Iniciativa Stent-Save a Life! Argentina / Stent-Save a Life! Argentina Initiative

RESUMEN 31. Introducción: La iniciativa Stent-Save a Life! (SSL) es un programa europeo que busca mejorar el acceso de pacientes con infarto agudo de miocardio con elevación del ST (IAMCEST) a un tratamiento de reperfusión basado en las recomendaciones de las guías clínicas, reduciendo así su morbimortalidad. Objetivo: Describir los resultados de los primeros tres años de la iniciativa SSL Argentina Material y métodos: Se realizó inicialmente un mapeo para analizar la situación local y luego se desarrolló el Programa Puerta-Balón (PPB) como un proceso de mejora continua para centros con capacidad de realizar angioplastia primaria (ATCp). Resultados: Desde marzo de 2016 hasta marzo de 2018 se trataron 3041 pacientes con IAMCEST en 38 centros participantes del citado programa. El 20% (n = 610) de esos pacientes tuvo su primer contacto médico (PCM) con el servicio de emergencias médicas. Excluyendo los 184 pacientes sin lesiones coronarias (6% del total), el 93% fue reperfundido, principalmente con ATCp (95%). El tiempo global de isquemia fue de 117 minutos, variando según el momento del PCM. La mortalidad global intrahospitalaria fue del 7%. Conclusiones: La falta de una "cultura de reperfusión" fue la barrera en común de centros públicos y privados que motivó el desarrollo del PPB. La identificación de los puntos críticos que impiden un tratamiento a tiempo, junto con la organización de los centros puertas adentro, representan el primer paso para mejorar la atención de estos pacientes. Es necesario el trabajo integrado de todos los actores involucrados a partir de la organización de redes de atención, adaptadas a la realidad local de cada centro y región.

ABSTRACT 39. Introduction: The Stent-Save a Life! (SSL) initiative is a European program that seeks to improve the access of patients with ST-segment elevation acute myocardial infarction (STEMI) to reperfusion therapies based on clinical guideline recommendations, thus reducing morbidity and mortality. Objective: The aim of this study was to describe the results of the first three years of the SSL Argentina initiative. Methods: Initially, a mapping was carried out to analyze the local situation and then the Door-to- Balloon Program (DBP) was developed as a continuous improvement process for centers with primary percutaneous coronary intervention (pPCI) capability. Results: From March 2016 to March 2018, 3,041 patients with STEMI were treated in 38 centers participating in this program. In 20% of cases (n=610) patients had their first medical contact with the emergency medical services. After excluding 184 patients (6%) without coronary lesions, reperfusion therapy was performed in 93% of cases, mainly by pPCI (95%). Total ischemic time was 117 minutes, with differences according to the time of first medical contact. Overall in-hospital mortality was 7%. Conclusions: The lack of a "reperfusion culture" was the common barrier of public and private centers that motivated the development of the DBP. The identification of critical points that prevent treatment on time, together with enhancement of in-hospital organization, represent the first step to improve the care of these patients. The integrated work of all the involved parties is necessary to develop care networks adapted to the local reality of each center and region.

[Evaluation of diastolic function during and post-exercise in patients with arterial hypertension]. / Evaluación de la función diastólica durante y post-ejercicio isométrico en pacientes con hipertensión arterial.

UNLABELLED: It is known that patients with arterial hypertension and ventricular hypertrophy have diastolic alterations, in particular during exercise. However, it is controversial if diastolic dysfunction continues once exercise had concluded. The objective was to assess the effects of isometric exercise on the diastolic function in patients with arterial hypertension. Five control patients (group 1, G1) and 7 patients with arterial hypertension (group 2, G2) were studied. All patients underwent cardiac catheterization and performed isometric exercise until heart rate increased 43 +/- 7%. Left ventricular systolic pressure (LVSP) and end diastolic pressure (LVEDP) were measured. We calculated, +dP/dt(max), the time constant of isovolumic pressure decay (tau) and t1/2 were all measured. RESULTS: The LVSP increased in G1 and G2 during exercise from 140 +/- 3 to 195 +/- 14 mm Hg (p < 0.05) and 161 +/- 9 to 238 +/- 15 mm Hg, respectively; returning to their basal values once exercise had concluded. The tau (tau) and t1/2 increased, while exercising in G2, from 23 +/- 2 and 15 +/- 2 msec to 35 +/- 7 and 23 +/- 4 msec, respectively. After exercise both variables continued elevated reaching 41 +/- 6 msec (p < 0.05) and 23 +/- 3 msec (p < 0.05), respectively. In conclusion, isometric exercise decreases relaxation rate and increases LVEDP in patients with arterial hypertension and ventricular hypertrophy. After exercise, isovolumic relaxation remained altered suggesting the presence of stunned myocardium.

Evaluacion de la funcion diastolica durante y post-ejercicio isometrico en pacientes con hipertension arterial / Evaluation of diastolic function during and post-exercise in patients with arterial hypertension

Es conocido que los pacientes con hipertrofia ventricular por hipertensión arterial presentan alteraciones diastólicas, particularmente durante el ejercicio. Sin embargo, es controvertido si luego del esfuerzo esta disfuncion se normaliza. El objetivo fue evaluar la función diastólica durante y después de la realización de ejercicio, en pacientes con hipertensión arterial. Se estudiaron 6 pacientes controles (grupo 1, G1) y 7 con diagnóstico de hipertensión arterial (Grupo 2, G2). Los pacientes fueron sometidos a un cateterismo cardíaco y realizaron ejercicio isométrico durante el estudio, hasta que la frecuencia cardíaca se incrementó un 43+ o -7% (p<0.05), con respecto al valor basal. Se midió la presión sistólica ventricular izquierda (PSVI) y la presión de fin de diástole (PFDVI) y se calculó la máxima velocidad de ascenso de la presión (+dP/dtmáx), la constante de tiempo de caída de la presión ventricular tau, el tiempo que tarda en caer la presión hasta un 50% de su valor al momento de la -dP/dtmáx (t1/2, mseg). La PSVI se incrementó, durante el ejercicio, desde 140+ o -3 hasta 195+ o -14 mm Hg (p<0.05) en G1 y de 161¡À9 hasta 238 + o -15 mm Hg en G2; retornando luego a susvalores basales. El tau y el t1/2 se incrementaron en G2, durante el ejercicio, desde un valor de 23+ o -2 y 15 + o -2 mseg hasta 35 + o - 7 y 23¡ + o - 4 mseg, respectivamente. Luego del esfuerzo, ambas variables permanecieron elevadas con respecto al basal, alcanzando valores de 41 + o - 6 mseg (p<0.05) y 23 + o -3 mseg (p<0.05), respectivamente. El ejercicio isométrico disminuye la velocidad de relajación e incrementa la PFDVI en pacientes con hypertension arterial e hipertrofia del ventrículo izquierdo. Luego del ejercicio la relajación permaneció alterada, a pesar de que el resto de las variables hemodinámicas retornaron a su valor basal, sugiriendo la presencia de atontamiento miocárdico

It is known that patients with arterial hypertension and ventricular hypertrophy have diastolicalterations, in particular during exercise. However, it is controversial if diastolic dysfunction continues once exercisehad concluded. The objective was to assess the effects of isometric exercise on the diastolic function in patientswith arterial hypertension. Five control patients (group 1, G1) and 7 patients with arterial hyper-tension (group 2,G2) were studied. All patients underwent cardiac catheterization and performed isometric exercise until heartrate increased 43+or -7%. Left ventricular systolic pressure (LVSP) and end diastolic pressure (LVEDP) weremeasured. We calculated, +dP/dtmax, the time constant of isovolumic pressure decay (tau) and t1/2 were allmeasured. Results: The LVSP increased in G1 and G2 during exercise from 140+ or -3 to 195+ or -14 mm Hg (p<0.05)and 161+ or -9 to 238+ or -15 mm Hg, respectively; returning to their basal values once exercise had concluded. The tau and t1/2 increased, while exercising in G2, from 23+ or -2 and 15+ or - msec to 35+ or -7 and 23+ or -4 msec, respectively. After exercise both variables continued elevated reaching 41+ or -6 msec (p<0.05) and 23+ or -3 msec (p<0.05), respectively. In conclusion, isometric exercise decreases relaxation rate and increases LVEDP in patients with arterial hypertension and ventricular hypertrophy. After exercise, isovolumic relaxation remained altered suggesting the presence of stunned myocardium

Evaluacion de la funcion diastolica durante y post-ejercicio isometrico en pacientes con hipertension arterial / Evaluation of diastolic function during and post-exercise in patients with arterial hypertension

Es conocido que los pacientes con hipertrofia ventricular por hipertensión arterial presentan alteraciones diastólicas, particularmente durante el ejercicio. Sin embargo, es controvertido si luego del esfuerzo esta disfuncion se normaliza. El objetivo fue evaluar la función diastólica durante y después de la realización de ejercicio, en pacientes con hipertensión arterial. Se estudiaron 6 pacientes controles (grupo 1, G1) y 7 con diagnóstico de hipertensión arterial (Grupo 2, G2). Los pacientes fueron sometidos a un cateterismo cardíaco y realizaron ejercicio isométrico durante el estudio, hasta que la frecuencia cardíaca se incrementó un 43+ o -7% (p<0.05), con respecto al valor basal. Se midió la presión sistólica ventricular izquierda (PSVI) y la presión de fin de diástole (PFDVI) y se calculó la máxima velocidad de ascenso de la presión (+dP/dtmáx), la constante de tiempo de caída de la presión ventricular tau, el tiempo que tarda en caer la presión hasta un 50% de su valor al momento de la -dP/dtmáx (t1/2, mseg). La PSVI se incrementó, durante el ejercicio, desde 140+ o -3 hasta 195+ o -14 mm Hg (p<0.05) en G1 y de 161í?9 hasta 238 + o -15 mm Hg en G2; retornando luego a susvalores basales. El tau y el t1/2 se incrementaron en G2, durante el ejercicio, desde un valor de 23+ o -2 y 15 + o -2 mseg hasta 35 + o - 7 y 23í + o - 4 mseg, respectivamente. Luego del esfuerzo, ambas variables permanecieron elevadas con respecto al basal, alcanzando valores de 41 + o - 6 mseg (p<0.05) y 23 + o -3 mseg (p<0.05), respectivamente. El ejercicio isométrico disminuye la velocidad de relajación e incrementa la PFDVI en pacientes con hypertension arterial e hipertrofia del ventrículo izquierdo. Luego del ejercicio la relajación permaneció alterada, a pesar de que el resto de las variables hemodinámicas retornaron a su valor basal, sugiriendo la presencia de atontamiento miocárdico (AU)

It is known that patients with arterial hypertension and ventricular hypertrophy have diastolicalterations, in particular during exercise. However, it is controversial if diastolic dysfunction continues once exercisehad concluded. The objective was to assess the effects of isometric exercise on the diastolic function in patientswith arterial hypertension. Five control patients (group 1, G1) and 7 patients with arterial hyper-tension (group 2,G2) were studied. All patients underwent cardiac catheterization and performed isometric exercise until heartrate increased 43+or -7%. Left ventricular systolic pressure (LVSP) and end diastolic pressure (LVEDP) weremeasured. We calculated, +dP/dtmax, the time constant of isovolumic pressure decay (tau) and t1/2 were allmeasured. Results: The LVSP increased in G1 and G2 during exercise from 140+ or -3 to 195+ or -14 mm Hg (p<0.05)and 161+ or -9 to 238+ or -15 mm Hg, respectively; returning to their basal values once exercise had concluded. The tau and t1/2 increased, while exercising in G2, from 23+ or -2 and 15+ or - msec to 35+ or -7 and 23+ or -4 msec, respectively. After exercise both variables continued elevated reaching 41+ or -6 msec (p<0.05) and 23+ or -3 msec (p<0.05), respectively. In conclusion, isometric exercise decreases relaxation rate and increases LVEDP in patients with arterial hypertension and ventricular hypertrophy. After exercise, isovolumic relaxation remained altered suggesting the presence of stunned myocardium (AU)

Evaluacion de la funcion diastolica durante y post-ejercicio isometrico en pacientes con hipertension arterial / Evaluation of diastolic function during and post-exercise in patients with arterial hypertension

Es conocido que los pacientes con hipertrofia ventricular por hipertensión arterial presentan alteraciones diastólicas, particularmente durante el ejercicio. Sin embargo, es controvertido si luego del esfuerzo esta disfuncion se normaliza. El objetivo fue evaluar la función diastólica durante y después de la realización de ejercicio, en pacientes con hipertensión arterial. Se estudiaron 6 pacientes controles (grupo 1, G1) y 7 con diagnóstico de hipertensión arterial (Grupo 2, G2). Los pacientes fueron sometidos a un cateterismo cardíaco y realizaron ejercicio isométrico durante el estudio, hasta que la frecuencia cardíaca se incrementó un 43+ o -7% (p<0.05), con respecto al valor basal. Se midió la presión sistólica ventricular izquierda (PSVI) y la presión de fin de diástole (PFDVI) y se calculó la máxima velocidad de ascenso de la presión (+dP/dtmáx), la constante de tiempo de caída de la presión ventricular tau, el tiempo que tarda en caer la presión hasta un 50% de su valor al momento de la -dP/dtmáx (t1/2, mseg). La PSVI se incrementó, durante el ejercicio, desde 140+ o -3 hasta 195+ o -14 mm Hg (p<0.05) en G1 y de 161í?9 hasta 238 + o -15 mm Hg en G2; retornando luego a susvalores basales. El tau y el t1/2 se incrementaron en G2, durante el ejercicio, desde un valor de 23+ o -2 y 15 + o -2 mseg hasta 35 + o - 7 y 23í + o - 4 mseg, respectivamente. Luego del esfuerzo, ambas variables permanecieron elevadas con respecto al basal, alcanzando valores de 41 + o - 6 mseg (p<0.05) y 23 + o -3 mseg (p<0.05), respectivamente. El ejercicio isométrico disminuye la velocidad de relajación e incrementa la PFDVI en pacientes con hypertension arterial e hipertrofia del ventrículo izquierdo. Luego del ejercicio la relajación permaneció alterada, a pesar de que el resto de las variables hemodinámicas retornaron a su valor basal, sugiriendo la presencia de atontamiento miocárdico (AU)

It is known that patients with arterial hypertension and ventricular hypertrophy have diastolicalterations, in particular during exercise. However, it is controversial if diastolic dysfunction continues once exercisehad concluded. The objective was to assess the effects of isometric exercise on the diastolic function in patientswith arterial hypertension. Five control patients (group 1, G1) and 7 patients with arterial hyper-tension (group 2,G2) were studied. All patients underwent cardiac catheterization and performed isometric exercise until heartrate increased 43+or -7%. Left ventricular systolic pressure (LVSP) and end diastolic pressure (LVEDP) weremeasured. We calculated, +dP/dtmax, the time constant of isovolumic pressure decay (tau) and t1/2 were allmeasured. Results: The LVSP increased in G1 and G2 during exercise from 140+ or -3 to 195+ or -14 mm Hg (p<0.05)and 161+ or -9 to 238+ or -15 mm Hg, respectively; returning to their basal values once exercise had concluded. The tau and t1/2 increased, while exercising in G2, from 23+ or -2 and 15+ or - msec to 35+ or -7 and 23+ or -4 msec, respectively. After exercise both variables continued elevated reaching 41+ or -6 msec (p<0.05) and 23+ or -3 msec (p<0.05), respectively. In conclusion, isometric exercise decreases relaxation rate and increases LVEDP in patients with arterial hypertension and ventricular hypertrophy. After exercise, isovolumic relaxation remained altered suggesting the presence of stunned myocardium (AU)

Effects of isometric exercise on the diastolic function in patients with severe aortic stenosis with or without coronary lesion.

BACKGROUND: There is no literature evaluating the effect of exercise on patients with aortic stenosis, in which patients with and without coronary artery disease were assessed separately. OBJECTIVE: To assess the effects of isometric exercise on the diastolic function in patients with aortic stenosis (AS). METHODS: 18 patients with AS, and 5 control patients were studied (group 1, G1). Patients with AS were divided in: group 2 (G2, n=10), without coronary lesion, and group 3 (G3, n=8), with coronary lesion. All patients underwent cardiac catheterization and performed isometric exercise until heart rate increased 32+/-9%. Left ventricular systolic pressure and end diastolic pressure (LVEDP), t1/2 (relaxation index), and the +dP/dt(max) were all measured. RESULTS: The +dP/dt(max) increased in G1, G2, and G3 during exercise returning to their basal values once exercise had concluded. While exercising, the LVEDP increased in G1, G2 and G3, returning to its original baseline value only in G1 and G2. The t1/2 increased, while exercising, in G2 and G3, and continued to be elevated after the exercise in both groups although it was only statistically significant in G3. The control group did not show significant changes. CONCLUSIONS: Isometric exercise decreases relaxation rate and increases LVEDP in patients with AS. After exercise, relaxation and LVEDP remained altered only in the patients with coronary lesion. The alteration in lusitropism and increased LVEDP after exercising suggest the presence of stunned myocardium.

[Effects of isometric exercise on the diastolic function in patients with severe aortic stenosis]. / Efectos del ejercicio isométrico sobre la funcion diastólica en pacientes con estenosis aórtica severa.

The objective of the study was to determine the effects of isometric exercise on the diastolic function in patients with aortic stenosis without coronary lesion (group 1, G1, n = 9) and with coronary lesion (group 2, G2, n = 11). Patients subjected to a cardiac catheterization performed isometric exercise until their heart rate increased in 32 +/- 9% compared to baseline. The left ventricular systolic pressure, the +dP/dtmax, and the end diastolic pressure (LVEDP) were measured, and the time constant of pressure decay (tau, tau) was calculated. The +dP/dtmax increased in G1 and G2 during exercise, from a value of 1989 +/- 190 and 2428 +/- 220 mmHg/sec up to 2286 +/- 214 y 2661 +/- 230 mmHg/sec, respectively, returning afterwards to its baseline value. The LVEDP increased during exercise in G1 and G2 from a value of 30.1 +/- 2.7 and 26.5 +/- 2.2 mmHg up to 38.4 +/- 1.7 and 36.1 +/- 4.0 mmHg, respectively (p < 0.05), returning to its baseline value only in G1. The tau (tau) increased during exercise in G1 and G2 from a value of 42.8 +/- 6.8 and 44.8 +/- 4.2 m/sec up to 55.3 +/- 9.2 and 60.4 +/- 5.9 msec respectively (p < 0.05), and remained elevated after exercise in both groups although it was statistically significant only in G2. The isometric exercise decreases the relaxation rate and increases the LVEDP in patients with aortic stenosis and left ventricular hypertrophy. After exercise, relaxation remained altered in the group of patients with coronary lesion. Alteration in the lusitropism and the increase of LVEDP after exercise suggest the presence of myocardial stunning.

Efectos del ejercicio isometrico sobre la funcion diastolica en pacientes con estenosis aortica severa / Effects of isometric exercise on the diastolic function in patients with severe aortic stenosis

The objective of the study was to determine the effects of isometric exercise on the diastolic function in patients with aortic stenosis without coronary lesion (group 1, G1, n = 9) and with coronary lesion (group 2, G2, n = 11). Patients subjected to a cardiac catheterization performed isometric exercise until their heart rate increased in 32 +/- 9% compared to baseline. The left ventricular systolic pressure, the +dP/dtmax, and the end diastolic pressure (LVEDP) were measured, and the time constant of pressure decay (tau, tau) was calculated. The +dP/dtmax increased in G1 and G2 during exercise, from a value of 1989 +/- 190 and 2428 +/- 220 mmHg/sec up to 2286 +/- 214 y 2661 +/- 230 mmHg/sec, respectively, returning afterwards to its baseline value. The LVEDP increased during exercise in G1 and G2 from a value of 30.1 +/- 2.7 and 26.5 +/- 2.2 mmHg up to 38.4 +/- 1.7 and 36.1 +/- 4.0 mmHg, respectively (p < 0.05), returning to its baseline value only in G1. The tau (tau) increased during exercise in G1 and G2 from a value of 42.8 +/- 6.8 and 44.8 +/- 4.2 m/sec up to 55.3 +/- 9.2 and 60.4 +/- 5.9 msec respectively (p < 0.05), and remained elevated after exercise in both groups although it was statistically significant only in G2. The isometric exercise decreases the relaxation rate and increases the LVEDP in patients with aortic stenosis and left ventricular hypertrophy. After exercise, relaxation remained altered in the group of patients with coronary lesion. Alteration in the lusitropism and the increase of LVEDP after exercise suggest the presence of myocardial stunning

Efectos del ejercicio isométrico sobre la funcion diastólica en pacientes con estenosis aórtica severa. / [Effects of isometric exercise on the diastolic function in patients with severe aortic stenosis]

The objective of the study was to determine the effects of isometric exercise on the diastolic function in patients with aortic stenosis without coronary lesion (group 1, G1, n = 9) and with coronary lesion (group 2, G2, n = 11). Patients subjected to a cardiac catheterization performed isometric exercise until their heart rate increased in 32 +/- 9

compared to baseline. The left ventricular systolic pressure, the +dP/dtmax, and the end diastolic pressure (LVEDP) were measured, and the time constant of pressure decay (tau, tau) was calculated. The +dP/dtmax increased in G1 and G2 during exercise, from a value of 1989 +/- 190 and 2428 +/- 220 mmHg/sec up to 2286 +/- 214 y 2661 +/- 230 mmHg/sec, respectively, returning afterwards to its baseline value. The LVEDP increased during exercise in G1 and G2 from a value of 30.1 +/- 2.7 and 26.5 +/- 2.2 mmHg up to 38.4 +/- 1.7 and 36.1 +/- 4.0 mmHg, respectively (p < 0.05), returning to its baseline value only in G1. The tau (tau) increased during exercise in G1 and G2 from a value of 42.8 +/- 6.8 and 44.8 +/- 4.2 m/sec up to 55.3 +/- 9.2 and 60.4 +/- 5.9 msec respectively (p < 0.05), and remained elevated after exercise in both groups although it was statistically significant only in G2. The isometric exercise decreases the relaxation rate and increases the LVEDP in patients with aortic stenosis and left ventricular hypertrophy. After exercise, relaxation remained altered in the group of patients with coronary lesion. Alteration in the lusitropism and the increase of LVEDP after exercise suggest the presence of myocardial stunning.

Efectos del ejercicio isometrico sobre la funcion diastolica en pacientes con estenosis aortica severa / Effects of isometric exercise on the diastolic function in patients with severe aortic stenosis

The objective of the study was to determine the effects of isometric exercise on the diastolic function in patients with aortic stenosis without coronary lesion (group 1, G1, n = 9) and with coronary lesion (group 2, G2, n = 11). Patients subjected to a cardiac catheterization performed isometric exercise until their heart rate increased in 32 +/- 9% compared to baseline. The left ventricular systolic pressure, the +dP/dtmax, and the end diastolic pressure (LVEDP) were measured, and the time constant of pressure decay (tau, tau) was calculated. The +dP/dtmax increased in G1 and G2 during exercise, from a value of 1989 +/- 190 and 2428 +/- 220 mmHg/sec up to 2286 +/- 214 y 2661 +/- 230 mmHg/sec, respectively, returning afterwards to its baseline value. The LVEDP increased during exercise in G1 and G2 from a value of 30.1 +/- 2.7 and 26.5 +/- 2.2 mmHg up to 38.4 +/- 1.7 and 36.1 +/- 4.0 mmHg, respectively (p < 0.05), returning to its baseline value only in G1. The tau (tau) increased during exercise in G1 and G2 from a value of 42.8 +/- 6.8 and 44.8 +/- 4.2 m/sec up to 55.3 +/- 9.2 and 60.4 +/- 5.9 msec respectively (p < 0.05), and remained elevated after exercise in both groups although it was statistically significant only in G2. The isometric exercise decreases the relaxation rate and increases the LVEDP in patients with aortic stenosis and left ventricular hypertrophy. After exercise, relaxation remained altered in the group of patients with coronary lesion. Alteration in the lusitropism and the increase of LVEDP after exercise suggest the presence of myocardial stunning (AU)