Archivos de cardiologia de Mexico最新文献

Transthyretin cardiac amyloidosis is a recently recognized disease, still significantly underdiagnosed. It is characterized by infiltration of amyloid proteins resulting from the destabilization of the transthyretin protein produced in the liver. There are two predominant presentations, the hereditary form and the wild-type form, both with cardiac involvement leading to heart failure and reducing life expectancy. In recent years, multiple treatment options targeting the cause of the disease, known as disease-modifying therapies, have emerged, and the use of traditional heart failure treatments has become necessary. This review addresses traditional and disease-modifying therapies for this disease, addressing their mechanisms of action, efficacy, safety, and real-world implementation.

Objective: To investigate the motivations and barriers to choosing interventional cardiology (IC) among women from Latin America.

Method: A questionnaire from the European association of Percutaneous Cardiovascular Interventions Women's Committee was distributed to Latin American cardiologists from March to April 2024, inquiring about social and professional profiles, and reasons for choosing or not IC.

Results: Three hundred and seven individuals (134 [44%] women and 173 [56%] men) from 17 different Latin American countries responded to the survey. Compared to men, women were younger (46 vs. 29% between 18 and 35 years old, p < 0.0001), less frequently married (48 vs. 50%, p = 0.03), and more frequently childless (68 vs. 32%, p < 0.001). One hundred and fifty (49%) respondents were interventional cardiologists, 51 (34%) women, and 99 (66%) men (p = 0.008). The main reason for choosing IC was "because it is my passion" (88 vs. 91%, p = 0.48, respectively). The three most frequent reasons for not choosing IC in women were, in order: concerns about radiation, on-calls, long working hours, and personal preference.

Conclusion: The primary motivation for women choosing IC is their passion for the field. Several barriers deter many of them from choosing it as a career path, including concerns about radiation exposure and on-calls with long working hours, emphasizing on the necessity of enhancing education on radiation safety and developing new strategies to preclude and support women in IC in Latin America.

Global longitudinal strain (GLS) is a crucial echocardiographic parameter for early detection of subclinical left ventricular (LV) dysfunction in cancer patients receiving cardiotoxic therapies. However, standard apical views are often limited by patient factors such as obesity, chest wall deformities, radiation, or post-surgical reconstruction. This study evaluates the feasibility and reliability of the subcostal view for LV GLS assessment as an alternative imaging approach in cancer patients. A prospective cohort study was conducted at the Sultan Qaboos Comprehensive Cancer Care and Research Center between March and December 2024, involving 108 cancer patients (median age: 45 years, 88.9% female). Each patient contributed paired LV GLS measurements from subcostal and apical four-chamber views. Agreement between the two views was assessed, with -20% as the normal GLS cutoff. The agreement between LV longitudinal strain (LVLS) subcostal four-chamber view and LVLS apical four-chamber view readings was good, with an intraclass correlation coefficient (ICC: 0.634, p < 0.0001). The agreement between LV GLS subcostal four-chamber view and LV GLS apical four-chamber was excellent (ICC: 0.949, p < 0.0001). The subcostal view demonstrated 90.7% agreement with apical views in detecting abnormal GLS (< -20), with a Cohen's Kappa of 0.754. Subcostal GLS was a strong predictor of apical GLS (area under the curve: 0.984), with an optimal threshold of -20.85 yielding 100% sensitivity and 92.31% specificity. The subcostal four-chamber view is a feasible and reliable alternative for LV GLS assessment in cancer patients.

The objective of this study was to evaluate the efficacy of percutaneous left atrial appendage occlusion (LAAO) compared with anticoagulation in patients with atrial fibrillation (AF) and its impact on the primary prevention of ischemic stroke and all-cause mortality. Patients with non-valvular AF and high thromboembolic risk (CHA₂DS₂-VASc > 2 points) were included. LAAO was compared against the use of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Articles were searched in PubMed, Scopus, and Web of Science up to June 11, 2025. Risk of bias was assessed using the RoB 2 tool and ROBINS-E, while statistical analysis was performed with Review Manager 5.4.1. A total of 10 studies with 5,779 patients were analyzed (2,916 with LAAO and 2,863 with anticoagulation). LAAO reduced, though without statistical significance, the incidence of ischemic stroke (OR: 0.82; 95% CI: 0.66-1.03; p = 0.09). However, it showed a significant reduction in all-cause mortality compared with the overall anticoagulant group (OR: 0.62; 95% CI: 0.46-0.80; p = 0.0004). LAAO emerges as a viable strategy to reduce mortality in patients with AF and high thromboembolic risk, particularly when long-term anticoagulation is not feasible. Its superiority over DOACs and comparable profile to VKAs, along with the absence of periodic INR monitoring and relevant drug interactions, make it an option that may optimize adherence and quality of life.

Objective: In indigenous people of Mexico, there is a scarcity of information on the relationship between cardiorespiratory fitness (CRF) and clinical cardiometabolic health. The objective was to study the relationship between CRF and cardiometabolic health in adult Mexican Rarámuri (also known as Tarahumara), and to study cardiac health and physiological adaptations to ultradistance running in a subgroup of Rarámuri.

Methods: In rural Rarámuri (n = 66) living at moderate altitude (1150-2400 m above sea level), we carried out measurements of anthropometry, hemodynamics (sitting blood pressure and heart rate), plasma glucose, electrocardiogram and echocardiography, and estimated CRF using a sub-maximal steptest.

Results: Mean age of the studied population was 36.1 (standard deviation 11.6) years. Two participants (3%) were underweight, and ~47% were overweight/obese. Hypertension was found in ~24% of the participants. Mean CRF was moderately high to moderately low at 49 and 34 mLO2/min/kg in men and women, respectively, and CRF was significantly and inversely associated with hemodynamic and biochemistry measures except for blood glucose (p < 0.05). In a sub-group of runners, three men had mildly increased relative ventricular mass (range 118-128 g/m2).

Conclusion: We found a relatively high proportion of overweight/obesity as well as hypertension. The expected inverse relationship between CRF and cardiometabolic measurements was observed. Abnormal physiological myocardiac adaptation to ultradistance running was minimal.