidad se celebró el 68º Congreso del Colegio Americano de Cardiología (ACC, por su sigla en inglés) entre los días 16 y 18 de marzo en Nueva Orleans, Luisiana. Ambientado en la ciudad del Mardi Gras y el jazz, nuevamente convocó a la cardiología mundial para promover el conocimiento a través de la presentación de múltiples actividades científicas. Contó con la presencia de más de 16.000 asistentes y se recibieron 2.300 artículos, muchos de los cuales, sin duda, modificarán la práctica clínica actual. Cabe destacar, asimismo, la presentación de la Guía de Prevención Primaria de la Enfermedad Cardiovascular, donde resalta el casi total abandono del ácido acetilsalicílico en prevención primaria debido a la falta de beneficio neto. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study
Summary: As every year, on this occasion the 68th Congress of the American College of Cardiology was held from March 16 to 18 in New Orleans, Louisiana. Set in the city of Mardi Gras and jazz, it once again called on global cardiology to promote knowledge through the presentation of multiple scientific activities. It counted with the presence of more than 16.000 attendees and 2.300 articles were received, many of which will undoubtedly modify the current clinical practice. It is also worth mentioning the presentation of the Primary Prevention of Cardiovascular Disease Guideline, which highlights the almost total discontinuation of acetylsalicylic acid in primary prevention due to the lack of net benefit. We will make a brief summary of some of the main scientific papers presented: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study
Resumo: Como todos os anos, nesta ocasião, o 68º Congresso do Colégio Americano de Cardiologia (ACC após sua sigla em inglês) foi realizado de 16 a 18 de março em Nova Orleans, Louisiana. Situado na cidade do Mardi Gras e jazz, mais uma vez convidou a cardiologia do mondo para promover o conhecimento através da apresentação de múltiplas atividades científicas. Contou com a presença de mais de 16.000 participantes e 2.300 artigos recebidos, muitos dos quais sem dúvida modificarão a prática clínica atual. Também vale ressaltar a apresentação da Diretriz para a Prevenção Primária de Doenças Cardiovasculares, que destaca o quase total abandono do ácido acetilsalicílico na prevenção primária devido à falta de benefício líquido. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study
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Resumen: La rotura del septum interventricular es una complicación grave del infarto agudo de miocardio (IAM), aunque poco frecuente. Se evidencia clínicamente como un deterioro hemodinámico progresivo, posterior al infarto. El ecocardiograma transtorácico es el principal estudio de imagen para el diagnóstico y la corrección quirúrgica constituye el pilar del tratamiento, ya que conlleva menor mortalidad que el tratamiento médico. Presentamos el caso de un paciente joven con IAM inferior que en la evolución presenta esta complicación, siendo intervenido de urgencia, con recuperación posterior.
Summary: The interventricular septum rupture is a serious, although infrequent complication of acute myocardial infarction. It is clinically evident as a progressive hemodynamic deterioration, after the infarction. Transthoracic echocardiography is the main imaging study for diagnosis, and surgical correction is the mainstay of treatment, since it has lower mortality than medical therapy. We present the case of a young patient with an inferior acute myocardial infarction, who presents this complication in the evolution, and was urgently operated, with subsequent recovery.
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Resumen: Introducción: la insuficiencia renal aguda (IRA) constituye una causa frecuente de morbimortalidad en el posoperatorio de cirugía cardíaca, con incidencia variable según la definición utilizada y los factores derivados del paciente y del procedimiento quirúrgico. Objetivo: los objetivos de este artículo fueron determinar la incidencia de IRA en un centro de cirugía cardíaca, la presencia de predictores y su asociación con mortalidad quirúrgica. Métodos: estudio prospectivo y observacional con elementos analíticos. Se incluyeron todos los pacientes con función renal normal y sin antecedentes de enfermedad renal sometidos a cirugía cardíaca en el período julio 2014 - julio 2015. Se determinó la creatininemia basal y a las 24 y 48 horas de la cirugía. La IRA fue definida utilizando el criterio RIFLE. Se valoró mortalidad quirúrgica y se analizaron variables pre e intraoperatorias como predictoras de desarrollo de IRA utilizando análisis uni y multivariado. Resultados: cumplieron los criterios de inclusión 400 pacientes. La incidencia de IRA por criterio RIFLE fue 10,3% (IC95% 8,7-11,8); la mortalidad quirúrgica en este grupo alcanzó 19,5%, mientras que en los controles fue 1,9%. Las variables asociadas al desarrollo de IRA fueron EuroSCORE más elevado, cirugía combinada, uso de circulación extracorpórea (CEC) y clampeo aórtico. La cirugía de revascularización miocárdica (CRM) presentó una asociación inversa con la aparición de IRA y constituyó predictor independiente en el análisis multivariado. La presencia de IRA fue un predictor independiente de mortalidad quirúrgica. Conclusiones: la incidencia de IRA es frecuente en el posoperatorio de cirugía cardíaca y se encuentra dentro de los valores internacionales. Su presencia implica mayor mortalidad quirúrgica.
Summary: Introduction: acute renal failure (ARF) is a frequent cause of morbidity and mortality in the postoperative period of cardiac surgery, with variable incidence depending on the definition used, factors derived from the patient and the surgical procedure. Objective: determine the incidence of ARF in a cardiac surgery center, the presence of predictors and its association with surgical mortality. Methods: this is a prospective and observational study with analytical elements. All patients with normal renal function and no history of kidney disease undergoing cardiac surgery were included in the period from July 2014 to July 2015. Baseline creatininemia was determined, and 24 and 48 hours later, after surgery. Acute renal failure was defined using the RIFLE criterion. Surgical mortality, pre and intra-operative variables were assessed using univariate and multivariate analysis. Results: four hundred patients met the inclusion criteria. The incidence of acute renal failure by RIFLE criterion was 10,3% (95% CI 8,7-11,8), surgical mortality in this group reached 19,5% while in controls it was 1,9%. The variables associated with the presence of ARF were the higher EuroSCORE, combined surgery, use of extracorporeal circulation and aortic clamping. The CRM presented an inverse association and was an independent predictor in the multivariate analysis. The presence of ARF was an independent predictor of surgical death. Conclusions: the incidence of ARF is frequent in the postoperative period of cardiac surgery and is within the international values. Its presence implies greater surgical mortality.
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Resumen: Los pacientes de mediana edad que requieren sustitución valvular aórtica quirúrgica constituyen un grupo en el que la decisión del tipo de prótesis a implantar (biológica o mecánica) continúa siendo discutida. Se realizó una búsqueda bibliográfica con el objetivo de determinar cuál de las prótesis beneficia más a este grupo. Cuando se evalúan las bioprótesis, la principal dificultad radica en el deterioro estructural, más intenso cuanto más joven es el paciente y que puede requerir reintervención por disfunción severa. Por otro lado, las prótesis mecánicas implican anticoagulación de por vida, con los riesgos derivados de este tratamiento. En el presente artículo se analiza la evidencia más significativa para orientar al médico clínico en la toma de decisiones.
Summary: Middle-aged patients who require surgical aortic valve replacement constitute a group in wich the decision of the type of prosthesis to implant (biological or mechanical) continues to be discussed. A bibliographic search was carried out in order to determine which of the prostheses benefits this group. When evaluating bioprostheses, the main difficulty lies in structural deterioration, more intense in the younger patient and that may require reintervention due to severe dysfunction. On the other hand, the mechanical prosthesis involve anticoagulation for life, with the risks derived from this treatment. The present article analyzes the most significant evidence to guide the clinical doctor in decision making process.
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El 33° Congreso Uruguayo de Cardiología, celebrado en Punta del Este del 9 al 11 de noviembre, constituye el evento científico cardiológico más importante del año a nivel nacional. Como es habitual contó con la presencia de destacados invitados locales e internacionales. En este marco se presentaron 23 temas libres que abarcaron diferentes áreas de la cardiología; a saber: cardiología clínica, cirugía cardíaca, electrofisiología, hemodinamia, imagen cardíaca y prevención cardiovascular. Dentro de ellos, comentaremos algunos de los más destacados. - Fenómeno de no reflujo en la angioplastia coronaria. Incidencia, tratamiento y eficacia con vasodilatadores coronarios. - La anticoagulación precoz luego de la colocación de bioprótesis aórtica se asocia a mejor pronóstico funcional. - Cardiotoxicidad por trastuzumab en pacientes con cáncer de mama. Serie de casos. - Strain auricular izquierdo por Speckle Tracking: protocolo para su estudio y creación de modelo para análisis segmentario.
The 33rd Uruguayan congress of cardiology, celebrated at Punta del Este from November 9th to 11th, is the most relevant national cardiologic scientific event of the year. It was attended by local and International guests, as usual. Twenty-three abstracts about different cardiologic topics were presented, namely: clinical cardiology, electrophysiology, cardiac surgery, hemodynamics, cardiac imaging and cardiovascular prevention. We will comment on some of the most relevant of them: - No-reflow phenomenon in percutaneous coronary intervention. Incidence, treatment and coronary vasodilators efficacy - Early anticoagulation after aortic bioprostheses implantation is associated with better functional prognosis - Trastuzumab cardiotoxicity in breast cancer patients. Case series. - Left atrial strain by Speckle tracking. Study protocol and creation of a new model for segmental analysis
Assuntos
Humanos , Cirurgia Torácica , Cardiologia , CongressoRESUMO
En este artículo las autoras presentan la manera en que desde la prensa escrita dominical (El Tiempo y El Espectador) y las revistas (Cambio y Semana) se observaron y describieron los fenómenos de la desmovilización y los desmovilizados, de la reinserción y los reinsertados, el marco legal que los regulaba y los problemas que enfrentaban las víctimas del conflicto armado durante los años 2004 y 2005. Describen en forma detallada los subtemas que la prensa escrita destaca en estos tres grandes temas. A partir de la forma y el estilo en que los medios construyen marcos interpretativos diferentes de estos fenómenos desde las crónicas, los reportajes y los artículos de opinión definen la "dimensionalidad del estado mental" y la "dimensionalidad informativa" lo que caracteriza a quienes hablan en la prensa escrita sobre estos fenómenos. En las crónicas se registra la información factual somera o detallada; en los reportajes se destacan las voces exigentes y amenazantes de los culpables y los logros y alabanzas de las autoridades y en los artículos de opinión se resaltan la crítica, los temores y las dudas sobre la realidad definida por los medios como importante. Terminan el artículo con una breve referencia a la mentalidad "copiadora-repetidora" y la mentalidad "acomodaticia-camaleónica" de los periodistas y a la mentalidad "reflexiva" de los columnistas.
In this article, the authors bring up the way in which the phenomena of demobilisation and demobilised people, reinsertion and reinserted people were observed by the Sunday written press (El Tiempo and El Espectador) and magazines (Cambio and Semana), including the legal framework that regulated them and the problems that the victims of the armed conflict had to go through during 2004 and 2005. They describe in detail the sub-topics that the written press highlights in these three great topics. From the way and style of the media to build different interpretative frameworks for these phenomena in their features, reports and opinion articles, the authors define the different "dimensionality of the mental state" and the "informative dimensionality" that characterise the people who speak in the written press about these phenomena. The features contain factual information either superficial or in detail; the reports highlight the demanding and threatening voices of the culprits and the achievements and praises of the authorities; last, the opinion articles are characterised by criticism, fear and doubts about the reality defined as important by the media. Finally, the authors make a brief reference to the "copying-repeating" mentality and the "accommodative-chameleon-like" mentality of the newspapers and the "reflective" mentality of the columnists.
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O estudo citofotométrico e citoquímico dos neurônios do núcleo istmo de Gallus gallus domesticus (L) com um dia e quatro meses de desenvolvimento pós-natal foi realizado com dois processos: violeta cresilo e ferro coloidal e um citofotomicroscópio Zeiss-modelo SMPH-01 unido a computador digital PDP-12. A pesquisa mostrou as diferenças existentes entre os neurônios das duas zonas do núcleo istmo: pars magnocelular e pars parvicelular. Nos pintos como um dia, os neurônios da pars magnocelular säo escassos e com áreas citoplasmáticas e nucleares grandes. O núcleo é bem delimitado, claro e com posiçäo excêntrica. Os neurônios la pars parvicelular säo pequenos e numerosos, com núcleos redondos e nucleólos visíveis. A forma da célula é ovóide e apresenta o citoplasma corado intensamente com violeta cresilo. A distribuiçäo dos valores de densidade óptica no citoplasma dos neurônios muda na pars magnocelular e na pars parvicelular. As células do núcleo istmo säo mais escuras, apresentando valores de densidade óptica mnuito alto, nos pintos com quatro meses. A reaçäo com ferro coloidal é mais forte nos exemplares com quatro meses. Sobre os resultados foram aplicados método estatísticos que permitem determinar as diferenças significativas