Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2025.04.002
Diego Segura-Rodríguez , Clara Bonanad , Elena Fortuny , Ángel Prades-Sánchez , Román Freixa-Pamias , Sergio Raposeiras-Roubín , David Vivas Balcones
In recent years, the handheld ultrasound device has emerged as an innovative tool in the extended physical examination, particularly for cardiovascular assessment, enabling a more detailed, comprehensive, and precise bedside evaluation. Its portability and versatility have proven useful in clinical decision-making, early diagnosis of cardiovascular diseases, and treatment of patients in various settings. This article reviews the available studies, clinical applications, and potential scenarios for its use, especially in primary care, but also in emergency settings or in developing countries. Moreover, it explores the challenges related to training, cost-effectiveness, artificial intelligence, and future prospects, including its integration into telemedicine and educational programs. The expansion in the use of these devices has the potential to improve the quality of care, optimize resources, and address inequities in access to healthcare.
{"title":"Papel del ecógrafo de bolsillo en la exploración cardiovascular multidisciplinar. Revisión del estado actual","authors":"Diego Segura-Rodríguez , Clara Bonanad , Elena Fortuny , Ángel Prades-Sánchez , Román Freixa-Pamias , Sergio Raposeiras-Roubín , David Vivas Balcones","doi":"10.1016/j.rccl.2025.04.002","DOIUrl":"10.1016/j.rccl.2025.04.002","url":null,"abstract":"<div><div>In recent years, the handheld ultrasound device has emerged as an innovative tool in the extended physical examination, particularly for cardiovascular assessment, enabling a more detailed, comprehensive, and precise bedside evaluation. Its portability and versatility have proven useful in clinical decision-making, early diagnosis of cardiovascular diseases, and treatment of patients in various settings. This article reviews the available studies, clinical applications, and potential scenarios for its use, especially in primary care, but also in emergency settings or in developing countries. Moreover, it explores the challenges related to training, cost-effectiveness, artificial intelligence, and future prospects, including its integration into telemedicine and educational programs. The expansion in the use of these devices has the potential to improve the quality of care, optimize resources, and address inequities in access to healthcare.</div></div>","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 213-225"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2025.02.003
Musa Bin Bashir , Jeyasundar Dhevenbu , Zhi Quan Wang
Introduction and objectives
The choice to start or stop anticoagulation therapy in elderly patients post-fall is a major clinical challenge because falls increase the risk of bleeding. However, anticoagulation is essential in patients with atrial fibrillation (AF) to prevent thromboembolic events, and concerns about bleeding and bias may result in the prescription of anticoagulants. This study, conducted from September 2019 to October 2023, examined patients aged > 50 years with AF who fell in-hospital, with the aim of identifying influencing anticoagulant prescriptions.
Methods
All the patients included in the study experienced falls during hospitalization. It is important to note that these falls were not a reason for admission.
Results
Out of the 327 patients in the study, 210 (64.2%) were discharged on anticoagulation therapy, and 79.5% received non-vitamin K antagonist oral anticoagulants. Significant associations were found between cardiology consultations and male participants (P < .001), those aged 65–74 (P < .001), and those with health insurance (P = .001). Patients aged 65–74 years (P < .001), rural residence (P = .03), independent ambulation (P < .001), and health insurance (P < .001) were significantly associated with anticoagulation discharge.
Conclusions
Contrary to expectations, the decision to initiate oral anticoagulation in hospitalized patients with AF and a history of accidental falls was not primarily based on risk scales such as CHA2DS2-VASc but rather on other clinical, social, and medical coverage conditions. This underscores the need for a more nuanced understanding of the factors influencing anticoagulation decisions in this vulnerable population.
{"title":"Bridging the gap: Addressing anticoagulation underutilization in elderly atrial fibrillation patients post-fall","authors":"Musa Bin Bashir , Jeyasundar Dhevenbu , Zhi Quan Wang","doi":"10.1016/j.rccl.2025.02.003","DOIUrl":"10.1016/j.rccl.2025.02.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The choice to start or stop anticoagulation therapy in elderly patients post-fall is a major clinical challenge because falls increase the risk of bleeding. However, anticoagulation is essential in patients with atrial fibrillation (AF) to prevent thromboembolic events, and concerns about bleeding and bias may result in the prescription of anticoagulants. This study, conducted from September 2019 to October 2023, examined patients aged<!--> <!-->><!--> <!-->50 years with AF who fell in-hospital, with the aim of identifying influencing anticoagulant prescriptions.</div></div><div><h3>Methods</h3><div>All the patients included in the study experienced falls during hospitalization. It is important to note that these falls were not a reason for admission.</div></div><div><h3>Results</h3><div>Out of the 327 patients in the study, 210 (64.2%) were discharged on anticoagulation therapy, and 79.5% received non-vitamin K antagonist oral anticoagulants. Significant associations were found between cardiology consultations and male participants (<em>P</em> <!--><<!--> <!-->.001), those aged 65–74 (<em>P</em> <!--><<!--> <!-->.001), and those with health insurance (<em>P</em> <!-->=<!--> <!-->.001). Patients aged 65–74 years (<em>P</em> <!--><<!--> <!-->.001), rural residence (<em>P</em> <!-->=<!--> <!-->.03), independent ambulation (<em>P</em> <!--><<!--> <!-->.001), and health insurance (<em>P</em> <!--><<!--> <!-->.001) were significantly associated with anticoagulation discharge.</div></div><div><h3>Conclusions</h3><div>Contrary to expectations, the decision to initiate oral anticoagulation in hospitalized patients with AF and a history of accidental falls was not primarily based on risk scales such as CHA<sub>2</sub>DS<sub>2</sub>-VASc but rather on other clinical, social, and medical coverage conditions. This underscores the need for a more nuanced understanding of the factors influencing anticoagulation decisions in this vulnerable population.</div></div>","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 185-192"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2025.01.011
Vanda Devesa Neto , João Gouveia Fiúza , Inês Pires , Luís Ferreira Santos , António Costa
Introduction and objectives
Chloroquine (CQ) and hydroxychloroquine (HCQ), initially developed for malaria prophylaxis, are now widely used in rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis. Despite their therapeutic benefits, these drugs can induce cardiotoxicity, particularly cardiomyopathy. This systematic review evaluates the prevalence, clinical features, and diagnostic challenges of CQ/HCQ-induced cardiomyopathy.
Methods
A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane databases, identifying 60 studies reporting 79 cases of CQ/HCQ-induced cardiomyopathy. Inclusion criteria required histopathological confirmation via endomyocardial biopsy. Data on clinical presentations, diagnostic findings, and outcomes were extracted and analyzed.
Results
Patients were predominantly female (76%), with a median age of 56 years. The cardiomyopathies observed included hypertrophic, dilated, and restrictive forms, frequently presenting with heart failure and conduction disorders, such as atrioventricular block and arrhythmias. Cardiac magnetic resonance imaging and endomyocardial biopsy revealed characteristic toxicological changes, including myocyte vacuolization and fibrosis. Management often involved discontinuation of therapy, but severe cases progressed to cardiac transplantation or resulted in mortality (19%).
Conclusions
CQ/HCQ-induced cardiomyopathy is an underrecognized complication with significant morbidity and mortality. Early detection through continuous cardiac monitoring in patients on long-term CQ/HCQ therapy is crucial. Effective management, including timely drug discontinuation, may improve outcomes, although prognosis remains guarded in advanced stages.
{"title":"Chloroquine and hydroxychloroquine induced cardiomyopathy: A systematic review of literature","authors":"Vanda Devesa Neto , João Gouveia Fiúza , Inês Pires , Luís Ferreira Santos , António Costa","doi":"10.1016/j.rccl.2025.01.011","DOIUrl":"10.1016/j.rccl.2025.01.011","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Chloroquine (CQ) and hydroxychloroquine (HCQ), initially developed for malaria prophylaxis, are now widely used in rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis. Despite their therapeutic benefits, these drugs can induce cardiotoxicity, particularly cardiomyopathy. This systematic review evaluates the prevalence, clinical features, and diagnostic challenges of CQ/HCQ-induced cardiomyopathy.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane databases, identifying 60 studies reporting 79 cases of CQ/HCQ-induced cardiomyopathy. Inclusion criteria required histopathological confirmation via endomyocardial biopsy. Data on clinical presentations, diagnostic findings, and outcomes were extracted and analyzed.</div></div><div><h3>Results</h3><div>Patients were predominantly female (76%), with a median age of 56 years. The cardiomyopathies observed included hypertrophic, dilated, and restrictive forms, frequently presenting with heart failure and conduction disorders, such as atrioventricular block and arrhythmias. Cardiac magnetic resonance imaging and endomyocardial biopsy revealed characteristic toxicological changes, including myocyte vacuolization and fibrosis. Management often involved discontinuation of therapy, but severe cases progressed to cardiac transplantation or resulted in mortality (19%).</div></div><div><h3>Conclusions</h3><div>CQ/HCQ-induced cardiomyopathy is an underrecognized complication with significant morbidity and mortality. Early detection through continuous cardiac monitoring in patients on long-term CQ/HCQ therapy is crucial. Effective management, including timely drug discontinuation, may improve outcomes, although prognosis remains guarded in advanced stages.</div></div>","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 193-203"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2025.02.002
Samuel Del Castillo García, Ignacio Iglesias Gárriz, Carmen Garrote Coloma, Javier Vara Manso, José Félix Corral Fernández, David Alonso Rodríguez, Felipe Fernández Vázquez
Introduction and objectives
Coronary artery calcium (CAC) score is a marker of coronary atherosclerotic burden and can provide diagnostic and prognostic information in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This study aims to evaluate the relationship between CAC and the need for revascularization in patients with NSTEACS.
Methods
We included prospectively 276 patients aged ≥ 18 years admitted with NSTEACS. A computed tomography was performed to measure CAC, categorized into groups: 0 Agatston units (AU), 1–100 AU, 101–400 AU, and > 400 AU. All patients underwent invasive coronary angiography.
Results
The median CAC score was 221 AU. A total of 62.7% of patients underwent revascularization; the proportion of revascularization increased with CAC, with 25% in the CAC = 0 group and 83.3% in the high CAC (> 400 AU) group. The CAC score demonstrated a negative predictive value of 69.4% for ruling out significant stenosis.
Conclusions
The CAC score is significantly associated with the need for revascularization in patients with NSTEACS, highlighting the atherosclerotic burden and its potential in risk stratification and clinical decision-making.
{"title":"Coronary artery calcium score in patients with non-ST-segment elevation acute coronary syndrome","authors":"Samuel Del Castillo García, Ignacio Iglesias Gárriz, Carmen Garrote Coloma, Javier Vara Manso, José Félix Corral Fernández, David Alonso Rodríguez, Felipe Fernández Vázquez","doi":"10.1016/j.rccl.2025.02.002","DOIUrl":"10.1016/j.rccl.2025.02.002","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Coronary artery calcium (CAC) score is a marker of coronary atherosclerotic burden and can provide diagnostic and prognostic information in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This study aims to evaluate the relationship between CAC and the need for revascularization in patients with NSTEACS.</div></div><div><h3>Methods</h3><div>We included prospectively 276 patients aged ≥<!--> <!-->18 years admitted with NSTEACS. A computed tomography was performed to measure CAC, categorized into groups: 0 Agatston units (AU), 1–100<!--> <!-->AU, 101–400<!--> <!-->AU, and ><!--> <!-->400<!--> <!-->AU. All patients underwent invasive coronary angiography.</div></div><div><h3>Results</h3><div>The median CAC score was 221<!--> <!-->AU. A total of 62.7% of patients underwent revascularization; the proportion of revascularization increased with CAC, with 25% in the CAC<!--> <!-->=<!--> <!-->0 group and 83.3% in the high CAC (><!--> <!-->400<!--> <!-->AU) group. The CAC score demonstrated a negative predictive value of 69.4% for ruling out significant stenosis.</div></div><div><h3>Conclusions</h3><div>The CAC score is significantly associated with the need for revascularization in patients with NSTEACS, highlighting the atherosclerotic burden and its potential in risk stratification and clinical decision-making.</div><div>.</div></div>","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 167-175"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2025.04.003
Carlos Minguito Carazo , Moisés Rodríguez Mañero
{"title":"Sofosbuvir and QT interval: A new chapter in the safety profile of direct-acting antivirals","authors":"Carlos Minguito Carazo , Moisés Rodríguez Mañero","doi":"10.1016/j.rccl.2025.04.003","DOIUrl":"10.1016/j.rccl.2025.04.003","url":null,"abstract":"","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 164-166"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2024.10.006
Belén Jiménez Azzaoui , Raúl Gascueña Rubia , Julia Gómez Diego , Carlos De Blas Ruiz , Inmaculada Fernández Rozas , Alberto Esteban-Fernández
{"title":"Características clínicas e impacto de la duración del complejo QRS en pacientes con bloqueo completo de rama izquierda","authors":"Belén Jiménez Azzaoui , Raúl Gascueña Rubia , Julia Gómez Diego , Carlos De Blas Ruiz , Inmaculada Fernández Rozas , Alberto Esteban-Fernández","doi":"10.1016/j.rccl.2024.10.006","DOIUrl":"10.1016/j.rccl.2024.10.006","url":null,"abstract":"","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 229-231"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rccl.2025.02.004
Olga Neva López-García , Daniel García-Arribas , Carmen Olmos , María José Devesa Medina , Javier Higueras Nafría , Sonia Izquierdo Rubio , Francisca Cuenca Alarcón , Maite Maroto Castellanos , Ana Fernández-Vega , Alejandro Cruz-Utrilla , Pablo Martínez-Vives , Enrique Rey
Introduction and objectives
QTc interval alterations have been described in patients receiving sofosbuvir. Our objective was to evaluate the effect of anti-hepatitis C virus drugs on the human cardiac conduction system.
Methods
We included all patients with hepatitis C virus infection that started treatment with direct-acting antivirals in a tertiary hospital between May 2016 and March 2017. Three electrocardiograms were performed in them: before starting treatment; during treatment; and at least 3 weeks after finished treatment. Heart rate, PR, QRS, and QTc intervals were compared between patients with and without sofosbuvir. Patients were followed for a mean time of 41.9 weeks.
Results
A total of 101 patients were studied, 61 received treatment with sofosbuvir and 40 without sofosbuvir. No differences were found between the 2 groups regarding heart rate, and PR intervals. There was a statistically significant enlargement of QTc in patients with sofosbuvir at the fourth week of treatment (415.3 ms vs 420.8 ms) that returned to baseline values once finalized (411.1 ms; P = .029). These differences were not observed in patients without sofosbuvir.
Conclusions
We observed a statistically significant prolongation of the QTc interval at the fourth week of treatment in patients with sofosbuvir, which returned to baseline levels once the treatment was finished. Further prospective studies are needed to assess the clinical relevance of these findings.
介绍和目的在接受索非布韦治疗的患者中有qtc间期改变的描述。我们的目的是评价抗丙型肝炎病毒药物对人心脏传导系统的影响。方法纳入2016年5月至2017年3月在某三级医院接受直接抗病毒药物治疗的所有丙型肝炎病毒感染患者。三个心电图表现在:在开始治疗;治疗期间;治疗结束后至少3周。比较使用索非布韦和不使用索非布韦患者的心率、PR、QRS和QTc间期。患者的平均随访时间为41.9周。结果101例患者接受索非布韦治疗61例，未接受索非布韦治疗40例。两组在心率和PR间隔方面没有发现差异。使用索非布韦的患者在治疗第四周的QTc （415.3 ms vs 420.8 ms）有统计学意义的增加，一旦结束(411.1 ms；p = .029)。在不使用索非布韦的患者中没有观察到这些差异。结论：我们观察到索非布韦治疗第四周时QTc间隔有统计学意义的延长，治疗结束后QTc间隔恢复到基线水平。需要进一步的前瞻性研究来评估这些发现的临床相关性。
{"title":"Electrocardiographic alterations during direct-acting antiviral therapy against hepatitis C virus","authors":"Olga Neva López-García , Daniel García-Arribas , Carmen Olmos , María José Devesa Medina , Javier Higueras Nafría , Sonia Izquierdo Rubio , Francisca Cuenca Alarcón , Maite Maroto Castellanos , Ana Fernández-Vega , Alejandro Cruz-Utrilla , Pablo Martínez-Vives , Enrique Rey","doi":"10.1016/j.rccl.2025.02.004","DOIUrl":"10.1016/j.rccl.2025.02.004","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>QTc interval alterations have been described in patients receiving sofosbuvir. Our objective was to evaluate the effect of anti-hepatitis C virus drugs on the human cardiac conduction system.</div></div><div><h3>Methods</h3><div>We included all patients with hepatitis C virus infection that started treatment with direct-acting antivirals in a tertiary hospital between May 2016 and March 2017. Three electrocardiograms were performed in them: before starting treatment; during treatment; and at least 3 weeks after finished treatment. Heart rate, PR, QRS, and QTc intervals were compared between patients with and without sofosbuvir. Patients were followed for a mean time of 41.9 weeks.</div></div><div><h3>Results</h3><div>A total of 101 patients were studied, 61 received treatment with sofosbuvir and 40 without sofosbuvir. No differences were found between the 2 groups regarding heart rate, and PR intervals. There was a statistically significant enlargement of QTc in patients with sofosbuvir at the fourth week of treatment (415.3<!--> <!-->ms vs 420.8<!--> <!-->ms) that returned to baseline values once finalized (411.1<!--> <!-->ms; <em>P</em> <!-->=<!--> <!-->.029). These differences were not observed in patients without sofosbuvir.</div></div><div><h3>Conclusions</h3><div>We observed a statistically significant prolongation of the QTc interval at the fourth week of treatment in patients with sofosbuvir, which returned to baseline levels once the treatment was finished. Further prospective studies are needed to assess the clinical relevance of these findings.</div></div>","PeriodicalId":36870,"journal":{"name":"REC: CardioClinics","volume":"60 3","pages":"Pages 176-184"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号