Risk of complications after a non-ST segment elevation acute myocardial infarction in a Latin-American cohort: An application of the ACTION ICU score.

BACKGROUND: European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTEMI) recommend Intensive Care Unit (ICU) surveillance during the first 24-48 h. Interestingly, the in-hospital mortality of NSTEMI patients has consistently decreased, giving some patients the option to be managed in general hospital wards. The ACTION ICU score has been proposed to identify high-risk patients with NSTEMI and guide the selective risk-based need for ICU care. OBJECTIVE: To evaluate the usefulness of the ACTION ICU score to predict patients' risk of developing complications requiring ICU care in a Latin-American cohort with NSTEMI. METHODS: We applied the ACTION ICU score in a retrospective cohort. A composite primary outcome included: cardiorespiratory arrest, shock, high-grade atrio-ventricular block, respiratory failure, stroke, or death. The predictive performance of this model was estimated with a conditional multivariable logistic regression analysis. RESULTS: Of 1,062 patients with NSTEMI, the primary outcome was present in 75 patients (7.1%), and 1,019 (96%) were admitted to ICU. The most common event was respiratory failure (4.0%), followed by cardiogenic shock (3.7%), and cardiac arrest (1.7%). The presence of heart failure signs or symptoms had the highest association with the primary outcome (OR:2.16; 95%CI:1.61-2.92). The best cut-off point for this population was 3 (complications risk: 4.0%, SEN:96%, SP:15.4%, NPV:98.1%, PPV:7.9%). CONCLUSION: The ACTION ICU score may be a promising tool to identify the need for ICU care in Latin-American patients with NSTEMI. Furthermore, additional research is needed to evaluate the cost-effectiveness of this strategy.

Diagnostic challenge presented by right atrial mass: A report of two cases.

Right atrial masses raised pose 3 major possibilities including tumors, thrombi, or vegetations. We present 2 cases: first, a 34-year-old male with no medical history, who presented with dyspnea, pleuritic pain, and fever; and the second, 65-year-old male with similar symptoms and a history of a left renal carcinoma. Both patients had right atrial masses found on a transthoracic echocardiogram. Cardiac magnetic resonance imaging and an 18 FDG-PET were necessary finding thrombi in the first patient; and tumoral thrombi in the second one. A multimodality imaging approach to right atrial masses is essential for proper diagnosis and therapeutic decision-making.

The right ventricle of transplanted hearts at 2,640 meters above sea level. A latin-american experience. / El ventrículo derecho de los corazones trasplantados a 2,640 metros sobre el nivel del mar. Una experiencia latinoamericana

BACKGROUND: High-altitude cardiovascular adaptations increase lung pressure. This effect on the right ventricle (RV) of transplanted hearts at altitudes above 2,500 meters above sea level (masl) has not been described. OBJECTIVE: The objective of the study was to describe echocardiography RV behavior in the immediate post-operative period (Days 1-7 post-Heart transplant [HTx]), 3, 6, 12, and 24 months after HTx in patients at 2640 masl. METHODS: Historical cohort of HTx patients in the period between 2005 and 2019, in a hospital located in Bogotá, Colombia. Socio-demographic, clinical, and echocardiographic evaluation data of the RV at 5 follow-up moments were analyzed. RESULTS: 91 patients underwent HTx, 64% remained at a height > 2500 masl in the post-operative period. Transthoracic echo was available in 37 patients (40.6%). Right ventricular dysfunction was found in 95% of patients, which was predominantly moderate (43%), with improvement 3 months after transplant. The immediate post-operative Tricuspid annular plane systolic excursion was 8.9 ± 4.9 mm, with recovery from the 3rd post-operative month (15.1 ± 3.6 mm) and without significant changes in month 24 (15.8 ± 4.9 mm). Immediate post-operative systolic pulmonary artery pressure (sPAP) was 39.2 ± 8.2 mmHg, showing a decrease at 24 post-operative months (31.0 ± 5.0 mmHg). The 5-year survival was 78% Confidence Interval 95% 60-85. CONCLUSION: After HTx, most patients present right ventricular dysfunction, improving at the 3rd month of transplant. There were no significant differences between patients living at more than 2500 masl and < 2500 masl.

ANTECEDENTES: Las adaptaciones cardiovasculares en la altitud aumentan la presión pulmonar; el efecto de estos cambios sobre el ventrículo derecho de corazones trasplantados a altitudes superiores a 2,500 msnm no ha sido descrito. OBJETIVO: Describir el comportamiento por ecocardiografía transtorácica del ventrículo derecho en el postoperatorio inmediato (días 1­7 post-HTx), 3, 6, 12 y 24 meses después del trasplante cardíaco en pacientes intervenidos a 2,640 ms nm. MÉTODOS: Cohorte histórica de pacientes trasplantados de corazón en un hospital de Bogotá, Colombia, entre 2005 y 2019. Los datos sociodemográficos, clínicos y ecocardiográficos del ventrículo derecho fueron analizados en 5 momentos del seguimiento postoperatorio. RESULTADOS: 91 pacientes fueron sometidos a trasplante cardíaco, el 64% residía a más de 2,500 msnm en el postoperatorio. El ecocardiograma transtorácico estuvo disponibles en 37 pacientes (40.6%). En el 95% de los pacientes se documentó disfunción del ventrículo derecho la cual fue predominantemente moderada (43%), con mejoría al 3 mes del trasplante. El TAPSE en el postoperatorio inmediato fue de 8.9±4.9 mm, con recuperación a partir del tercer mes postoperatorio (15.1±3.6 mm); la mejoría se mantuvo hasta el mes 24 (15.8±4.9 mm). La PsAP postoperatoria inmediata fue de 39.2±8.2 mmHg y disminuyó a los 24 meses (31.0±5.0 mmHg). La supervivencia a los 5 años fue del 78% IC95% 60-85. CONCLUSIONES: Posterior al trasplante cardíaco, la mayoría de los pacientes presentó disfunción ventricular derecha, mejorando al tercer mes del trasplante. No hubo diferencias significativas entre los pacientes que vivían a mas de 2,500 msnm y menos de 2,500 msnm.

Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review.

Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi's infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite's life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.

Fibrosis endomiocárdica: una cardiomiopatía restrictiva en países en vía de desarrollo / Endomyocardial fibrosis: a restrictive cardiomyopathy in developing countries

Resumen Objetivo: La fibrosis endomiocárdica (FE) es una cardiomiopatía restrictiva infrecuente. En América Latina son escasos los reportes. En el presente trabajo se realiza una descripción de una serie de pacientes diagnosticados de FE en Colombia. Método: Realizamos una búsqueda en los registros de imágenes de resonancia magnética (RM) cardiaca realizadas en nuestra institución entre 2016 y 2019 en busca de pacientes con diagnóstico de FE. Se describieron sus características sociodemográficas, clínicas y de imagen. Resultados: Nueve pacientes fueron diagnosticados de FE (el 66.7% mujeres), con una edad promedio de 69 años. Los pacientes presentaron un promedio de 2.6 años de evolución. El principal síntoma referido fue disnea, seguido de síncope, dolor torácico y palpitaciones. En ninguno de ellos se sospechó FE como diagnóstico inicial. En cuanto a los hallazgos ecocardiográficos, se identificó compromiso predominante del ventrículo izquierdo, seguido de compromiso biventricular. Todos los pacientes presentaron patrón de llenado restrictivo con dilatación auricular izquierda severa. En el análisis retrospectivo se cumplieron los criterios de Mocumbi para el diagnóstico de FE en el 100% de los pacientes con gravedad moderada (77.8%). Las imágenes de RM mostraron función sistólica biventricular y volúmenes preservados. Se observó depósito focal de gadolinio subendocárdico a nivel apical y se confirmó la presencia de trombo en el 66% de los casos Conclusión:: La FE es una cardiomiopatía restrictiva infrecuente circunscrita a países tropicales. La mayoría de los pacientes en nuestra serie presentaron compromiso aislado del ventrículo izquierdo, seguido de compromiso biventricular, con función ventricular usualmente preservada.

Abstract Objective: Endomyocardial fibrosis (EF) is an unusual restrictive cardiomyopathy. In Latin America there are few reports. Here, we made a description of patients diagnosed with EF in Colombia. Method: We conducted a search in the records of cardiac magnetic resonance imaging (MRI) performed in our institution between 2016-2019 looking for patients with a diagnosis of EF; sociodemographic, clinical and imaging characteristics were described. Results: Nine patients were diagnosed with EF (66.7% female), with an average age of 69 years. Patients presented an average evolution of 2.6 years. The main reported symptom was dyspnea, followed by syncope, chest pain, and palpitations. None of them was initially suspected for EF. Regarding echocardiographic findings, predominant left ventricular involvement was identified, followed by bi-ventricular involvement. All the patients presented a restrictive filling pattern with severe left atrial dilation. In a retrospective analysis, Mocumbi criteria for diagnosis of EF were met in 100% of the patients, majority with moderate severity (77.8%). Cardiac MRI showed biventricular systolic function and volumes preserved. Focal subendocardial late gadolinium enhancement was observed on the apex and apical thrombus was confirmed in 66% of the patients Conclusion: FE is an uncommon restrictive cardiomyopathy limited to tropical countries. Most of patients in our series presented isolated involvement of left ventricle, followed by bi-ventricular involvement, with ventricular function usually preserved.

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death.

Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community's apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host-parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease's clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy's (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.

Endomyocardial fibrosis: a restrictive cardiomyopathy in developing countries.

OBJECTIVE: Endomyocardial fibrosis (EF) is an unusual restrictive cardiomyopathy. In Latin America there are few reports. Here, we made a description of patients diagnosed with EF in Colombia. METHOD: We conducted a search in the records of cardiac magnetic resonance imaging (MRI) performed in our institution between 2016-2019 looking for patients with a diagnosis of EF; sociodemographic, clinical and imaging characteristics were described. RESULTS: Nine patients were diagnosed with EF (66.7% female), with an average age of 69 years. Patients presented an average evolution of 2.6 years. The main reported symptom was dyspnea, followed by syncope, chest pain, and palpitations. None of them was initially suspected for EF. Regarding echocardiographic findings, predominant left ventricular involvement was identified, followed by bi-ventricular involvement. All the patients presented a restrictive filling pattern with severe left atrial dilation. In a retrospective analysis, Mocumbi criteria for diagnosis of EF were met in 100% of the patients, majority with moderate severity (77.8%). Cardiac MRI showed biventricular systolic function and volumes preserved. Focal subendocardial late gadolinium enhancement was observed on the apex and apical thrombus was confirmed in 66% of the patients. CONCLUSION: FE is an uncommon restrictive cardiomyopathy limited to tropical countries. Most of patients in our series presented isolated involvement of left ventricle, followed by bi-ventricular involvement, with ventricular function usually preserved.

OBJETIVO: La fibrosis endomiocárdica (FE) es una cardiomiopatía restrictiva infrecuente. En América Latina son escasos los reportes. En el presente trabajo se realiza una descripción de una serie de pacientes diagnosticados de FE en Colombia. MÉTODO: Realizamos una búsqueda en los registros de imágenes de resonancia magnética (RM) cardiaca realizadas en nuestra institución entre 2016 y 2019 en busca de pacientes con diagnóstico de FE. Se describieron sus características sociodemográficas, clínicas y de imagen. RESULTADOS: Nueve pacientes fueron diagnosticados de FE (el 66.7% mujeres), con una edad promedio de 69 años. Los pacientes presentaron un promedio de 2.6 años de evolución. El principal síntoma referido fue disnea, seguido de síncope, dolor torácico y palpitaciones. En ninguno de ellos se sospechó FE como diagnóstico inicial. En cuanto a los hallazgos ecocardiográficos, se identificó compromiso predominante del ventrículo izquierdo, seguido de compromiso biventricular. Todos los pacientes presentaron patrón de llenado restrictivo con dilatación auricular izquierda severa. En el análisis retrospectivo se cumplieron los criterios de Mocumbi para el diagnóstico de FE en el 100% de los pacientes con gravedad moderada (77.8%). Las imágenes de RM mostraron función sistólica biventricular y volúmenes preservados. Se observó depósito focal de gadolinio subendocárdico a nivel apical y se confirmó la presencia de trombo en el 66% de los casos. CONCLUSIÓN: La FE es una cardiomiopatía restrictiva infrecuente circunscrita a países tropicales. La mayoría de los pacientes en nuestra serie presentaron compromiso aislado del ventrículo izquierdo, seguido de compromiso biventricular, con función ventricular usualmente preservada.

Caracterización de neumonía por Staphylococcus aureus meticilino resistente en hospital militar de alta complejidad / Characterization of Methicillin-resistant Staphylococcus aureus pneumonia in high complex militar hospital

Introducción: Por su capacidad de resistencia, las cepas de Staphylococcus aureus resistentes a la meticilina (SAMR) representan un reto importante en la terapéutica. Se desarrolló este estudio con el fin de caracterizar la población con neumonía por SAMR del Hospital Militar Central. Métodos: Se condujo un estudio descriptivo de corte transversal, en pacientes con diagnóstico de neumonía bacteriana con aislamiento microbiológico positivo para SAMR. El análisis de los datos se realizó a través de medidas de tendencia central y de dispersión. Resultados: Durante el periodo de 4 años de estudio hubo 211 aislamientos correspondientes a S. aureus de los cuales 22 correspondieron a neumonía bacteriana por SAMR. La neumonía nosocomial fue la forma más frecuente de presentación (54,5%), seguida por neumonía adquirida en la comunidad (36,3%). El 36,3% de los pacientes eran militares activos, el 31,8% militares retirados o civiles. La frecuencia de comorbilidades fue del 92,3% siendo la enfermedad renal crónica y malignidad las más frecuentes. Conclusión: Desde el punto de vista clínico la neumonía por SAMR se caracterizó por una mayor cantidad de pacientes jóvenes y sin comorbilidades contrastando con neumonía nosocomial que se caracterizó por una población de más edad y con mayor prevalencia de comorbilidades.

Introduction: Strains methicillin-resistant Staphylococcus aureus (MRSA), to be resistant to most beta-lactam available and different families of antibiotics, represent a major challenge in therapeutics; for this reason, it is necessary to conduct studies to characterize better patients with MRSA infection. Methods: A descriptive study of cross section of patients diagnosed with bacterial pneumonia with positive microbiological isolation for MRSA was conducted by reviewing medical records and susceptibility testing relevant demographic and clinical data were extracted. The data analysis was conducted through measures of central tendency and dispersion. Results: During the period of 4 years of study; there were 211 isolates corresponding to S. aureus; of which 22 were for MRSA bacterial pneumonia. Nosocomial pneumonia was the most common presentation (54,5%); followed by community-acquired pneumonia (36,3%). 36,3% of patients were military personnel, 31,8% retired military or civilians. The frequency of comorbidities was 92,3% being chronic kidney disease and the most common malignancy. Conclusion: From the clinical point of view MRSA pneumonia it was characterized by a greater number of young patients without comorbidities; which contrasted with nosocomial pneumonia was characterized by an aging population and higher prevalence of comorbidities.