Archivos de cardiologia de Mexico最新文献

Objective: Artificial intelligence (IA) is transforming healthcare by enhancing diagnosis and treatment, with up to 90% accuracy in cardiology. However, its adoption faces challenges, including limited training and resources in some regions. While scientific output in Latin America and Caribe (LAC) has grown, it remains low compared to other regions, underscoring the need for innovative solutions to the cardiovascular health crisis. This study analyzes AI-related cardiology research in LAC from 2018 to 2023.

Method: This descriptive scientometric study used the Scopus database to analyze AI in cardiology research in LAC. SciVal, VOSviewer, and R Studio were applied to assess publication volume, collaboration types, citations, and research networks.

Results: A total of 152 documents, 1,054 citations, and 1,095 authors were identified, averaging 6.9 citations per document. Key topics included atrial fibrillation, percutaneous coronary intervention, and cardiac monitoring. Colombia, Argentina, and Mexico led in scientific output, with international collaboration accounting for 63.8% of publications and an upward trend in research output over time.

Conclusions: AI-related cardiology research in LAC is growing, but certain limitations. This analysis highlights key areas and the need to enhance scientific production. It provides a base for future studies and collaborations to address the cardiovascular health crisis and expand AI adoption in cardiovascular care.

Objective: To evaluate the initial safety and effectiveness of fluoroscopy-free atrial fibrillation ablation in a high-complexity center in Argentina.

Method: Prospective, observational, single-center study at the Cardiovascular Institute of Buenos Aires, where 100 atrial fibrillation ablation procedures were performed without fluoroscopy between March and November 2024. Electroanatomical mapping (CARTO 3), intracardiac echocardiography, and specialized catheters were used to guide the procedures.

Results: Complete pulmonary vein isolation was achieved in 100% of cases. The mean patient age was 63.5 years, with a male predominance (71%). Complications occurred in 3% of cases (two pericardial effusions and one post-procedural stroke). No esophageal or vascular complications were reported.

Conclusions: Atrial fibrillation ablation without fluoroscopy in a high-complexity center is feasible, safe, and effective, reducing radiation exposure without compromising clinical outcomes.

Atrial high-rate episodes (AHREs) are atrial tachyarrhythmias detected by cardiac implantable electronic devices when the atrial rate exceeds the device's programmed detection threshold. The frequency and duration of these episodes vary, with those lasting more than 5 min generally considered clinically significant. The occurrence of AHREs has been associated, in multiple clinical trials, with an increased risk of progression to overt atrial fibrillation (AF) and a higher incidence of thromboembolic events, particularly ischemic stroke. Several studies have demonstrated that the strength of these associations is directly proportional to AHREs duration and is further influenced by comorbidities such as advanced age, hypertension, and a history of heart failure. Despite the elevated embolic risk, clinical uncertainty persists regarding the optimal timing and indication for initiating long-term oral anticoagulation in patients with AHREs. Consequently, this narrative review aims to outline a contemporary clinical approach and propose a treatment algorithm for AHREs, grounded in the current body of evidence.

A 46-year-old Mexican woman developed type 4 pulmonary hypertension (PH) due to tumor embolism from choriocarcinoma (CC), which is an uncommon presentation of this malignancy. She presented with precordial pain, dyspnea, and rapid functional decline. Imaging revealed obstructive thrombi in the pulmonary arteries, initially suggestive of operable chronic thromboembolic PH (CTEPH). A bilateral subsegmental pulmonary thromboendarterectomy was performed, the standard treatment for CTEPH, aimed at removing obstructive material and restoring hemodynamic stability. However, histopathological examination of the surgical specimens showed malignant cells positive for human chorionic gonadotropin, confirming CC as the source of tumor emboli and leading to reclassification of her condition as type 4.2.2 PH. The patient died intraoperatively due to severe airway bleeding and inability to wean from cardiopulmonary bypass.

A review is performed to evaluate the effectiveness of valve repair in patients with functional mitral regurgitation in terms of mortality and hospitalizations due to heart failure. Randomized clinical trials and cohort studies were included with patients who had moderate to severe mitral regurgitation, an ejection fraction of 20-50%, and NYHA functional class II-IV, despite receiving optimal medical therapy (OMT). Articles published between 2020 and 2025 in PubMed, Scopus, and Web of Science were reviewed. A total of 2,520 patients from seven studies were included. In 787 patients, the use of MitraClip was compa.

Objective: The chronic kidney disease (CKD) in pediatric patients is a serious condition that sometimes is associated with congenital heart disease (CHD), this significantly increasing morbidity and mortality rates. The use of interventional cardiac catheterization has emerged in the last three decades as a less invasive alternative to surgical correction of many simple CHD, and it can be useful and viable option for patients with compromised renal function.

Method: Retrospective and descriptive study.

Results: We present the cases of three patients in pediatric age with CKD and CHD, whom successfully were underwent percutaneous closure.

Conclusions: It is highlighting the efficacy and safety of cardiac catheterization in this high-risk group patients with CKD in advanced stages.

Objective: To characterize coronary plaque features using optical coherence tomography (OCT) in patients with Wellens syndrome, compared to patients with acute coronary syndrome without Wellens criteria.

Methods: A case-control study was conducted at a tertiary center, including patients with non-ST elevation acute coronary syndrome (NSTE-ACS). OCT findings and cardiovascular events at 9-month follow-up were compared between groups. Subgroup analysis was performed for: (a) Wellens type A (biphasic T-waves) versus type B (deep symmetric inversions) and (b) left anterior descending (LAD) plaque location (proximal, mid, and distal). Receiver operating characteristic (ROC) curves were generated to evaluate the discriminatory power of OCT parameters for identifying Wellens syndrome.

Results: A total of 53 patients with NSTE-ACS and culprit LAD lesions, 13 with Wellens syndrome were compared to 40 controls. OCT identified distinct features in Wellens patients, including higher prevalence of macrophage infiltration, thin-cap fibroatheroma (TCFA), large lipid arc > 180°, and smaller minimum lumen area (MLA). Red thrombus and plaque rupture were also more frequent in the Wellens group. No significant differences in 9-month clinical outcomes were observed. ROC analysis identified a lipid arc > 180°, presence of TCFA, and MLA ≤ 1.4 mm2 as the OCT parameters with the highest discriminatory value for Wellens syndrome.

Conclusions: OCT imaging revealed distinct plaque characteristics in Wellens syndrome, including larger lipid arcs, TCFA, and smaller MLA. Despite these high-risk features, short-term clinical outcomes were comparable to non-Wellens NSTE-ACS patients.