Scielo RSS <![CDATA[Revista chilena de cardiología]]> https://scielo.conicyt.cl/rss.php?pid=0718-856020190003&lang=es vol. 38 num. 3 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Enfoque minimalista en el implante de válvula aórtica percutánea]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300173&lng=es&nrm=iso&tlng=es Resumen Introducción: En pacientes con estenosis Aórtica (EA) severa sintomática, el implante de válvula aórtica percutánea transcatéter (TAVI) por vía transfemoral constituye el estándar de tratamiento en aquellos de riesgo quirúrgico intermedio o alto. El uso de un abordaje minimalista ha demostrado ser seguro y efectivo, si bien no existen reportes sobre la realidad nacional Métodos: Estudio descriptivo sobre la experiencia con pacientes sometidos al implante de TAVI bajo un protocolo minimalista en Unidad de Cardiología Intervencional y Hemodinamia del Hospital Sótero del Río desde Enero de 2018. Se analizaron las variables clínicas de los pacientes y del procedimiento así como desenlaces clínicos intrahospitalarios y seguimiento alejado. Resultados: Entre Enero 2018 hasta Abril 2019, un total de 10 pacientes fueron sometidos al implante de TAVI por vía transfemoral. El score STS-PROM promedio fue de 7,1. Se logró un implante exitoso en el 100% de los casos con un gradiente medio residual de 8 mmHg y sin leak moderado a severo en ningún paciente. No hubo eventos cerebrovasculares isquémicos perioperatorios ni muerte en este grupo. Se requirió implante de marcapasos definitivo en 3 pacientes y un paciente presentó hematoma femoral perioperatorio que requirió transfusión de glóbulos rojos. La mediana de la estadía hospitalaria fue de 2 días. Conclusiones: El uso de una estrategia minimalista para el implante de TAVI en nuestra realidad nacional es seguro y aplicable. Los resultados perioperatorios y a 30 días fueron comparables a los descritos en experiencias internacionales.<hr/>Abstract Background: In patients with symptomatic severe aortic stenosis, transcatheter percutaneous aortic valve implant (TAVI) is the standard treatment in those with intermediate or high surgical risk. The use of a minimalist approach has proven to be safe and effective, although there are no reports on the national reality Methods: Descriptive study on the experience with patients undergoing TAVI implantation under a minimalist protocol at the Interventional Cardiology and Hemodynamics Unit of the Hospital Sótero del Río since January 2018. Clinical characteristics of the patients and the procedure were analyzed as well as intrahospital outcomes and at 30-days follow up. Results: Between January 2018 and April 2019, a total of 10 patients underwent TAVI implantation by transfemoral approach in our institution. The average STS-PROM score was 7.1. A successful implant was achieved in 100% of cases with an average residual gradient of 8 mmHg and no moderate to severe leak in any patient. There were no perioperative ischemic cerebrovascular events nor death in this group. A definitive pacemaker implant was required in 3 patients and one patient developed femoral hematoma that required red blood cell transfusion. The median hospital stay was 2 days. Conclusions: The use of a minimalist strategy for TAVI implantation in our national reality is safe and applicable. Immediate results and at 30-days follow up were comparable to those described in international experiences. <![CDATA[Relación entre el volumen plaquetario medio y la gravedad de la enfermedad arterial coronaria]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300182&lng=es&nrm=iso&tlng=es Resumen: Antecedentes y objetivos: Las plaquetas desempeñan un papel principal en la patogénesis de las enfermedades de las arterias coronarias. El volumen plaquetario medio (VPM) es un indicador del volumen plaquetario circulante y se ha demostrado que está relacionado con la actividad plaquetaria. El objetivo del presente estudio es investigar si el VPM está asociado con la gravedad de la enfermedad de las arterias coronarias. Métodos: Medimos VPM en 910 pacientes consecutivos con síndrome coronario agudo sintomático sometidos a angiografía coronaria. Se recogieron los datos básicos de los pacientes. La enfermedad coronaria significativa se definió como una estenosis &gt;50% en al menos 1 vaso coronario y la gravedad como la enfermedad de tres vasos y/o la enfermedad del tronco de la coronaria izquierda. Resultados: Este estudio incluyó 477 (52,4%) hombres y 433 (47,6%) mujeres. Los resultados mostraron una relación significativa entre el VPM y la gravedad de la enfermedad arterial coronaria (P=0,001) y un modelo de regresión logística confirmó que el aumento de cada unidad en el volumen plaquetario medio puede aumentar el riesgo de enfermedad arterial coronaria grave en 4,67%. Encontramos que el VPM es mayor en los pacientes de sexo masculino y fumador de cigarrillos. Conclusión: El VPM está relacionado con la gravedad de la enfermedad arterial coronaria, y podría ser un parámetro útil para la evaluación primaria de la gravedad del compromiso de las arterias coronarias en pacientes con síntomas de enfermedad coronaria.<hr/>Abstract: Background and aim: Platelets play a principal role in pathogenesis of coronary artery diseases. Mean platelet volume (MPV) is an indicator of circulating platelet size and has been demonstrated to be correlated with platelet activity. The aim of the current study was to investigate whether MPV is associated with the severity of coronary artery disease. Methods: We measured MPV in 910 consecutive patients with symptomatic acute coronary syndrome undergoing coronary angiography. The basic data of patients were collected. Significant coronary artery disease was defined as &gt;50% stenosis in at least 1 coronary artery and severe coronary artery disease was defined as three vessel disease and/or left main artery disease. Results: This study included 477 (52.4%) males and 433(47.6%) females. A significant relationship between MPV and severity of coronary artery disease (p= 0.001) was found. Logistic regression analysis confirmed that each unit increment in mean platelet volume was associated to a 4.67% increase in the in the risk of severe coronary artery disease. In addition, we found that MPV was higher in males and in cigarette smokers. Conclusion: This study showed that MPV is related to severity of coronary artery disease. MPV might be a useful parameter for primary evaluation of severity of coronary artery involvement in patients with symptoms of coronary artery diseases. <![CDATA[Comportamiento hemodinámico y respiratorio durante la movilización temprana de pacientes sometidos a cirugía cardíaca: Experiencia en un Hospital Público]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300190&lng=es&nrm=iso&tlng=es Abstract: Objective: To describe the hemodynamic and respiratory changes during early mobilization (EM) after cardiac surgery. Methods: An analytical observational retrospective cohort study was performed in a Coronary Care Unit of a tertiary hospital. 75 patients submitted to cardiac surgery (From March 2017 up to July 2017) were included. Inclusion criteria were hemodynamic and respiratory stability before starting EM. Hemodynamic and respiratory behavior during EM were evaluated. EM was performed in 3 steps: supine, seated at the edge of the bed (SEB) and biped (BIP). Heart rate (HR), breathing rate (BR), mean arterial pressure (MAP), oxygen saturation (O2Sat) and Borg and Pain scales were evaluated. Results: Six patients, (8%) could not complete the mobilization satisfactorily, which was significantly associated to greater extracorporeal circulation time (ECC T) (p= 0.02). HR, BR, MAP Borg and Pain scales, that were significantly changed during EM, returned fully after the procedure. O2Sat was significantly increased at the end of EM (p=0.000). Prolonged ECC time predicted a 4.6 fold risk for inability to perform EM for 48 hours. Conclusion: EM of patients undergoing cardiac surgery is a safe and feasible intervention. In addition, the prolonged ECC T was observed to be a risk factor for delayed mobilization in this type of patients. <![CDATA[Pericarditis Constrictiva, variedad fibroelástica. Nuevas técnicas diagnósticas por imágenes]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300198&lng=es&nrm=iso&tlng=es Abstract Constrictive Pericarditis is a disease characterized by fibrous thickening of the pericardium that generates a failure in cardiac function. The case of a 54-year-old man, marathon runner with progressive symptoms of congestive heart failure and significantly reduction of Functional Class II-III (NYHA) lasting seven months is presented. Clinical findings are described and the diagnostic value of several imaging techniques - echocardiography, multi-slice computerized tomography and cardiac magnetic resonance - is emphasized. Constrictive fibrous pericarditis was confirmed at pericardiectomy. <![CDATA[Implante percutáneo de válvula aórtica transcatéter por vía femoral en paciente joven con obesidad extrema]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300204&lng=es&nrm=iso&tlng=es Resumen: TAVI transfemoral en una paciente con obesidad extrema y estenosis aórtica severa. Una mujer extremadamente obesa (IMC 62.5 Kg/M2) con estenosis aórtica severa fue descartada para cirugía bariátrica y reemplazo valvular aórtico. Se efectuó una TAVI por vía transfemoral, sin anestesia general. Se describen cuidadosas técnicas para efectuar la punción femoral y su sellado posterior. La paciente se recuperó sin incidentes, la gradiente transvalvular aórtica se redujo significativamente y hubo mínima insuficiencia valvular.<hr/>Abstract: An extremely obese woman (BMI 62.5 Kg/M2) with severe symptomatic aortic stenosis was discarded for bariatric surgery or aortic valve replacement. A transfemoral TAVI was performed, without general anesthesia. Careful techniques to perform and seal the transfemoral puncture are described. The patient recovered uneventfully with a significant decrease in aortic valve gradient and minimal aortic insufficiency. <![CDATA[Patrón de flujo en “4D Flow” y su vínculo con la aortopatía bicúspide]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300210&lng=es&nrm=iso&tlng=es Abstract: Bicuspid aortic valve (BAV) disease is generally associated with thoracic aortic dilatation (TAD). Related factors include; genetical, morphological (valvular phenotype) and most recently, hemodynamic profiles associated with flow pattern and wall shear stress. Cardiac magnetic resonance 4D Flow (4DF) can give an integral evaluation of these later flow variables. Remarkable, different spectrums of flow and vortex direction exist in BAV that are related to the site of TAD (proximal or distal). Therefore, we present a 57 years old patient with BAV (Sievers 0) with anteroposterior leaflets distribution in which 4DF depicted an anteriorly and righthand oriented jet that correlated with the zone of grater AD; also, vortex rotation was counterclockwise, corresponding to the most frequent vortex type in BAV. In conclusion, 4DF is a powerful and ground-breaking tool that enhances our knowledge of BAV related aortopathy. <![CDATA[Percepción sobre mortalidad cardiovascular femenina en trabajadoras de la salud]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300213&lng=es&nrm=iso&tlng=es Abstract Background: Most women perceive oncological disease as their principal cause of death. However, it has been shown that cardiovascular disease (CVD) is currently the leading cause of mortality in women in developed countries. Aim: to evaluate how this perception has changed in relation to health education campaigns present in Chile during the study period. Method: A survey was performed in 2007 (n= 409) and repeated in 2016 (n=431), including women working at a health institution, divided in 2 groups: professionals with a university degree (U) or health administrative and technical workers (W). The overall perception of CVD as a cause of death increased from 20% in 2007 to 37% in 2016 (p&lt;0.01). The increase in the % of women perceiving CVD as main cause of death was greater in W women (14% to 34%, p&lt;0.01) than in U women (39% to 44%, NS). Oncological diseases, mainly breast cancer, continued to be perceived as the main mortality cause in both groups of women in 2016. Conclusion: Although significant, the increase in % of women naming CVD as the main cause of death at a health institution was relatively small. Campaigns to increase the awareness of the significance of CVD in women should probably be revised. <![CDATA[Infarto Agudo del Miocardio: conducta en el período prehospitalario]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300218&lng=es&nrm=iso&tlng=es Resumen: El tratamiento del Infarto Agudo del Miocardio con supradesnivel del segmento ST debe iniciarse en el escenario prehospitalario, en el sitio del primer contacto médico. El diagnóstico electrocardiográfico precoz debe ser realizado, idealmente, dentro de los primeros 10 min después de la consulta y confirmado por un especialista. A este respecto, la teletransmisión del electrocardiograma a un centro de llamados atendido por especialistas en horario 24/7 es un modelo muy eficiente, idealmente como parte de una red de tratamiento. El control del dolor y la administración de agentes antiplaquetarios son imperativos y si la intervención coronaria percutánea (angioplastia primaria) no es factible dentro de las ventanas de tiempo universalmente recomendadas, se debiera realizar un tratamiento fibrinolítico, seguido por angioplastia diferida.<hr/>Abstract: Treatment of acute myocardial infarction should be initiated in the prehospital scenario at the site of first medical contact. Prompt electrocardiographic diagnosis should be performed ideally within 10min after consultation and diagnosis confirmed by a specialist. Teletransmission of the electrocardiogram to a call center staffed with specialists on a 24/7 basis is a very efficient model, ideally as part of a network of treatment. Pain control and administration of antiplatelets agents are mandatory and if primary percutaneous intervention is not feasible within time limits universally recommended, prehospital fibrinolyisis should be performed followed by deferred angioplasty. <![CDATA[Mecanismo sensor y de adaptación a los niveles de oxígeno y su implicancia en las enfermedades cardiovasculares: a propósito del Premio Nobel de Fisiología-Medicina 2019]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300225&lng=es&nrm=iso&tlng=es Resumen El Premio Nobel 2019 en Fisiología-Medicina se confirió a los Profesores Gregg Semenza, William Kaelin y Sir Peter Ratcliffe por sus investigaciones en la maquinaria molecular que regula la expresión de genes sensibles a los cambios en los niveles de oxígeno. La síntesis de eritropoyetina inducida por la disminución de los niveles sanguíneos de oxígeno condujo al estudio del gen de la eritropoyetina y descubrimiento de los elementos de respuesta a hipoxia (HRE) en la región promotora y posteriormente al factor transcripcional inducible por hipoxia tipo 1 (HIF-1). Este factor consta de dos subunidades: HIF-1α, sensible al oxígeno, y HIF-1β, expresada constitutivamente. HIF1 activa la transcripción de genes que codifican enzimas, transportadores y proteínas mitocondriales que disminuyen la utilización de oxígeno al cambiar el metabolismo oxidativo al metabolismo glicolítico y además aquellos involucrados en la angiogénesis y diferenciación celular. Las investigaciones paralelas en la enfermedad von Hippel-Lindau (VHL), un desorden autosómico dominante, permitieron descubrir el mecanismo de degradación de HIF1 en condiciones de normoxia y como se estabiliza bajo hipoxia. El impacto de HIF en clínica radica en el establecimiento de nuevas dianas terapéuticas para combatir la anemia y diversas enfermedades cardiovasculares. HIF promueve la angiogénesis a través de la expresión del factor de crecimiento vascular endotelial (VEGF), agente cardioprotector con potencial para tratar la isquemia/reperfusión, hipertrofia patológica e insuficiencia cardíaca.<hr/>Abstract The Nobel Prize in Physiology-Medicine was awarded to Drs. Gregg Semenza, William Kaelin and Sir Peter Ratcliffe for their research in the molecular machinery that regulates the expression of genes sensitive to the change in oxygen levels. The synthesis of erythropoietin induced by the decrease levels of oxygen in the blood led to investigate the promoter of the erythropoietin gene where the so-called hypoxia response elements (HRE) were described. Semenza et al. described a protein that binds to HREs and called it hypoxia-inducible transcriptional factor (HIF) that regulates gene expression among those involved in angiogenesis, cell differentiation and glycolytic enzymes. HIF presents two oxygen-sensitive subunits HIF-1α and HIF-1β constitutively expressed. In parallel, Kaelin et al. investigated von Hippel-Lindau disease (VHL), an autosomal dominant disorder, discovering a mutation of this protein generated a behavior similar to hypoxia. The impact of HIF-1α lies in the search for new strategies such as hydrolase inhibitors to combat prevalent diseases, including anemia and cardiovascular diseases These compounds promote the expression of vascular endothelial growth factor (VEGF), a cardioprotective agent with potential use in pre- and post-conditioning therapy, cardiac hypertrophy and heart failure. <![CDATA[Dra. Odette Farrú Albohaire. Con la pediatría en el corazón]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-85602019000300236&lng=es&nrm=iso&tlng=es Resumen El Premio Nobel 2019 en Fisiología-Medicina se confirió a los Profesores Gregg Semenza, William Kaelin y Sir Peter Ratcliffe por sus investigaciones en la maquinaria molecular que regula la expresión de genes sensibles a los cambios en los niveles de oxígeno. La síntesis de eritropoyetina inducida por la disminución de los niveles sanguíneos de oxígeno condujo al estudio del gen de la eritropoyetina y descubrimiento de los elementos de respuesta a hipoxia (HRE) en la región promotora y posteriormente al factor transcripcional inducible por hipoxia tipo 1 (HIF-1). Este factor consta de dos subunidades: HIF-1α, sensible al oxígeno, y HIF-1β, expresada constitutivamente. HIF1 activa la transcripción de genes que codifican enzimas, transportadores y proteínas mitocondriales que disminuyen la utilización de oxígeno al cambiar el metabolismo oxidativo al metabolismo glicolítico y además aquellos involucrados en la angiogénesis y diferenciación celular. Las investigaciones paralelas en la enfermedad von Hippel-Lindau (VHL), un desorden autosómico dominante, permitieron descubrir el mecanismo de degradación de HIF1 en condiciones de normoxia y como se estabiliza bajo hipoxia. El impacto de HIF en clínica radica en el establecimiento de nuevas dianas terapéuticas para combatir la anemia y diversas enfermedades cardiovasculares. HIF promueve la angiogénesis a través de la expresión del factor de crecimiento vascular endotelial (VEGF), agente cardioprotector con potencial para tratar la isquemia/reperfusión, hipertrofia patológica e insuficiencia cardíaca.<hr/>Abstract The Nobel Prize in Physiology-Medicine was awarded to Drs. Gregg Semenza, William Kaelin and Sir Peter Ratcliffe for their research in the molecular machinery that regulates the expression of genes sensitive to the change in oxygen levels. The synthesis of erythropoietin induced by the decrease levels of oxygen in the blood led to investigate the promoter of the erythropoietin gene where the so-called hypoxia response elements (HRE) were described. Semenza et al. described a protein that binds to HREs and called it hypoxia-inducible transcriptional factor (HIF) that regulates gene expression among those involved in angiogenesis, cell differentiation and glycolytic enzymes. HIF presents two oxygen-sensitive subunits HIF-1α and HIF-1β constitutively expressed. In parallel, Kaelin et al. investigated von Hippel-Lindau disease (VHL), an autosomal dominant disorder, discovering a mutation of this protein generated a behavior similar to hypoxia. The impact of HIF-1α lies in the search for new strategies such as hydrolase inhibitors to combat prevalent diseases, including anemia and cardiovascular diseases These compounds promote the expression of vascular endothelial growth factor (VEGF), a cardioprotective agent with potential use in pre- and post-conditioning therapy, cardiac hypertrophy and heart failure.