Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles <... more Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles < 586 pg/ml. Los pacientes con NT-proBNP elevado eran más añosos, con mayor frecuencia de sexo femenino; tuvieron una proporción mayor de marcadores séricos elevados y una ...
Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent ... more Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent platelet agonist and converts fibrinogen to fibrin. Hirudin is a powerful, direct, and specific antithrombin agent that can be used in many therapeutic scenarios in which heparin is routinely used. In this systemic review, we summarize evidence from randomized clinical trials evaluating the benefits and risks of recombinant hirudin for the treatment of acute coronary syndromes and patients undergoing percutaneous coronary intervention.
Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo card... more Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo cardiovascular. El puntaje de calcio coronario (PCC) es un predictor superior al EIMC, pero de costo elevado y en nuestro pais pocos pacientes pueden acceder a su medicion. Objetivos 1) Evaluar la precision diagnostica del EIMC para la deteccion de un PCC > 0. 2) Determinar el punto de corte optimo del EIMC para discriminar entre la presencia o la ausencia de calcio coronario. Material y metodos Estudio descriptivo transversal de muestras consecutivas obtenidas en los consultorios de prevencion cardiovascular. Se midio el EIMC medio y maximo mediante un eco-Doppler carotideo. Se efectuo una tomografia computarizada de 64 pistas para la evaluacion del PCC. Se determino la precision diagnostica del EIMC para la deteccion de un PCC > 0 mediante un analisis ROC. Resultados Se incluyeron 202 sujetos consecutivos que participan de un programa de prevencion primaria. Caracteristicas de la poblacion (media } desviacion estandar): edad 57 } 13 anos, sexo femenino: 49%, tabaquismo: 13%, estatinas: 37%, diabetes mellitus: 13%, puntaje de Framingham en no diabeticos: 9% } 7%, EIMC medio: 0,953 } 0,342 mm, EIMC maximo: 1,383 } 0,679 mm, prevalencia de placa aterosclerotica carotidea: 37% y de PCC > 0: 62%. Las correlaciones entre el EIMC medio y maximo y el PCC fueron moderadas (r = 0,56 y r = 0,55, respectivamente). El area bajo la curva ROC del EIMC maximo fue de 0,822 (IC 95% 0,763-0,880) y la del EIMC medio fue de 0,829 (IC 95% 0,771-0,888). El punto de corte optimo del EIMC maximo para discriminar entre PCC > 0 o PCC = 0 fue de . 1,01 mm y la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) fueron del 78%, 75%, 83% y 67%, respectivamente. El punto de corte optimo del EIMC medio para discriminar entre PCC > 0 o PCC = 0 fue . 0,82 mm y la sensibilidad, la especificidad, el VPP y el VPN fueron del 77%, 78%, 85% y 67%, respectivamente. Conclusiones En esta poblacion predominantemente de riesgo bajo, la precision diagnostica del EIMC para detectar PCC > 0 fue moderada. Una ecografia Doppler carotidea gnormal no excluyo la presencia de aterosclerosis subclinica coronaria. Estos resultados podrian mejorar la seleccion de pacientes que requieran la medicion del PCC para estratificar el riesgo cardiovascular.
The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Eurosc... more The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR) METHODS AND RESULTS: 208 patients with severe AS underwent the 6MWT before AVR, as part of a randomised trial (ASSERT) comparing stented and stentless aortic valves. Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n = 14) in patients walking &lt;300 metres compared to 4% (n = 4) in those who walked &gt; or =300 metres (p = 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6-minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09 to 0.85, p = 0.025). The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis before AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score.
Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is unc... more Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.
NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfun... more NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfunction and adverse outcome in patients with non-ST-elevation acute coronary syndromes (NSTEACS). However, the underlying pathophysiological mechanisms responsible for this association have not been well established. We sought to explore the relation between NT-proBNP levels and extension of coronary artery disease (CAD) and the presence of more complex and severe coronary lesions. This prospective, multicenter angiographic substudy included 585 patients admitted with NSTEACS. Blinded measurements of NT-proBNP and troponin T were performed at a median time of 3 hours after admission and analyzed centrally. Angiograms were read at a core laboratory by 2 independent readers blinded to patient data. Complex coronary lesion was defined as the presence of at least one of the following: thrombus (+), TIMI flow &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 2, or ulcerated plaque. NT-probrain natriuretic peptide levels increased proportionally as LV function decreased. The levels of NT-proBNP were directly related to the extent of the CAD. This association was maintained when we analyzed patients with normal LV function (n = 257). Patients with complex coronary lesions or those with at least one of its individual component had higher levels of NT-proBNP compared with those without complex coronary lesions. After adjusting for clinical and electrocardiographic variables and other biomarkers, positive troponin (OR 2.20, 95% CI 1.50-3.22, P…
Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se r... more Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se relacionan unas con otras. El análisis multivariado es una herramienta estadística para determinar la contribución relativa de diferentes causas a un determinado evento o resultado. Los investigadores clínicos necesitan este tipo de análisis, dado que las enfermedades presentan múltiples causas y el pronóstico se determina, usualmente, por un gran número de factores. Esta herramienta va a ser aplicada en dos escenarios clínicos mediante dos ejemplos.
La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa u... more La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa una causa importante de miocardiopatia restrictiva. En esta presentacion se describe el caso de una paciente con insuficiencia cardiaca (IC) secundaria a miocardiopatia infiltrativa por deposito amiloide y obstruccion dinamica del tracto de salida del ventriculo izquierdo. El diagnostico hematologico fue de mieloma multiple por cadenas livianas y se demostro amiloidosis en dos tejidos extracardiacos.(resumen completo en pdf)
Revista Argentina de Radiología / Argentinian Journal of Radiology, 2020
ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infec... more ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad.El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.
Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy... more Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy and there is no available information on base - line characteristic...
Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute cor... more Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are criti...
Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious d... more Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan. Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocard...
Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles <... more Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles < 586 pg/ml. Los pacientes con NT-proBNP elevado eran más añosos, con mayor frecuencia de sexo femenino; tuvieron una proporción mayor de marcadores séricos elevados y una ...
Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent ... more Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent platelet agonist and converts fibrinogen to fibrin. Hirudin is a powerful, direct, and specific antithrombin agent that can be used in many therapeutic scenarios in which heparin is routinely used. In this systemic review, we summarize evidence from randomized clinical trials evaluating the benefits and risks of recombinant hirudin for the treatment of acute coronary syndromes and patients undergoing percutaneous coronary intervention.
Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo card... more Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo cardiovascular. El puntaje de calcio coronario (PCC) es un predictor superior al EIMC, pero de costo elevado y en nuestro pais pocos pacientes pueden acceder a su medicion. Objetivos 1) Evaluar la precision diagnostica del EIMC para la deteccion de un PCC > 0. 2) Determinar el punto de corte optimo del EIMC para discriminar entre la presencia o la ausencia de calcio coronario. Material y metodos Estudio descriptivo transversal de muestras consecutivas obtenidas en los consultorios de prevencion cardiovascular. Se midio el EIMC medio y maximo mediante un eco-Doppler carotideo. Se efectuo una tomografia computarizada de 64 pistas para la evaluacion del PCC. Se determino la precision diagnostica del EIMC para la deteccion de un PCC > 0 mediante un analisis ROC. Resultados Se incluyeron 202 sujetos consecutivos que participan de un programa de prevencion primaria. Caracteristicas de la poblacion (media } desviacion estandar): edad 57 } 13 anos, sexo femenino: 49%, tabaquismo: 13%, estatinas: 37%, diabetes mellitus: 13%, puntaje de Framingham en no diabeticos: 9% } 7%, EIMC medio: 0,953 } 0,342 mm, EIMC maximo: 1,383 } 0,679 mm, prevalencia de placa aterosclerotica carotidea: 37% y de PCC > 0: 62%. Las correlaciones entre el EIMC medio y maximo y el PCC fueron moderadas (r = 0,56 y r = 0,55, respectivamente). El area bajo la curva ROC del EIMC maximo fue de 0,822 (IC 95% 0,763-0,880) y la del EIMC medio fue de 0,829 (IC 95% 0,771-0,888). El punto de corte optimo del EIMC maximo para discriminar entre PCC > 0 o PCC = 0 fue de . 1,01 mm y la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) fueron del 78%, 75%, 83% y 67%, respectivamente. El punto de corte optimo del EIMC medio para discriminar entre PCC > 0 o PCC = 0 fue . 0,82 mm y la sensibilidad, la especificidad, el VPP y el VPN fueron del 77%, 78%, 85% y 67%, respectivamente. Conclusiones En esta poblacion predominantemente de riesgo bajo, la precision diagnostica del EIMC para detectar PCC > 0 fue moderada. Una ecografia Doppler carotidea gnormal no excluyo la presencia de aterosclerosis subclinica coronaria. Estos resultados podrian mejorar la seleccion de pacientes que requieran la medicion del PCC para estratificar el riesgo cardiovascular.
The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Eurosc... more The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR) METHODS AND RESULTS: 208 patients with severe AS underwent the 6MWT before AVR, as part of a randomised trial (ASSERT) comparing stented and stentless aortic valves. Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n = 14) in patients walking &lt;300 metres compared to 4% (n = 4) in those who walked &gt; or =300 metres (p = 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6-minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09 to 0.85, p = 0.025). The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis before AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score.
Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is unc... more Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.
NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfun... more NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfunction and adverse outcome in patients with non-ST-elevation acute coronary syndromes (NSTEACS). However, the underlying pathophysiological mechanisms responsible for this association have not been well established. We sought to explore the relation between NT-proBNP levels and extension of coronary artery disease (CAD) and the presence of more complex and severe coronary lesions. This prospective, multicenter angiographic substudy included 585 patients admitted with NSTEACS. Blinded measurements of NT-proBNP and troponin T were performed at a median time of 3 hours after admission and analyzed centrally. Angiograms were read at a core laboratory by 2 independent readers blinded to patient data. Complex coronary lesion was defined as the presence of at least one of the following: thrombus (+), TIMI flow &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 2, or ulcerated plaque. NT-probrain natriuretic peptide levels increased proportionally as LV function decreased. The levels of NT-proBNP were directly related to the extent of the CAD. This association was maintained when we analyzed patients with normal LV function (n = 257). Patients with complex coronary lesions or those with at least one of its individual component had higher levels of NT-proBNP compared with those without complex coronary lesions. After adjusting for clinical and electrocardiographic variables and other biomarkers, positive troponin (OR 2.20, 95% CI 1.50-3.22, P…
Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se r... more Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se relacionan unas con otras. El análisis multivariado es una herramienta estadística para determinar la contribución relativa de diferentes causas a un determinado evento o resultado. Los investigadores clínicos necesitan este tipo de análisis, dado que las enfermedades presentan múltiples causas y el pronóstico se determina, usualmente, por un gran número de factores. Esta herramienta va a ser aplicada en dos escenarios clínicos mediante dos ejemplos.
La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa u... more La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa una causa importante de miocardiopatia restrictiva. En esta presentacion se describe el caso de una paciente con insuficiencia cardiaca (IC) secundaria a miocardiopatia infiltrativa por deposito amiloide y obstruccion dinamica del tracto de salida del ventriculo izquierdo. El diagnostico hematologico fue de mieloma multiple por cadenas livianas y se demostro amiloidosis en dos tejidos extracardiacos.(resumen completo en pdf)
Revista Argentina de Radiología / Argentinian Journal of Radiology, 2020
ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infec... more ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad.El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.
Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy... more Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy and there is no available information on base - line characteristic...
Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute cor... more Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are criti...
Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious d... more Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan. Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocard...
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