Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders.

Clinicians frequently equate symptoms of volume overload to heart failure (HF) but such generalization may preclude diagnostic or etiologic precision essential to optimizing outcomes. HF itself must be specified as the disparate types of cardiac pathology have been traditionally surmised by examination of left ventricular (LV) ejection fraction (EF) as either HF with preserved LVEF (HFpEF-LVEF >50%) or reduced LVEF of (HFrEF-LVEF <40%). More recent data support a third, potentially transitional HF subtype, but therapy, assessment, and prognosis have been historically dictated within the corresponding LV metrics determined by echocardiography.

Left Ventricular Longitudinal Global Strain to Predict Severe Coronary Disease in Patients with Precordial Pain Suggestive of Non-ST-Segment Elevation Acute Coronary Syndrome.

Background: Diagnosing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not always straightforward. Left ventricular global longitudinal strain (LVGLS) is an echocardiographic method capable of detecting subclinical regional and global ventricular contractile dysfunction due to myocardial ischemia. The objectives of this study were to evaluate the efficacy of LVGLS in diagnosing severe coronary disease in patients with chest pain suggestive of NSTE-ACS and to assess the relationships between LVGLS reduction and ultrasensitive troponin T (UsTnT) elevation, electrocardiographic changes suggestive of ischemia, and the number of vessels with severe obstructions.

Concordance and prevalence of subclinical atherosclerosis in different vascular territories.

Background: Subclinical atherosclerosis (SA) in the carotid, femoral, and coronary territories is a powerful predictor of cardiovascular (CV) events. Whether it is sufficient to assess SA in a single vascular territory in early-stage disease is uncertain. We aimed to determine the prevalence and concordance of SA in these vascular beds in asymptomatic patients without known CV disease.

[Comparison of risk scores to predict subclinical atherosclerosis].

Subclinical atherosclerosis is a powerful predictor of cardiovascular events, although it is unknown which of the risk scores is more useful to predict its presence in a Latin American population. The objective was to compare the performance of the risk scores: Framingham, Regicor and Atherosclerotic Cardiovascular Disease Risk Estimator to predict the presence of subclinical atherosclerosis in asymptomatic persons without known cardiovascular disease; as well as determining its prevalence and distribution in the different vascular beds. From 2014 to 2017, patients from 35 to 75 years, asymptomatic and without known cardiovascular disease who underwent a carotid and femoral Doppler echo and calcium score were evaluated.

[Percutaneous balloon angioplasty for treatment of chronic thromboembolic pulmonary hypertension].

Chronic thromboembolic pulmonary hypertension is characterized by the presence of organized thrombotic material in the pulmonary arteries which causes elevation of the pulmonary vascular resistance, right heart failure, and death if not treated. Pulmonary thromboendarterectomy is the treatment of choice and can be curative when the obstruction is proximal. There are cases in which this therapy is not possible, and pulmonary angioplasty is a therapeutic alternative of growing interest.

Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients.

Objectives: This study aimed to analyze whether blood pressure (BP) measurement is concordant between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and determine whether the decision on treatment changes is similar on the basis of information provided by both methods.

Methods: Treated hypertensive patients were studied with ABPM and HBPM to evaluate therapeutic efficacy and/or diagnose resistant hypertension (HTN). Modification of pharmacological treatment was decided on the basis of pre-established criteria; therefore, the number of therapeutic changes between both techniques was compared.

Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings.

Background: Complete left bundle branch block (CLBBB) is an electrocardiographic (ECG) dromotropic disorder seen in patients with various structural heart diseases and sometimes is associated with poor prognosis. Its presence confounds the application of standard ECG criteria for the diagnosis of left ventricular hypertrophy (LVH), myocardial infarction (MI) in the chronic phase, and pathologies that produce changes on ST-T segment. The aim of this investigation was to establish the relationship between CLBBB and cardiac structural abnormalities assessed by echocardiography.

[Takotsubo Syndrome: experience in three institutions of Cordoba City].

Takotsubo Syndrome is an acquired cardiomyopathy characterized by a transient left ventricular antero-apical asynergy or disynergy (apical ballooning), symptoms and electrocardiographic changes are suggestive of an acute coronary syndrome, moderate cardiac enzymatic release and absence of significant atherosclerotic lesions in coronary arteries. It predominantly affects postmenopausal women and it is frequently preceded by situations of physical or psychological stress. The physiopathology is not completely understood but there is consensus that it is triggered by a surge of catecholamines consequent to the aforementioned stress conditions.

[Post-traumatic false (pseudo) aneurysm of the left main coronary artery].

Coronary pseudo-aneurysm is an extremely rare entity. Its natural history is scarcely known and its treatment is controversial. We report a case of pseudo-aneurysm of the left main coronary artery associated with an antero-apical infarct of the left ventricle diagnosed five years after a cardiac arrest following a non-penetrating thoracic trauma.

Arrhythmias in a patient with sarcoidosis.

Arrhythmias in a Patient With Sarcoidosis. Sarcoidosis is a multisystemic granulomatous disease of unknown etiology; up to 27% of cases entail cardiac involvement. Conduction abnormalities and ventricular tachycardia are the most common arrhythmias and can cause sudden death.

Renoprotective effect of high periprocedural doses of oral N-acetylcysteine in patients scheduled to undergo a same-day angiography.

Background: Few studies that have assessed the effect of abbreviated oral N-acetylcysteine (NAC) regimens in radiocontrast-induced nephropathy (RCIN) yield mixed results.

Objective: To evaluate the renoprotective effect of high periprocedural oral doses (HPOD) of NAC in patients with chronic renal impairment undergoing a same-day angiography.

Methods: Sixty one patients with renal impaired function scheduled to undergo a same-day angiography were randomly assigned to NAC 1200 mg orally 3 hours before and 3 after the procedure, or a placebo.

Multicenter randomized comparison of direct vs. conventional stenting: the DIRECTO trial.

With conventional stenting, predilatation frequently induces dissections that require deploying stents longer than originally planned. To assess whether direct stenting is safe and may prevent dissections and reduce the length of stents implanted, we conducted a randomized study comparing direct (n = 73) and conventional (n = 78) stenting. Direct stenting was successful in 89% of cases, 11% crossed over to predilation without complications.

Clinical features of hypertrophic cardiomyopathy in the young.

Background: We analysed the experience with hypertrophic cardiomyopathy in two paediatric centres to establish the differences from older patients.

Methods: Out of 45 young patients seen from 1974 to 1999, we included 38. Criterions for exclusion were secondary forms, or association with severe congenital cardiac disease which could alter the outcome.

Mid-Term Results of Dual-Chamber Pacing in Children with Hypertrophic Obstructive Cardiomyopathy.

BACKGROUND: Permanent dual-chambered pacing (DDD) is an alternative to surgical treatment in patients with severe hypertrophic obstructive cardiomyopathy (HOCM) who do not have a satisfactory response to medical treatment. METHODS: Five children with severe HOCM still symptomatic despite medical treatment underwent permanent DDD pacing and were followed for 21 +/- 9.7 months.