Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction.

INTRODUCTION: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. OBJECTIVE: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. METHODS: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. RESULTS: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. CONCLUSIONS: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.

INTRODUCCIÓN: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. OBJETIVO: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. MÉTODOS: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. RESULTADOS: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. CONCLUSIONES: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.

Factores de riesgo cardiometabólico y tratamiento antitrombótico en población mexicana con fibrilación auricular e insuficiencia cardiaca con fracción de expulsión reducida / Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction

Resumen Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.

Abstract Introduction: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. Objective: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. Methods: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. Results: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. Conclusions: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.

Gender differences and management of stroke risk of nonvalvular atrial fibrillation in an upper middle-income country: Insights from the CARMEN-AF registry.

BACKGROUND: Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF. OBJECTIVE: To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry. METHODS: A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014-2017). They were categorized according to Gender. RESULTS: Overall, 48.6% were women, mean age 70 ±â€¯12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men). CONCLUSIONS: CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC.

Social signals and aversive learning in honey bee drones and workers.

The dissemination of information is a basic element of group cohesion. In honey bees (Apis mellifera Linnaeus 1758), like in other social insects, the principal method for colony-wide information exchange is communication via pheromones. This medium of communication allows multiple individuals to conduct tasks critical to colony survival. Social signaling also establishes conflict at the level of the individual who must trade-off between attending to the immediate environment or the social demand. In this study we examined this conflict by challenging highly social worker honey bees, and less social male drone honey bees undergoing aversive training by presenting them with a social stress signal (isopentyl acetate, IPA). We utilized IPA exposure methods that caused lower learning performance in appetitive learning in workers. Exposure to isopentyl acetate (IPA) did not affect performance of drones and had a dose-specific effect on worker response, with positive effects diminishing at higher IPA doses. The IPA effects are specific because non-social cues, such as the odor cineole, improve learning performance in drones, and social homing signals (geraniol) did not have a discernible effect on drone or worker performance. We conclude that social signals do generate conflict and that response to them is dependent on signal relevance to the individual as well as the context. We discuss the effect of social signal on learning both related to its social role and potential evolutionary history.

[Clinical practice guideline. Diagnosis and treatment of dyslipidemia.] / Guía de práctica clínica. Diagnóstico y tratamiento de las dislipidemias.

Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.

Las enfermedades crónicas no transmisibles son un problema de salud pública en México; entre ellas, la enfermedad coronaria y la diabetes son la primera y la segunda causa de muerte en el país, seguidas de los eventos vasculares cerebrales embólicos. Entre los principales factores de riesgo se encuentra la hipercolesterolemia. La detección y el tratamiento de las alteraciones de los lípidos son clave para la prevención y manejo de las enfermedades crónicas no transmisibles. Dos encuestas nacionales representativas han mostrado que las anormalidades de los lípidos son los factores de riesgo más comunes en los adultos mexicanos. El propósito de esta guía es servir de base para identificar de manera oportuna las dislipidemias, además de sistematizar los criterios para el diagnóstico y tratamiento en el primer y segundo nivel de atención.

[Ablation or modification of slow pathway in AV nodal reentrant tachycardia and electrophysiological changes]. / Ablación o modificación de la vía lenta en la taquicardia por reentrada nodal AV y sus cambios electrofisiológicos.

INTRODUCTION: The endpoint of successful treatment of slow pathway ablation is elimination of AV nodal reentrant tachycardia (AVNRT). However, the mechanism of elimination is not well understood and is controversial if complete elimination or persistent dual AV nodal physiology is associated with a higher success, recurrence and/or complications rate. OBJECTIVES: The purpose was to examine the results after slow pathway ablation in AVNRT and changes in AV nodal conduction in patients with and without loss of dual AV nodal physiology. METHODS AND RESULTS: The study included 106 patients (age 47 +/- 17 years). In 64% with elimination of inducible AVNRT still had dual AV nodal physiology (group I) and absent in 36%, group II). Both, anterograde fast pathway and slow pathway effective refractory period (ERP) showed a tendency to decrease but without statistical significance: 340 +/- 39 ms to 329 +/- 45 ms, 290 +/- 16 to 279 +/- 43 ms respectively, p = NS. In group II, anterograde fast pathway ERP decreased significantly 328 +/- 83 ms to 282 +/- 75 ms, p < 0.001. Anterograde Wenckebach cycle length increased in both groups: 360 +/- 65 to 375 +/- 61 ms, p < 0.05 group I, and 351 +/- 20 to 381 +/- 14 ms, p < 0.001 group II. CONCLUSIONS: Ablation procedures of the AV node slow pathways that eliminate AVNRT modify the AV node electrophysiologic conduction properties. These modifications are more important in patients with complete elimination of dual AV nodal physiology; nonetheless, in a high rate of patients the elimination is incomplete but without reinduction of clinical tachycardia. It has been suggested that elimination of the AVNRT despite the persistence of dual AV nodal physiology is due to the presence of more than one AV node slow pathway with different electrophysiological properties.

Mortalidad hospitalaria del infarto agudo del miocardio / Hospitalary mortality from acute myocardial infarction

Estudiamos en forma retrospectiva la mortalidad hospitalaria en cien pacientes sucesivos con Infarto Agudo del Miocardio (IAM), ingresados al Servicio de Medicina Interna del Hospital Dr. Adolfo Pons (I.V.S.) en Maracaibo. El 69% de los enfermos resultaron ser del sexo masculino. La edad promedio de los pacientes fue de 57,6 ñ 12 años. En el 24% de los pacientes se detectaron trastornos del ritmo cardíaco, y en el 16%, signos clínicos de insuficiencia cardíaca. La mortalidad general fue del 12%; el 22,5% de las mujeres fallecieron. Todos los pacientes con choque cardiogénico murieron. La mortalidad en los grupos de enfermos con edema pulmonar agudo y con insuficiencia cardíaca moderada fue de 42,8 y 33,3% respectivamente. Es necesario el diagnóstico y tratamiento precoz de las arritmias y de la disfunción ventricular izquierda aguda para lograr una reducción en nuestras cifras de mortalidad por IAM