Assessment of atherothrombosis and its treatment in Mexico: first-year data of the REACH Registry.

BACKGROUND: Atherothrombosis, a generalized and progressive process, is currently a major healthcare problem in Mexico. METHODS: The worldwide Reduction of Atherothrombosis for Continued Health (REACH) registry aimed to evaluate risk factors for atherosclerosis, long-term cardiovascular (CV) event rates, and current management of either patients with established symptomatic atherosclerotic disease or asymptomatic subjects with multiple risk factors for atherothrombotic disease. One-year follow-up of the global REACH database was available for 64 977 outpatients. This report includes the Mexican subregistry wherein 62 internists, cardiologists, and neurologists evaluated baseline patient characteristics, risk factors, medications, and CV event rates as primary outcomes at 1-year follow-up. RESULTS: Complete 1-year follow-up data were available for 837 Mexicans. We observed a high prevalence of diabetes (47.1%), hypertension (74.7%), and hypercholesterolemia (57.8%). Antiplatelet, antihypertensive and/or glucose-lowering agents, and lipid-lowering drugs were used in 87.6%, 84.1%, and 61% of patients, respectively. The all-cause mortality rate was 3.3%. The composite outcome CV death/myocardial infarction/stroke/hospitalization for atherothrombotic events was higher in the symptomatic group (14.6%) than in asymptomatic subjects with multiple risk factors (5.1%; P = 0.01), similar to Latin American results of the global REACH report. The highest CV event rate occurred among symptomatic atherothrombotic patients with 3 vascular disease locations (30.2%), followed by those with 2 (21.9%) and 1 location (13.4%; P = 0.0006). CONCLUSIONS: Prevalence of risk factors and CV event rates including hospitalization in Mexican atherothrombotic patients was high despite the current medication use, which suggests it is necessary to have more aggressive risk-factor management.

Biología molecular de la insuficiencia cardíaca / Molecular biology of heart failure

Heart failure is a complex disorder involving maladaptive responses that result in defective regulation and function of multiple biological systems. Adequate understanding of these processes is basic for the development of novel therapeutic approaches. This review, directed to the molecular biology of the heart, is divided in three sections, with some redundancy between them: hypertrophy and remodeling, molecular composition of the failing heart, and molecular mechanisms leading to heart failure.

[Molecular biology of heart failure]. / Biología molecular de la insuficiencia cardíaca.

Heart failure is a complex disorder involving maladaptive responses that result in defective regulation and function of multiple biological systems. Adequate understanding of these processes is basic for the development of novel therapeutic approaches. This review, directed to the molecular biology of the heart, is divided in three sections, with some redundancy between them: hypertrophy and remodeling, molecular composition of the failing heart, and molecular mechanisms leading to heart failure.

[Progress in the treatment of diabetic patients with ischemic cardiopathy]. / Progresos en el tratamiento del diabético con cardiopatía isquémica.

Among the risk factors for ischemic cardiopathy none influences more long-term restenosis and mortality as diabetes mellitus. Diabetes mellitus is ranked third as cause of death; 65 to 85% of these patients die due to cardiovascular disease. The use of coronary stents associated to glycoprotein IIb/IIIa inhibitors has proven to be superior to stents alone or PTCA in the treatment of ischemic cardiopathy in diabetic patients. Despite these improved results, restenosis rates remain higher as compared to non-diabetic patients. Intracoronary radiation has been shown decrease restenosis and repeat target lesion revascularizations in diabetic patients with intra-stent restenosis. In order to decrease restenosis in diabetic patients, stents coated with site-specific pharmacological and molecular approaches may prove useful in suppressing hyperplasia of the intimal and preventing restenosis. Coronary artery bypass grafting seems to be the best option for diabetic patients with multiple coronary artery disease, especially if they have proximal left anterior descending artery estenosis, complex lesions to be approached by angioplasty, previous myocardial infarction, three vessel disease, or impaired left ventricular function. In spite of improvements in the treatment of diabetic patients with coronary artery disease, restenosis and mortality rates continue to be higher as compared to non-diabetic patients; therefore, new strategies are required.

Cuantificación de la hipertensión arterial pulmonar por fono y ecocardiografía modo M en niños con cardiopatía congénita / Measurement of pulmonary arterial hypertension with phono and echocardiography in children with congenital heart disease

Se efectuaron los estudios fono y ecocardiográficos modo M de 20 niños con cardiopatía congénita de corto circuito intra y extracardíaco. La presión sistólica de la arteria pulmonar (PSP), calculada a través de la duración de la fase de relajación isovolumétrica del ventrículo derecho, tuvo una correlación significativa con la PSP determinada en el cateterismo cardiaco (r=0.92). La medición del período pre-expulsivo/período expulsivo (PPE/PE) del ventrículo derecho, a partir del ecograma pulmonar, ayudó a distinguir los pacientes (PPE/PE>=0.30) con un valor promedio de PSP=64.5 mmHg (p<0.01). La existencia de cierre mesosistólico en el ecograma pulmonar diferenció a los pacientes con un valor promedio de PSP=60 mmHg (p<0.005). No se encontraron correlaciones significativas entre la PSP y la profundidad de la onda "a" (r= -0.50) y la pendiente E-F (r= -0.40) del ecograma pulmonar. Tampoco entre la presión telediastólica del ventrículo derecho y el intervalo PR-AC (r=0.57) del electrocardiograma y el ecograma tricuspídeo. Nuestro estudio demuestra que existen algunos signos fono y ecocardiográficos modo M que son de gran ayuda en el diagnóstico y cuantificación de la hipertensión arterial pulmonar en niños con cardiopatía congénita de corto circuito intra y extracardíaco

Fístula arteriovenosa coronaria: estudio de 14 casos / Coronary arteriovenous fistula: report of 14 cases

Se analizan los 14 casos de fístulas arteriovenosas coronarias observadas en el Instituto Nacional de Cardiología Ignacio Chávez. La fístula se originaba en la coronaria derecha en el 57.1% de los casos, en la coronaria, izquierda en el 35.7% y en ambas coronarias en el 7.2%. Por otra parte, la desembocadura de los trayectos fistulososo se hizo en el ventrículo derecho en 71.4%, en la aurícula en 7.2% y en la arteria pulmonar en 21.4%. Los datos del examen físico, el estudio radiológico y el electrocardiograma son los que habitualmente se encuentran en las malformaciones con cortocircuito entre la aorta y las cavidades derechas o la arteria pulmonar. El diagnóstico definitivo se logra por la angiografía. El ecocardiograma bidimensional y Doppler pueden ser de gran utilidad en el reconocimiento de la fístula. La historia natural depende de la edad del paciente, de la magnitud del cortocircuito, de la presencia de hipertensión arterial pulmonar y de la presentación de complicaciones. Aún cuando en algunos casos con coroticurcuitos pequeños la tolerancia es buena, la malformación es potencialmente grave, y así, el 14.3% de los pacientes presentaron endocarditis infecciosa, el 42.9% sufrieron insuficiencia cardíaca, el 14.3% tenían angor pectoris y el 54.5% presentaron hipertensión arterial pulmonar. La mortalidad en esta serie fue de 28.6%. El tratamiento óptimo de las fístulas arteriovenosas coronarias parece ser su ligadura durante la infancia. Sin embargo, el procedimiento quirúrgico no está exento de riesgos y 2 de los 3 pacientes de esta serie que fueron operados después de 1967 presentaron infartos del miocardio perioperatorios. La mejoría de la técnica quirúrgica debe prevenir esta complicación