Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

The management of ST-segment elevation myocardial infarction (STEMI) after reperfusion requires critical decision-making in patients with multivessel disease (MVD), acute heart failure, and left ventricular (LV) thrombus. Complete revascularisation of non-culprit lesions ≥70% is recommended either during the index procedure or within the first 19 days, particularly in haemodynamically stable patients. Coronary artery bypass grafting is indicated for high-risk anatomy or complex lesions following successful percutaneous coronary intervention, where a hybrid approach may combine percutaneous intervention with surgery, and timing should be adjusted according to whether a stent was implanted. Post-infarction heart failure, which occurs in 28-31% of cases, requires urgent management; continuous monitoring and timely intervention can reduce complications. In patients with cardiogenic shock or mechanical complications, intra-aortic balloon pump support and inotropes may be necessary. Right ventricular infarction is managed with volume resuscitation, urgent revascularisation, and, when required, pharmacological support or pacing. LV thrombus, more frequent after anterior infarction with LVEF <50%, mandates early detection by echocardiography and/or tomography, and prompt anticoagulation, preferably with warfarin, with triple therapy considered in patients at high thrombotic risk. This manuscript outlines recommendations to optimise prognosis through early, evidence-based, and individualised interventions.

Objectives: To evaluate the association between beta-blocker use and the presence of depressive symptoms in older adults with hypertension (HTN).

Materials and methods: A cross-sectional observational study was conducted among patients from the Central FAP Hospital and the Naval Medical Center. Older adults with a diagnosis of HTN who had been receiving antihypertensive treatment for at least one month were included. Depressive symptoms were assessed using the PHQ-9 questionnaire. Social, clinical, and functional variables were analyzed using bivariate tests (Chi-square and Fisher's exact test), as well as Poisson regression with robust variance to estimate crude and adjusted prevalence ratios (PR).

Results: A total of 149 older adults were included. Of these, 27.5% were taking beta-blockers, and 39% presented depressive symptoms. No significant association was found between beta-blocker use and the presence of depressive symptoms (PR:1.09; 95% CI: 0.70-1.69; p = 0.693). In contrast, a higher risk of depressive symptoms was observed among patients with greater frailty (PR: 5.72; 95% CI: 2.17-15.0; p < 0.001) and a lower risk among those with technical or university education (PR: 0.43; 95% CI: 0.25-0.74; p = 0.003).

Conclusions: No association was found between beta-blocker use and depressive symptoms in patients with HTN. Factors such as frailty, educational level, and duration of HTN diagnosis showed significant associations and should be considered in the comprehensive assessment of emotional risk in this population.

We present the case of a 41-year-old woman with left atrial isomerism, severe sinus node dysfunction, and left ventricular hypertrabeculation, who required implantation of a dual-chamber implantable cardioverter-defibrillator with left bundle branch area pacing. Her family history revealed multiple cases of heterotaxy and conduction disorders. Genetic testing identified a heterozygous interstitial duplication on chromosome 17q23.2 involving the MED13 gene, whose clinical significance has not yet been determined.

Objective: The presence of coronary lesions of less than 50% in patients with myocardial ischaemia is a common diagnosis in cardiac catheterisation laboratories. The aim of this study was to determine the clinical course of patients with myocardial ischaemia in the absence of obstructive coronary lesions.

Materials and methods: A prospective analytical study was conducted in 110 patients of both sexes with documented myocardial ischaemia and coronary lesions of less than 50% on coronary angiography. The follow-up period was three years.

Results: The mean age was 64.5 ± 7.2 years, with a predominance of females (57%). The most prevalent risk factors were hypertension (58.2%) and dyslipidaemia (44.5%). In 8.3% of cases, re-hospitalisation was required, with heart failure reported as the leading cause (6.5%). Cardiovascular event-free survival during follow-up was 80%, and was higher in patients without coronary lesions. A higher incidence of cardiovascular events was associated with diabetes mellitus, a family history of ischaemic heart disease, and chronic kidney disease.

Conclusions: Patients with myocardial ischaemia in the absence of obstructive coronary lesions experienced adverse events during follow-up, particularly those with diabetes mellitus, a family history of ischaemic heart disease, and chronic kidney disease.

Introduction: Introduction. In Ecuador, there is limited data on the treatment of patients with heart failure (HF).

Objective: This study aimed to determine the rate of use of prognosis-modifying drugs and their association with prognosis.

Materials and methods: A retrospective observational study was conducted on patients with chronic HF included in the "Los Ceibos" registry between January 2017 and December 2022. Patients were followed for a median of 2.28 years (interquartile range [IQR]: 1.25-3.49).

Results: A total of 711 patients diagnosed with HF were included. Among them, 82.7% (n=588) received angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); 82.3% (n=585) received beta-blockers (BBs); and 51.3% (n=365) were treated with mineralocorticoid receptor antagonists (MRAs). Among patients with HFrEF, those receiving triple therapy (ACEI/ARB/ARNI + BB + MRA) had lower all-cause mortality compared to other groups (38.8%, log-rank p=0.014). In patients with Heart Failure with preserved Ejection Fraction (HFpEF), no mortality differences were observed according to the number of medications used (log-rank p=0.720). MRA use was not associated with a prognostic benefit in HFpEF (p>0.05). Patients receiving triple therapy with ARNI + BB + MRA had better survival during follow-up compared to any other drug combination (log-rank p=0.027).

Conclusions: A high rate of ACEI/ARB/ARNI and BB use was observed. The use of triple therapy, particularly the combination of ARNI + BB + MRA, was associated with improved prognosis in patients with HFrEF over a four-year follow-up period. No prognostic benefit of MRA use was observed in patients with HFpEF.

Vascular rings represent less than 1% of congenital cardiovascular anomalies, with double aortic arch being the most common variant. It is typically diagnosed in infants, with respiratory symptoms in over 90% of cases. We present the case of a 31-year-old male patient with recurrent childhood respiratory infections and asthma, who presented with progressive dysphagia. Contrast-enhanced computed tomography angiography revealed a double aortic arch with right-sided dominance, and the esophagram revealed compression of the proximal third of the esophagus. A left posterolateral thoracotomy was performed with division of the distal left arch, division of the ligamentum arteriosum, adhesions release, and thoracic aorta reconstruction. Postoperative recovery was favorable, with complete resolution of symptoms. Double aortic arch is rarely diagnosed in adulthood. This case highlights its atypical presentation, with predominant gastrointestinal symptoms, and the importance of considering it in the differential diagnosis of dysphagia.

The aortopulmonary window is a rare congenital heart defect. Isolated aortopulmonary window, without other associated anomalies, accounts for up to 25% of all cases. Surgical closure has long been, and remains, the gold standard in many cardiovascular centres. However, percutaneous closure has emerged as a viable alternative using various types of occluder devices, selected based on the morphology, size, and rims of the defect to minimise complications such as valvular interference or coronary ostial obstruction. We report the case of an infant with an isolated aortopulmonary window successfully treated with percutaneous closure using a muscular ventricular septal defect occluder device, with no complications. The patient was discharged 48 hours after the procedure.

Introduction: Risk prediction in acute heart failure (AHF) has led to the development of multiple prognostic models. Emerging data highlight the prognostic significance of right ventricular (RV) to pulmonary artery (PA) uncoupling, which has been linked to adverse outcomes. Among patients with heart failure with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF), a highly heterogeneous group, the prognostic relevance of RV-PA uncoupling in forecasting long-term mortality is still not well defined. This study aimed to evaluate the association between RV-PA uncoupling and long-term mortality in a cohort of hospitalized HFpEF and HFmrEF patients.

Materials and methods: We performed a retrospective analysis based on a prospective registry of adult patients admitted with a primary diagnosis of AHF between 2015 and 2020. Eligible patients had a left ventricular ejection fraction (LVEF) > 40%. The main outcome was all-cause mortality over long-term follow-up. RV-PA coupling was quantified using the ratio between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP).

Results: Out of 465 patients, simultaneous estimation of TAPSE and sPAP was feasible in 361 cases (77%). During a median follow-up of 20.9 months, 100 patients (27.7%) died. A TAPSE/sPAP ratio of 0.38 was identified as the optimal cut-off for risk discrimination. Notably, 41.8% of patients had values below this threshold. Multivariable analysis confirmed that RV-PA uncoupling (TAPSE/sPAP < 0.38) was independently associated with increased long-term mortality (HR: 2.21; 95% CI 1.26-3.81; P = 0.005).

Conclusion: In patients hospitalized for AHF with preserved and mildly reduced ejection fraction, RV-PA uncoupling, as determined by the TAPSE/sPAP ratio, was independently associated with long-term all-cause mortality. This echocardiographic parameter may help identify a subgroup of patients at higher risk during follow-up.

Objectives: Mediastinitis is an unusual postoperative complication in pediatric cardiovascular surgery, associated with high morbidity and mortality. Case reports are limited, especially in Latin America, where cardiac surgery has advanced significantly.

Materials and methods: A retrospective study of mediastinitis post-cardiac surgery cases at a high-complexity center in Colombia, between January 2015 and June 2023, was conducted. A detailed description of the clinical characteristics and therapeutic approaches was provided.

Results: A population of 16 children with mediastinitis was characterized, predominantly male (68.7%); 62.5% were aged 1-3 months. The most common defects were transposition of the great arteries and univentricular heart. Gram-negative bacteria (37.5%) were the most common isolates, followed by gram-positive bacteria (25%). Vacuum-assisted closure (VAC) was required in 43.7% of cases.

Conclusion: Advances in congenital heart disease management have led to complications such as mediastinitis, prompting the development of therapeutic strategies that would benefit from better characterization in high-complexity centers to improve outcomes.