Mortality and Morbidity in Adults With Rheumatic Heart Disease.

Importance: Rheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries.

Objective: To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD.

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

Introduction: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF.

Objective: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender.

Methods: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender.

Post-cardioversion time Course of Atrial Remodeling Markers and their Association with Recurrence in Subjects with Long-standing, Persistent Atrial Fibrillation.

Background: Activation of the renin-angiotensin-aldosterone axis with elevation of inflammatory markers and the resulting fibrosis play a very important role in atrial remodeling in patients with atrial fibrillation (AF), which is associated with post-cardioversion recurrence.

Aim Of The Study: The purpose of the study was to describe the time course of angiotensin II (AngII), aldosterone, and of the amino terminal pro-peptide of type III pro-collagen (PIIINP) following cardioversion, and their association with arrhythmia recurrence.

Methods: Ninety-nine subjects with long-standing, persistent, non-valvular atrial fibrillation who underwent successful electrical cardioversion were included, with a 6 month follow up.

Rivaroxaban in Rheumatic Heart Disease-Associated Atrial Fibrillation.

Background: Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited.

Methods: We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHADSVASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm, left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist.

Cardiovascular autonomic responses during head-up tilt test in newly diagnosed type 2 diabetes.

Background: Autonomic dysfunction is commonly observed in patients with long-standing type 2 diabetes. Previous studies have confirmed the value of both subjectively assessed symptoms and objective measurements of autonomic nervous system function in diagnosing cardiovascular autonomic neuropathy. However, the head-up tilt test (HUTT) has been rarely used to investigate cardiovascular autonomic responses in subjects with high risk of newly diagnosed type 2 diabetes (nT2D).

Early Cerebral Hypoperfusion in Patients with Orthostatic Intolerance Without Tachycardia During Head-Up Tilt Test is Independent of Vasovagal Response.

Background: Cerebral hypoperfusion before syncope has been shown in patients with chronic orthostatic intolerance (OI) without tachycardia, but it is unknown if an initial decrease of cerebral blood flow velocity (CBFv) could be related to the vasovagal response (VVR) to head-up tilt test (HUTT).

Objective: The objective of the study was to compare cardiovascular, cerebrovascular, and autonomic variables during HUTT in OI patients with or without a VVR.

Methods: We included 74 subjects (58% female, mean age 33 ± 12 years) who underwent a 30-min HUTT and were divided into three groups: OI with VVR positive (VVR+), OI without VVR negative (VVR-), and asymptomatic healthy subjects with negative HUTT (control group).

Anticoagulation Therapy by Age and Embolic Risk for Nonvalvular Atrial Fibrillation in Mexico, an Upper-Middle-Income Country: The CARMEN-AF Registry.

Background: Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF).

Objective: To report the patterns of OAT according to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country.

Material And Methods: There were 1,423 consecutive patients ≥18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period.

Transient Orthostatic Hypertension During Head-Up Tilt Test in Young Adults: A Phenotype of Blood Pressure Variability.

Purpose: The mechanisms underlying orthostatic hypertension (OHT) remain poorly understood. The authors evaluated the cardiovascular, cerebrovascular dynamics, and autonomic response to head-up tilt test (HUTT) in young adults with symptoms of orthostatic intolerance and transient OHT.

Methods: Forty-four female subjects were included (34 ± 13 years old) and categorized in three groups after a 30-minute 70° passive HUTT: symptomatic patients with OHT (surge of systolic blood pressure ≥20 mm Hg for at least 5 minutes at any given time during HUTT), orthostatic intolerance (symptomatic patients without orthostatic blood pressure changes), and healthy asymptomatic control subjects.

Similar Cerebral Blood Flow and Autonomic Responses to Upright Tilt Test in Adult Patients With Different Hemodynamic Mechanisms Leading to Reflex Syncope.

Purpose: Although the underlying mechanisms of reflex syncope remain under debate, there is evidence that it results from decreased cardiac output related to splanchnic blood pooling or a fall in systemic vascular resistance. The aim was to evaluate the response of cerebrovascular and autonomic variables to passive orthostatic challenge in adult patients with different mechanisms leading to reflex syncope.

Methods: The study included 30 subjects (66% women, mean age 34 ± 14 years) who suffered a hemodynamic collapse during a drug-free head-up tilt test.

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

Background: Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF.

Cardiovascular and Cerebral Hemodynamics in Asymptomatic Healthy Subjects With/Without Abnormal Head-up Tilt Test Versus Recurrent Fainters.

Purpose: The aim of this study was to compare hemodynamic and autonomic responses during head-up tilt test (HUTT) between healthy volunteers and patients with a history of fainting and confirmed vasovagal syncope. We hypothesize that the autonomic and hemodynamic physiologic responses remain intact during orthostatic stress in people without previous fainting and negative HUTT, but deteriorate similarly in patients with recurrent vasovagal syncope and in asymptomatic healthy subjects who develop a vasovagal response during HUTT.

Methods: The study included 57 asymptomatic healthy volunteers (42% women, mean age 23.

The World Heart Federation Roadmap for Nonvalvular Atrial Fibrillation.

Background: The World Heart Federation has undertaken an initiative to develop a series of Roadmaps to promote development of national policies and health systems approaches, and to identify potential roadblocks on the road to effective prevention, detection, and management of cardiovascular disease in low-and middle-income countries (LMICs) and develop strategies for overcoming these. This Roadmap focuses on atrial fibrillation (AF). AF is the most common, clinically significant arrhythmia and, among other clinical outcomes, is associated with increased risk of stroke.

Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation.

Background: In patients with an acute coronary syndrome (ACS), no conclusive agreement has been reached to date regarding the association between the different types of atrial fibrillation (AF) and the in-hospital mortality risk. We conducted a retrospective cohort study in patients with ACS to determine the prognostic implications of the different types of AF.

Methods: We analyzed 6705 consecutive patients with ACS admitted to a coronary care unit (CCU), including 3094 with ST segment elevation myocardial infarction (STEMI) and 3611 with non-ST-elevation acute coronary syndrome (NSTE-ACS).

Arg347Cys polymorphism of α1a-adrenergic receptor in vasovagal syncope. Case-control study in a Mexican population.

Background: Vasovagal syncope is a common clinical condition, consequential to reduced cerebral blood flow resulting from a failure in cardiovascular homeostasis during orthostasis. Blood pressure regulation is the basis for syncope development. In this regulation, the α1a-adrenergic receptor plays a major role.

Dronedarone in high-risk permanent atrial fibrillation.

Background: Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk permanent atrial fibrillation.

Apixaban in patients with atrial fibrillation.

Background: Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high risk of stroke. Apixaban, a novel factor Xa inhibitor, may be an alternative treatment for such patients.

[Psychopathology and personality in patients with vasovagal syncope].

Unlabelled: Syncope is characterized by a sudden and brief Loss of the normal state of consciousness (fainting), caused by multiple factors (biological, psychological and social), which consequences can be Lethal if it is not timely diagnosed and treated. These episodes affect the total sphere of the subject (on an individual, work, school, social, and family level).

Purpose Of The Study: Contribute to the study of vasovagal syncope (WS) patients, describing their personality and psychopathological characteristics.

[Primary and secondary prevention of sudden cardiac death in the ICD Registry-Latin America].

Introduction And Objectives: The ICD Registry is an observational study conducted in Latin America to collect data on indications and follow-up care for primary or secondary prevention of sudden cardiac death patients. The objective of this study is to compare and evaluate the characteristics of primary versus secondary prevention in the patient population enrolled in the registry.

Methods: Demographic data, indication, etiology, NYHA functional class and left ventricular ejection fraction (LVEF), pharmacological treatment at implant and the type of ICD implanted were also collected.

[Comparison of metoprolol vs clonazepam as a first treatment choice among patients with neurocardiogenic syncope].

Objective: We compared the effects of a metoprolol and clonazepam in patients with neurocardiogenic syncope.

Methods: We compared the effects of a metoprolol and clonazepam in a prospective, randomised trial in 54 patients. Patients were randomly assigned to metoprolol (starting dose 50 mg bid) or clonazepam (starting dose 0.

[Vasovagal syncope: from genetic to bedside].

Recent studies suggest vasovagal syncope has a significant heritable component indicating that, at least some forms of vasovagal syncope may have a genetic cause. The beta1-adrenergic receptor is a key cell surface signaling protein expressed in the heart and major determinant of cardiac function. The role of genetics in the phenotypic manifestations of vasovagal syncope is unclear.

[KCNQ 1 (KvLQT1) missense mutation causing congenital long QT syndrome (Jervell-Lange-Nielsen) in a Mexican family].

Background: Long QT syndromes (LQTS) are inherited cardiac disorders caused by mutations in the genes that encode sodium or potassium transmembrane ion channel proteins. More than 200 mutations, in at least six genes, have been found in these patients. The Jervell and Lange-Nielsen (JLN) syndrome is the recessive form of the disease and is associated with deafness.

[Permanent cardiac pacing in vasovagal syncope: when and which?].

Vasovagal syncope is a common clinical problem forming the pathophysiological basis of half the cases of syncope. Although it usually has a favourable prognosis, it may be a highly limiting clinical problem in a particular subset of patients among whom syncopal recurrences are frequent and without prodromic symptoms, or have a traumatic outcome. For this subgroup of patients the term "malignant vasovagal syncope" has been proposed.