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La ablacion por radiofrecuencia se ha impuesto como la tecnica de primera eleccion para el tratamiento de la mayoria las arritmias cardiacas. En otros paises, los avances tecnologicos recientes, como el mapeo tridimensional no... more
La ablacion por radiofrecuencia se ha impuesto como la tecnica de primera eleccion para el tratamiento de la mayoria las arritmias cardiacas. En otros paises, los avances tecnologicos recientes, como el mapeo tridimensional no fluoroscopico o el mapeo sin contacto, o diferentes modalidades de ablacion como los sistemas irrigados, crioablacion, laser o microwave han permitido mejorar los resultados que se obtenian con los sistemas convencionales. En el presente trabajo se describen los resultados en una poblacion incluida en forma consecutiva y no seleccionada, que fue tratada con los sistemas de mapeo y ablacion convencionales. Se comunica el exito primario obtenido en el laboratorio de electrofisiologia, teniendo en cuenta el seguimiento de corto plazo (1 mes postablacion) que se completo en la totalidad de los pacientes. Se incluyeron 511 pacientes consecutivos sometidos a 546 procedimientos entre julio de 1997 y diciembre de 2002. Las arritmias tratadas fueron: aleteo auricular 153 (30%), reentrada nodal 149 (29%), vias accesorias 103 (20%), taquicardia auricular 42 (8%), taquicardia ventricular 27 (5%), fibrilacion auricular (aislamiento de las venas pulmonares) 24 (5%) y ablacion completa del nodo AV 13 (3%). La edad promedio fue de 50 ± 20 anos. La ablacion se realizo con exito en 144 pacientes con aleteo auricular (95%), en 147 con reentrada nodal (99%), en 95 con vias accesorias (92%), en 37 con taquicardia auricular (88%), en 16 con taquicardia ventricular (59%), en 13 con fibrilacion auricular (venas pulmonares) (54%) y en 13 pacientes con bloqueo del nodo AV (100%). El promedio de exito fue del 90,9% (465 de 511 pacientes). Se produjeron complicaciones en 14 pacientes (2,7%). En el grupo de ninos y adolescentes (≤ 18 anos) se realizaron 66 procedimientos en 60 pacientes. La edad promedio fue de 13 ± 4 anos (rango 3 a 18 anos). El exito de la ablacion fue del 95%. No hubo complicaciones. Concluimos que la ablacion por radiofrecuencia es un metodo eficaz y seguro en el tratamiento de practicamente todas las arritmias cardiacas, aun la fibrilacion auricular recientemente incluida. La ablacion podria considerarse la primera indicacion en el tratamiento de las taquiarritmias cardiacas sostenidas. Aun sin contar con la avanzada tecnologia disponible en el presente en otros paises, los resultados del procedimiento a nivel nacional son igualmente aceptables. REV ARGENT CARDIOL 2003;71: 402-408
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Research Interests: Cardiology, Medicine, Logistic Regression, Prospective studies, Population, and 15 moreHumans, Internal Medicine, Female, Male, Atrial Fibrillation, Anticoagulants, Body Mass Index, Clinical Sciences, Aged, Prevalence, Odds ratio, Prognosis, Coronary Artery Disease, Ejection Fraction, and Asymptomatic
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Antecedentes y objetivos Existen datos que asocian a la angina preinfarto con el desarrollo de infartos mas pequenos . La informacion es controvertida respecto del mecanismo implicado, postulandose : circulacion colateral, tratamiento... more
Antecedentes y objetivos Existen datos que asocian a la angina preinfarto con el desarrollo de infartos mas pequenos . La informacion es controvertida respecto del mecanismo implicado, postulandose : circulacion colateral, tratamiento previo, reperfusion precoz y precondicionamiento isquemico . Reanalizamos los datos de una serie prospectiva de 112 infartos tratados con angioplastia o fibrinoliticos .
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Background Cancer therapeutics–related cardiac dysfunction usually known as cardiotoxicity (CTX) is a common adverse effect of anthracyclines and anti-Her2 agents. In recent years, evidence of usefulness of ultrasensitive troponin for... more
Background Cancer therapeutics–related cardiac dysfunction usually known as cardiotoxicity (CTX) is a common adverse effect of anthracyclines and anti-Her2 agents. In recent years, evidence of usefulness of ultrasensitive troponin for early diagnosis of CTX has increased, however the cut-off values of this biomarker remain uncertain. Purpose To assess the usefulness of ultrasensitive troponin T (UsTnT) to identify patients at risk of developing CTX and determine cut-off values for this biomarker. Methods Patients with diagnosis of solid or hematologic malignancies scheduled to receive therapy including anthracyclines and/or trastuzumab were prospectively included. Echocardiogram was performed prior to chemotherapy, and repeated 3 and 6 months later. UsTnT was measured at baseline and 3 months after starting chemotherapy and the increase of this biomarker from baseline was calculated. This UsTnT has a range of 3–10,000 pg/mL with a 99th percentile <15 pg/mL. Receiver operating cha...
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Background Chemotherapy treatments with anthracyclines and Trastuzumab are widely used in different hematologic or solid malignancies but myocardial injury and left ventricular dysfunction, usually called cardiotoxicity (CTX), is a... more
Background Chemotherapy treatments with anthracyclines and Trastuzumab are widely used in different hematologic or solid malignancies but myocardial injury and left ventricular dysfunction, usually called cardiotoxicity (CTX), is a frequent adverse effect. Some studies have demonstrated that early detection and treatment of CTX is essential for the recovery of left ventricular ejection fraction (LVEF), however its behavior after starting treatment is not well established. Purpose Evaluate the behavior of LVEF after starting treatment for heart failure in patients with diagnosis of CTX. Methods Patients with diagnosis of solid or hematologic malignancies scheduled to receive therapy including anthracyclines and/or trastuzumab were prospectively included. Echocardiogram was performed before starting treatment, and then 3 and 6 months after. CTX was defined, according to guidelines, as a drop of LVEF ≥10% to a value <53% and in these patients treatment of left ventricular dysfunctio...
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This clinical practice guideline for treating transthyretin amyloid (ATTR) cardiomyopathy is based on the best available evidence of clinical effectiveness. The PICO format was used to generate a list of questions focused on the... more
This clinical practice guideline for treating transthyretin amyloid (ATTR) cardiomyopathy is based on the best available evidence of clinical effectiveness. The PICO format was used to generate a list of questions focused on the effectiveness and safety of the specific treatment of patients with ATTR cardiomyopathy. The search was conducted in PubMed, Cochrane and Epistemokus, between July-August 2020, and selected articles between 2000-2020, in English and Spanish. The level of evidence and recommendations were analyzed and classified by the GRADE system. The following drugs were included in the analysis: tafamidis, diflunisal, inotersen, patisiran y doxycycline and ursodeoxycholic acid. The expert panel had an agreement that tafamidis 80mg/daily is the only available drug with moderate evidence and weak recommendation for the reduction of total mortality, cardiovascular morbidity, heart failure hospitalization and progression of the disease in patients with ATTR cardiomyopathy and NYHA class = 3. In contrast, tafamidis 20 mg/daily had low-quality evidence in this group of patients. The expert panel did not recommend inotersen, patisiran and diflunisal in patients with ATTR cardiomyopathy due to the lack of supporting evidence, local drug availability, and the potential risk of toxicity. When patients did not have access to tafamidis, the expert panel stated a weak recommendation to use doxycycline and ursodeoxycholic acid in patients with ATTR cardiomyopathy.
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The aim of this update is to highlight the relationship between the heart and the kidney throughout the entire journey involved in heart transplantation. Faced with heart transplantation, the cardiovascular and renal systems behave as... more
The aim of this update is to highlight the relationship between the heart and the kidney throughout the entire journey involved in heart transplantation. Faced with heart transplantation, the cardiovascular and renal systems behave as mates of a journey that, at times, is difficult to determine when it starts, and that forces them to overcome different obstacles, such as hemodynamic changes, neuro-humoral and inflammatory response, surgical injury, immune reaction, and drug toxicity. This relationship can be seen as an adventure that they must inevitably share. We will try to accompany both organs in this journey, but paying special attention to the kidney, and to describe the associations and protection and damage mechanisms generated throughout its course. In this journey we can recognize solidarity responses to maintain the balance between both systems, but in this attempt to protect, collateral injury occurs.
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The aim of this update is to highlight the relationship between the heart and the kidney throughout the entire journey involved in heart transplantation. Faced with heart transplantation, the cardiovascular and renal systems behave as... more
The aim of this update is to highlight the relationship between the heart and the kidney throughout the entire journey involved in heart transplantation. Faced with heart transplantation, the cardiovascular and renal systems behave as mates of a journey that, at times, is difficult to determine when it starts, and that forces them to overcome different obstacles, such as hemodynamic changes, neurohumoral and inflammatory response, surgical injury, immune reaction, and drug oxicity. This relationship can be seen as an adventure that they must inevitably share. We will try to accompany both organs in this journey, but paying special attention to the kidney, describing the associations and the protection and damage mechanisms that are generated throughout its course. In this journey we can recognize solidarity responses to maintain the balance between both systems, but in this attempt to protect, collateral injury occurs.
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Heart transplantation is currently a procedure of choice for patients with advanced heart failure. Despite a continuous improvement in morbidity and mortality made to date, complications requiring hospitalization continue to be high. The... more
Heart transplantation is currently a procedure of choice for patients with advanced heart failure. Despite a continuous improvement in morbidity and mortality made to date, complications requiring hospitalization continue to be high. The main objective of this study was to describe complications that required hospitalization after a heart transplant, and the secondary objective is to evaluate its incidence according to age group in a cohort of heart transplant recipients in Argentina. A retrospective cohort study was carried out. One hundred and ninety-eight heart transplant recipients were consecutively included in the period between January 2010 and May 2019. During follow-up, 105 patients (53%) had at least one readmission, and the most frequent cause of cardiovascular readmission was graft rejection (31%), while infections were the most frequent non-cardiovascular causes (21%). Mortality density incidence was 8 (95% CI 5.4-11.7) per 100-patients/year for the group that had readm...
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Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, is a rare skin condition marked by the sudden appearance of erythematous and painful papules, plaques or nodules, mainly on the arms, neck, face and back, associated... more
Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, is a rare skin condition marked by the sudden appearance of erythematous and painful papules, plaques or nodules, mainly on the arms, neck, face and back, associated with fever, leukocytosis, neutrophilia and diffuse neutrophil infiltrate. (1) The pathogenesis is not clearly established and is described as multifactorial. (2) There are three presentation forms, including the idiopathic or classic, associated with oncologic or oncohematologic diseases as the paraneoplastic syndrome and the drug-induced form (especially associated with granulocyte colony stimulating factor). (1) Systemic involvement is extremely rare. There are few case reports in the literature that describe this syndrome with cardiovascular involvement. (1, 3, 4) We present the case report of a patient with confirmed Sweet’s syndrome, with severe pericardial involvement and hemodynamic decompensation. He is a 42 year-old man without any relevant cardiovascular history, diagnosed with Sweet’s syndrome confirmed by a skin biopsy a year ago. During followup, a myelodysplastic syndrome in leukemic phase was discovered, currently being treated with azacitidine, and in the waiting list for bone marrow allogeneic transplantation Our patient had a prolonged hospital stay because of febrile neutropenia with possible epididymo-orchitis, for which he completed antibiotic therapy without germ identification in cultures. During hospitalization he presented with fever and new skin lesions compatible with Sweet’s syndrome reactivation. This was associated with neutrophil increase due to granulocyte colony stimulating factor administered a few days before. Concomitantly, he presented with pericardial-type thoracic pain, accompanied by shortness of breath in functional class IV, with clinical parameters of shock. Laboratory testing revealed pancytopenia, normal renal function and normal cardiac markers, including ultra sensitive troponin. NT-proBNP level was14,000 pg/ml. The chest x-ray showed new onset cardiomegaly without flow redistribution (Figure 1). Electrocardiogram showed sinus tachycardia, low voltage in peripheral leads and diffuse ST-segment elevation of 1 mm (Figure 2). Transthoracic echocardiogram revealed new severe left ventricular systolic dysfunction involving apical segments that was not present on the last echocardiogram performed 14 days before, without significant valve diseases or pericardial effusion. A Swan-Ganz catheter was introduced showing a mixed distributive or cardiogenic pattern. Non-invasive ventilation and intravenous diuretics were started, with good response and without requiring the use of inotropes. With presumptive diagnosis of myopericardial involvement in Sweet’s syndrome, hydrocortisone 1 mg/ kg/day was started. At 48 hours, clinical parameters, invasive monitoring values and ventricular function were normalized. A myocardial biopsy was performed that showed the typical interstitial edema and perivascular neutrophil infiltrate, confirming Sweet’s syndrome diagnosis. Sweet’s syndrome is characterized by sudden fever, neutrophilia and skin lesions associated with neutrophil infiltrates. Systemic involvement is rare. (5) Cohen et al. described extracutaneous manifestations in Sweet’s syndrome associated with hematologic diseases, especially acute leukemia and myelodysplastic syndrome. (2) Central nervous system, bone, lung or
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Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usually mentioned as a relative contraindication for inclusion in the list of heart transplantation since it is associated with failure of the... more
Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usually mentioned as a relative contraindication for inclusion in the list of heart transplantation since it is associated with failure of the implanted right ventricle. There is evidence suggesting that the behavior of the pulmonary circulation depends on its interaction with theright ventricle, so a parameter that evaluates ventricular-arterial coupling could predict right ventricular failure better than isolated hemodynamic parameters. Objective: The aim of this study was to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PSP) to predict the incidence of post-transplantation right ventricular failure compared with invasive hemodynamic parameters measured before transplantation. Methods: This was a retrospective cohort study using variables prospectively collected from the heart transplantation database of a University Hospital of...
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Introduccion: La insuficiencia cardiaca es una patologia que se encuentra en expansion a nivel global y las herramientas terapeuticas disponibles aun son insuficientes. Objetivos: Conocer las caracteristicas epidemiologicas y clinicas de... more
Introduccion: La insuficiencia cardiaca es una patologia que se encuentra en expansion a nivel global y las herramientas terapeuticas disponibles aun son insuficientes. Objetivos: Conocer las caracteristicas epidemiologicas y clinicas de los pacientes con diagnostico de insuficiencia cardiaca en la Republica Argentina, asi como las terapeuticas implementadas y su pronostico, tanto en pacientes ambulatorios como en internados por una reagudizacion. Material y metodos: Se realizo un relevamiento observacional, prospectivo multicentrico de pacientes con insuficiencia cardiaca cronica ambulatorios e internados por insuficiencia cardiaca descompensada en la Republica Argentina durante el periodo agosto 2012-marzo 2013, reclutados para participar en el Registro a largo plazo de Insuficiencia Cardiaca organizado por la Sociedad Europea de Cardiologia. Para facilitar el reclutamiento, el diseno contemplo la inclusion solamente un dia semanal. Se realizo seguimiento al ano de los pacientes. ...
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Research Interests: Geography and Archipelago
Introduccion: La insuficiencia cardiaca es una patologia con una elevada prevalencia y morbimortalidad. Es un cuadro muy heterogeneo, y no existe unanimidad en su clasificacion. Objetivo: Comparar la incidencia de mortalidad hospitalaria... more
Introduccion: La insuficiencia cardiaca es una patologia con una elevada prevalencia y morbimortalidad. Es un cuadro muy heterogeneo, y no existe unanimidad en su clasificacion. Objetivo: Comparar la incidencia de mortalidad hospitalaria y anual, y de reinternaciones durante el primer ano de seguimiento, segun la forma de presentacion clinica. Materiales y metodos: Se evaluo una cohorte retrospectiva de 758 pacientes consecutivos del plan de salud de nuestro hospital e internados en unidad de cuidados intensivos cardiologicos con insuficiencia cardiaca aguda. Se realizo un analisis descriptivo, y de sobrevida, y se evaluo la asociacion entre la forma de presentacion clinica y la mortalidad anual. Resultados: La terapeutica y el uso de recursos fueron diferentes en las distintas presentaciones. La mortalidad hospitalaria global fue del 6,3%, siendo del 5,4% para el EAP, 4,9% para la SV y 40,7% para el SC (p<0,001). La tasa de incidencia de mortalidad cada 100 pacientes-ano segui...
Research Interests: Medicine and Gynecology
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Background: Patients with peripheral vascular disease represent a group at high risk of cardiovascular events, and must therefore achieve the secondary prevention goals recommended in the guidelines. Objectives: Primary: To determine what... more
Background: Patients with peripheral vascular disease represent a group at high risk of cardiovascular events, and must therefore achieve the secondary prevention goals recommended in the guidelines. Objectives: Primary: To determine what percentage of patients undergoing peripheral revascularization surgery reached LDL cholesterol goals at 6 months of the intervention compared with patients undergoing coronary artery bypass grafting. Secondary: To determine the percentage of patients reaching these levels at 18 months of follow-up, the percentage of patients with total cholesterol dosage and lipid fraction (LDL-C, HDL-C and TG) assessment at 6 and 18 months of follow-up and the percentage of statin use during the previous year and during the long term follow-up after surgery. Methods: The degree of lipid control in a retrospective cohort of patients undergoing peripheral revascularization surgery was compared with another group of patients undergoing coronary artery bypass graftin...
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espanolIntroduccion: La insuficiencia cardiaca es una patologia con una elevada prevalencia y morbimortalidad. Es un cuadro muy heterogeneo, y no existe unanimidad en su clasificacion. Objetivo: Comparar la incidencia de mortalidad... more
espanolIntroduccion: La insuficiencia cardiaca es una patologia con una elevada prevalencia y morbimortalidad. Es un cuadro muy heterogeneo, y no existe unanimidad en su clasificacion. Objetivo: Comparar la incidencia de mortalidad hospitalaria y anual, y de reinternaciones durante el primer ano de seguimiento, segun la forma de presentacion clinica. Materiales y metodos: Se evaluo una cohorte retrospectiva de 758 pacientes consecutivos del plan de salud de nuestro hospital e internados en unidad de cuidados intensivos cardiologicos con insuficiencia cardiaca aguda. Se realizo un analisis descriptivo, y de sobrevida, y se evaluo la asociacion entre la forma de presentacion clinica y la mortalidad anual. Resultados: La terapeutica y el uso de recursos fueron diferentes en las distintas presentaciones. La mortalidad hospitalaria global fue del 6,3%, siendo del 5,4% para el EAP, 4,9% para la SV y 40,7% para el SC (p EnglishBackground: Heart failure is a highly prevalent disease with e...
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espanolIntroduccion: La insuficiencia cardiaca es una patologia que se encuentra en expansion a nivel global y las herramientas terapeuticas disponibles aun son insuficientes. Objetivos: Conocer las caracteristicas epidemiologicas y... more
espanolIntroduccion: La insuficiencia cardiaca es una patologia que se encuentra en expansion a nivel global y las herramientas terapeuticas disponibles aun son insuficientes. Objetivos: Conocer las caracteristicas epidemiologicas y clinicas de los pacientes con diagnostico de insuficiencia cardiaca en la Republica Argentina, asi como las terapeuticas implementadas y su pronostico, tanto en pacientes ambulatorios como en internados por una reagudizacion. Material y metodos: Se realizo un relevamiento observacional, prospectivo multicentrico de pacientes con insuficiencia cardiaca cronica ambulatorios e internados por insuficiencia cardiaca descompensada en la Republica Argentina durante el periodo agosto 2012-marzo 2013, reclutados para participar en el Registro a largo plazo de Insuficiencia Cardiaca organizado por la Sociedad Europea de Cardiologia. Para facilitar el reclutamiento, el diseno contemplo la inclusion solamente un dia semanal. Se realizo seguimiento al ano de los paci...
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La ablacion por radiofrecuencia se ha impuesto como la tecnica de primera eleccion para el tratamiento de la mayoria las arritmias cardiacas. En otros paises, los avances tecnologicos recientes, como el mapeo tridimensional no... more
La ablacion por radiofrecuencia se ha impuesto como la tecnica de primera eleccion para el tratamiento de la mayoria las arritmias cardiacas. En otros paises, los avances tecnologicos recientes, como el mapeo tridimensional no fluoroscopico o el mapeo sin contacto, o diferentes modalidades de ablacion como los sistemas irrigados, crioablacion, laser o microwave han permitido mejorar los resultados que se obtenian con los sistemas convencionales. En el presente trabajo se describen los resultados en una poblacion incluida en forma consecutiva y no seleccionada, que fue tratada con los sistemas de mapeo y ablacion convencionales. Se comunica el exito primario obtenido en el laboratorio de electrofisiologia, teniendo en cuenta el seguimiento de corto plazo (1 mes postablacion) que se completo en la totalidad de los pacientes. Se incluyeron 511 pacientes consecutivos sometidos a 546 procedimientos entre julio de 1997 y diciembre de 2002. Las arritmias tratadas fueron: aleteo auricular 153 (30%), reentrada nodal 149 (29%), vias accesorias 103 (20%), taquicardia auricular 42 (8%), taquicardia ventricular 27 (5%), fibrilacion auricular (aislamiento de las venas pulmonares) 24 (5%) y ablacion completa del nodo AV 13 (3%). La edad promedio fue de 50 ± 20 anos. La ablacion se realizo con exito en 144 pacientes con aleteo auricular (95%), en 147 con reentrada nodal (99%), en 95 con vias accesorias (92%), en 37 con taquicardia auricular (88%), en 16 con taquicardia ventricular (59%), en 13 con fibrilacion auricular (venas pulmonares) (54%) y en 13 pacientes con bloqueo del nodo AV (100%). El promedio de exito fue del 90,9% (465 de 511 pacientes). Se produjeron complicaciones en 14 pacientes (2,7%). En el grupo de ninos y adolescentes (≤ 18 anos) se realizaron 66 procedimientos en 60 pacientes. La edad promedio fue de 13 ± 4 anos (rango 3 a 18 anos). El exito de la ablacion fue del 95%. No hubo complicaciones. Concluimos que la ablacion por radiofrecuencia es un metodo eficaz y seguro en el tratamiento de practicamente todas las arritmias cardiacas, aun la fibrilacion auricular recientemente incluida. La ablacion podria considerarse la primera indicacion en el tratamiento de las taquiarritmias cardiacas sostenidas. Aun sin contar con la avanzada tecnologia disponible en el presente en otros paises, los resultados del procedimiento a nivel nacional son igualmente aceptables. REV ARGENT CARDIOL 2003;71: 402-408
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espanolIntroduccion. Los pacientes con enfermedad vascular periferica representan un grupo de alto riesgo de eventos cardiovasculares por lo que deben alcanzar metas de prevencion secundaria de enfermedad cardiovascular. Objetivos.... more
espanolIntroduccion. Los pacientes con enfermedad vascular periferica representan un grupo de alto riesgo de eventos cardiovasculares por lo que deben alcanzar metas de prevencion secundaria de enfermedad cardiovascular. Objetivos. Determinar que porcentaje de pacientes sin antecedentes de enfermedad coronaria sometidos a cirugia vascular (CV) alcanzan las metas de colesterol luego de ser intervenidos en relacion a pacientes sometidos a cirugia de revascularizacion miocardica (CRM) electiva. Materiales y Metodos Se comparo el grado de control de dislipemia de una cohorte retrospectiva de pacientes sometidos a CV sin antecedentes clinicos de enfermedad coronaria en relacion a pacientes sometidos a cirugia de revascularizacion coronaria. Resultados. Se siguieron 468 individuos, 98 operados de CV y 370 de CRM por un periodo de 18 meses. La media de LDL a los 6 meses de la cirugia fue significativamente menor en los coronarios que en los vasculares (84.7±25 vs. 98.8±35 mg/dl; p=0.001). ...
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Antecedentes y objetivos Existen datos que asocian a la angina preinfarto con el desarrollo de infartos mas pequenos . La informacion es controvertida respecto del mecanismo implicado, postulandose : circulacion colateral, tratamiento... more
Antecedentes y objetivos Existen datos que asocian a la angina preinfarto con el desarrollo de infartos mas pequenos . La informacion es controvertida respecto del mecanismo implicado, postulandose : circulacion colateral, tratamiento previo, reperfusion precoz y precondicionamiento isquemico . Reanalizamos los datos de una serie prospectiva de 112 infartos tratados con angioplastia o fibrinoliticos .