Publications by authors named "Diego Araiza-Garaygordobil"

43 Publications

Dengue and the heart.

Cardiovasc J Afr 2021 Jul 20;32:1-8. Epub 2021 Jul 20.

Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada. Email: Adrian.

Dengue is a neglected viral arthropod-borne tropical disease transmitted by the bite of infected spp. mosquitoes. It is responsible for a significant global burden of disease and corresponding socio-economic implications. There are four different virus serotypes, all of which are found predominantly in countries with tropical climates. Patients with dengue may present with cardiovascular (CV) manifestations, contributing to associated death and disability. A systematic review was conducted to identify CV manifestations of dengue, wherein 30 relevant studies were identified in the MEDLINE and PubMed databases. CV complications of dengue include rhythm abnormalities, hypotension, myocarditis, pericarditis and deterioration in myocardial function. Prompt recognition and treatment of CV complications of dengue are essential to reduce morbidity and mortality in these patients, who are at risk of progressing to cardiogenic shock and heart failure.
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http://dx.doi.org/10.5830/CVJA-2021-033DOI Listing
July 2021

Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Study in Mexico City.

CJC Open 2021 Apr 25;3(4):409-418. Epub 2020 Nov 25.

Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México.

Background: A low proportion of patients with ST-elevation myocardial infarction (STEMI) in low- to middle-income countries receive reperfusion therapy. Although primary percutaneous coronary intervention (PCI) is the method of choice, a pharmacoinvasive strategy (PIs) is reasonable when primary PCI cannot be delivered on a timely basis. The aim of our study was to assess the efficacy and safety of a PIs compared with primary PCI in a real-world setting.

Methods: This was a prospective registry that included patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary composite end point was the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days according to the reperfusion strategy used. The key safety end point was major bleeding (Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days.

Results: We included 579 patients with STEMI, 49.7% underwent primary PCI and 50.2% received PIs. Those who received a PIs approach were more likely to present with Killip class > 1 and to have a history of diabetes but were less likely to have a previous cardiovascular disease diagnosis. No statistically significant difference was shown in the primary composite end point according to reperfusion strategy (hazard ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21;  = 0.24). Major bleeding was not different among groups (hazard ratio for PIs, 0.92; 95% confidence interval, 0.45-1.86;  = 0.81). Two patients in the PIs group (0.6%) and no patients in the PCI group had intracranial bleeding ( = 0.15).

Conclusions: In this prospective real-world registry, major cardiovascular outcomes and bleeding were not different among patients who underwent a PIs or primary PCI. The study suggests that a PIs is an effective and safe option for patients with STEMI when access to primary PCI is limited.
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http://dx.doi.org/10.1016/j.cjco.2020.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129473PMC
April 2021

Acute Myocardial Infarction During the COVID-19 Outbreak in Mexico City: What to Expect in the Future in Developing Countries?

Salud Publica Mex 2021 02 27;63(2, Mar-Abr):163-165. Epub 2021 Feb 27.

Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez. Mexico City, Mexico..

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http://dx.doi.org/10.21149/11853DOI Listing
February 2021

Systemic thrombolysis in a patient with massive acute valvular thrombosis.

Am J Emerg Med 2021 Apr 26. Epub 2021 Apr 26.

Coronary Intensive Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico.

Prosthetic valve thrombosis (PVT) is considered an exceptionally rare condition, often associated with pro-thrombotic factors or suboptimal anticoagulant therapy. Guidelines recommend emergent surgery for patients with left heart valve prosthetic thrombosis who present in cardiogenic shock, and systemic thrombolysis is reserved in scenarios where surgery is not immediately available. However, several factors may affect surgical prognosis and are overlooked by current recommendations. We describe the case of a 34-year-old female who presented in the emergency department with cardiogenic shock and acute pulmonary edema due to acute valve thrombosis.
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http://dx.doi.org/10.1016/j.ajem.2021.04.061DOI Listing
April 2021

Response to letter from Dr. Atsuyuki watanabe entitled "point-of-care lung ultrasound predicts in-hospital mortality in acute heart failure; is this reversible?" (QJM-2021-625).

QJM 2021 May 10. Epub 2021 May 10.

Instituto Nacional de Cardiología "Ignacio Chávez", Coronary Care Unit, Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030, Mexico, Mexico City.

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http://dx.doi.org/10.1093/qjmed/hcab133DOI Listing
May 2021

Demographic description and outcomes of a metropolitan network for myocardial infarction treatment.

Arch Cardiol Mex 2021 Jan 20. Epub 2021 Jan 20.

Coronary Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico.

Objective: The objective of the study was to describe the myocardial infarction treatment network and compare in-hospital mortality in patients undergoing either primary angioplasty or pharmacoinvasive strategy in Mexico City and a broad metropolitan area.

Methods: Cohort study including patients with ST-elevation myocardial infarction. We recorded demographic and clinical data, laboratory tests and in-hospital mortality in patients that underwent primary angioplasty and pharmacoinvasive strategy. Kaplan-Meier analysis was used to assess mortality and Cox-regression assessed mortality risk factors.

Results: Three hundred forty patients from a network of 60 hospitals and 9 states were analyzed. Of the total population, 166 were treated with pharmacoinvasive strategy and 174 with primary angioplasty. Door to thrombolytic time was 54 min and door to wire crossing time was 72.5 min; no differences in total ischemia time were demonstrated. No differences for in-hospital mortality (6.3% vs. 5.4%, p = 0.49) were found when comparing pharmacoinvasive and primary angioplasty groups. The main predictors for in-hospital mortality were: glucose > 180 mg/dl (HR 3.73), total ischemia time > 420 min (HR 3.18), heart rate > 90 bpm (HR 5.46), Killip and Kimball > II (HR 11.03), and left ventricle ejection fraction < 40% (HR 3.21).

Conclusions: This myocardial infarction network covers a large area and constitutes one of the biggest in the world. There were no differences regarding in-hospital mortality between pharmacoinvasive strategy and primary angioplasty. Pharmacoinvasive strategy is an effective and safe option for prompt reperfusion in Mexico.
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http://dx.doi.org/10.24875/ACM.20000133DOI Listing
January 2021

[El equipo corazón-cerebro: neurocardiología].

Arch Cardiol Mex 2020 Dec 1. Epub 2020 Dec 1.

Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México.

Las enfermedades cardiovasculares y cerebrovasculares ocupan los primeros lugares de morbimortalidad en México y el mundo. El sistema nervioso y el sistema cardiovascular comparten una red intrínseca de mecanismos fisiológicos y patológicos que competen al neurólogo y al cardiólogo.
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http://dx.doi.org/10.24875/ACM.20000213DOI Listing
December 2020

[Gender differences in mortality in patients with ST-segment elevation myocardial infarction].

Arch Cardiol Mex 2020 Nov 11. Epub 2020 Nov 11.

Department of Coronary Care Unit and Emergency, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.

Background: Women with ST-segment elevation myocardial infarction (STEMI) have worst outcomes than men.

Objective: The objective of the study was to determine gender differences in mortality in patients with STEMI.

Methods: Cohort study including patients with STEMI. We recorded demographic and clinical data, laboratory tests, and in-hospital mortality in patients who underwent primary angioplasty and pharmacoinvasive strategy. Kaplan-Meier analysis was used to assess mortality differences between both genders.

Results: A total of 340 patients were analyzed, 296 males and 44 females. Mean age of the female group was 64.3 ± 12.3 years. About 98% of females were among Killip-Kimball Class I-II. They had higher risk scores compared to man, longer ischemic time and first medical contact with a difference in comparison to man of 47 and 60 min, respectively. Mortality was 9.1% (4) in the female group.

Conclusions: Although the proportion of women had higher mortality than man, we did not found any difference with statistical significance probably due to the lack of representation. We need more awareness in the female population about STEMI, since longer first medical contact time and longer total ischemic time might be one possible explanation of a higher mortality.
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http://dx.doi.org/10.24875/ACM.20000160DOI Listing
November 2020

Clinical phenotypes, aetiologies, management, and mortality in acute heart failure: a single-institution study in Latin-America.

ESC Heart Fail 2021 02 11;8(1):423-437. Epub 2020 Nov 11.

Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico.

Aims: Little is known regarding acute heart failure (AHF) clinical characteristics and its hospital outcome in Latin America. This study sought to assess the prevalence of, and identify differences among, in-hospital outcomes in patients hospitalized for AHF who were stratified by clinical phenotype at a hospital in Latin America.

Methods And Results: This is a retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin American teaching hospital from January 2006 to December 2018. Cox regression analysis was used to identify predictors of mortality. Of 21 042 patients admitted, 7759 (36.6%) had AHF. Their median age was 62 years, and 35% were women. De novo heart failure was seen in 39.4% of patients. Most common was AHF-associated acute coronary syndromes (ACS-HF) in 43.0%, decompensated heart failure (DHF) in 33.7%, hypertensive heart failure (HT-HF) in 11.8%, and cardiogenic shock (CS) in 5.2%. Pulmonary oedema (PO) (3.3%) and right heart failure (RHF) (3.0%) were least frequent. Coronary artery disease was the most frequent aetiology in 56.5% of patients, valvular heart disease in 22.4%, and cardiomyopathies in 12.3%. Other less frequent aetiology included adult congenital heart disease (2.5%), lung diseases (2.1%), acute aortic syndromes (1.4%), pericardial diseases (0.8%), and intracardiac tumours (0.3%). Aetiology could not be established in 1.6% of patients. Before admission, patients with worsening chronic heart failure and reduced ejection fraction were treated with renin-angiotensin system blockers (60.4%), beta-blockers (42.5%), or spironolactone (34.4%). The percentages of patients given in-hospital management with intravenous diuretics, vasodilators, inotropes, and vasopressors were 81.2%, 33.4%, 18.9%, and 20.4%, respectively. The overall in-hospital mortality was 17.9% (71.3%, 43.9%, 23.8%, 14.9%, 13.6%, and 10.1% for CS, PO, RHF, DHF, ACS-HF, and HT-HF, respectively; P < 0.0001). Multivariate analysis revealed that PO (hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.73-4.14, P < 0.0001) and CS (HR 3.37, 95% CI 2.12-5.35, P < 0.0001) were independent predictors of in-hospital mortality. Use of intravenous diuretics was linked to reduction of in-hospital mortality (HR 0.70, 95% CI 0.59-0.59, P < 0.0001). By contrast, increased in-hospital mortality was associated with the use of intravenous inotrope or vasopressor (HR 1.49, 95% CI 1.27-1.76 and HR 2.91, 95% CI 2.41-3.51, P < 0.0001, respectively).

Conclusions: Real-world evidence from a university hospital in Latin America shows that the high mortality among patients with AHF may depend, among other factors, on patients' AHF clinical phenotypes. The clinical characteristics and aetiologies of AHF appear to differ between these data from Mexico and those from European and US registries.
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http://dx.doi.org/10.1002/ehf2.13092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835571PMC
February 2021

Impact of the Coronavirus Disease-19 Pandemic on Acute Cardiovascular Emergencies in a Third Level Cardiology Hospital: A Call for Action.

Rev Invest Clin 2020 May 7;72(5). Epub 2020 May 7.

Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

The consequences of the coronavirus disease (COVID)-19 pandemic go beyond the number of cases and deaths attributed to severe acute respiratory syndrome (SARS)-coronavirus-2 infection. The overwhelmed health care systems and the strict social containment measures have had an impact on the threshold at which patients seek medical care for diseases other than COVID-19, including cardiovascular conditions.
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http://dx.doi.org/10.24875/RIC.20000349DOI Listing
May 2020

A 51-year-old Starr-Edwards caged-ball valve.

Arch Cardiol Mex 2020 ;90(3):361-362

Coronary Care Unit. Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, Mexico".

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http://dx.doi.org/10.24875/ACM.20000189DOI Listing
August 2021

On stethoscopes, patient records, artificial intelligence, and zettabytes: A glimpse into the future of digital medicine in Mexico.

Arch Cardiol Mex 2020 ;90(2):177-182

Artificial Intelligence in Cardiology, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Science and technology are modifying medicine at a dizzying pace. Although access in our country to the benefits of innovations in the area of devices, data storage and artificial intelligence are still very restricted, the advance of digital medicine offers the opportunity to solve some of the biggest problems faced by medical practice and public health in Mexico. The potential areas where digital medicine can be disruptive are accessibility to quality medical care, centralization of specialties in large cities, dehumanization of medical treatment, lack of resources to access evidence-supported treatments, and among others. This review presents some of the advances that are guiding the new revolution in medicine, discusses the potential barriers to implementation, and suggest crucial elements for the path of incorporation of digital medicine in Mexico.
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http://dx.doi.org/10.24875/ACME.M20000113DOI Listing
August 2021

Evaluation of pharmacoinvasive strategy versus percutaneous coronary intervention in patients with acute myocardial infarction with ST-segment elevation at the National Institute of Cardiology (PHASE-MX).

Arch Cardiol Mex 2020 ;90(2):137-141

Department of Emergency, Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez. Mexico City, Mexico.

Objective: The objective of PHASE-MX registry is to validate the efficacy and safety of the pharmacoinvasive strategy in comparison with percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI) in a metropolitan region of Mexico. The primary outcome will consist of the composite of cardiovascular death, re-infarction, stroke and cardiogenic shock.

Methods: The PHASE-MX registry will include a prospective cohort of patients with STEMI who received reperfusion treatment (mechanical of pharmacological) in the first 12 h after the onset of symptoms. The registry is designed to compare the efficacy and safety of primary PCI and pharmacoinvasive strategy. The simple size was calculated in 344 patients divided into two groups, with an estimated loss rate of 10%. Patients included in the PHASE-MX cohort will be followed for up to one year.

Conclusion: In Mexico, only 5 out of 10 patients with STEMI have access to reperfusion therapy. Pharmacoinvasive strategy is takes advantage of the accessibility of fibrinolysis and the effectiveness of PCI. The present research protocol aims to provide information that serves as a link between information derived from controlled clinical trials and records derived from real world experience.
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http://dx.doi.org/10.24875/ACME.M20000107DOI Listing
August 2021

Electrical storm: An unusual manifestation of coronary ectasia.

Arch Cardiol Mex 2020 ;90(2):207-209

Department of Hemodynamics, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

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http://dx.doi.org/10.24875/ACME.M20000116DOI Listing
August 2021

Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol.

Echocardiography 2020 09 29;37(9):1353-1361. Epub 2020 Aug 29.

Surgical and Medical Specialties Direction, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Background: Coronavirus disease 2019 (COVID-19) is characterized by severe lung involvement and hemodynamic alterations. Critical care ultrasonography is vital because it provides real time information for diagnosis and treatment. Suggested protocols for image acquisition and measurements have not yet been evaluated.

Methods: This cross-sectional study was conducted at two centers from 1 April 2020 to 30 May 2020 in adult patients with confirmed COVID-19 infection admitted to the critical care unit. Cardiac and pulmonary evaluations were performed using the ORACLE protocol, specifically designed for this study, to ensure a structured process of image acquisition and limit staff exposure to the infection.

Results: Eighty-two consecutively admitted patients were evaluated. Most of the patients were males, with a median age of 56 years, and the most frequent comorbidities were hypertension and type 2 diabetes, and 25% of the patients had severe acute respiratory distress syndrome. The most frequent ultrasonographic findings were elevated pulmonary artery systolic pressure (69.5%), E/e' ratio > 14 (29.3%), and right ventricular dilatation (28%) and dysfunction (26.8%). A high rate of fluid responsiveness (82.9%) was observed. The median score (19 points) on pulmonary ultrasound did not reveal any variation between the groups. Elevated pulmonary artery systolic pressure was associated with higher in-hospital mortality.

Conclusion: The ORACLE protocol was a feasible, rapid, and safe bedside tool for hemodynamic and respiratory evaluation of patients with COVID-19. Further studies should be performed on the alteration in pulmonary hemodynamics and right ventricular function and its relationship with outcomes.
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http://dx.doi.org/10.1111/echo.14837DOI Listing
September 2020

A randomized controlled trial of lung ultrasound-guided therapy in heart failure (CLUSTER-HF study).

Am Heart J 2020 09 15;227:31-39. Epub 2020 Jun 15.

Instituto Nacional de Cardiología "Ignacio Chávez,", Mexico City, Mexico.

Background: Lung ultrasound (LUS) has emerged as a new tool for the evaluation of congestion in heart failure (HF); incorporation of LUS during follow-up may detect congestion earlier and prompt interventions to prevent hospitalizations. The aim of this study was to test the hypothesis that the incorporation of LUS during follow-up of patients with HF may reduce the rate of adverse events compared with usual care.

Methods: In this single-blinded, randomized controlled trial, patients were randomized into an LUS-guided arm or control arm. Patients were followed in 4 prespecified visits during a 6-month period. LUS was performed in every patient visit in both groups; however, LUS results were available for the treating physician only in the LUS group. The primary outcome was the composite of urgent HF visits, rehospitalization for worsening HF, and death from any cause.

Results: One hundred twenty-six patients were randomized to either LUS (n = 63) or control (n = 63) (age 62.5 ± 10 years, median left ventricular ejection fraction 31%). The primary end point occurred in 30 (47.6%) patients in the control group and 20 (31.7%) patients in the LUS group (P = .041). LUS-guided treatment was associated with a 45% risk reduction in the primary end point (hazard ratio 0.55, 95% CI 0.31-0.98, P = .044), mainly driven by a reduction in urgent HF visits (hazard ratio 0.28, 95% CI 0.13-0.62, P = .001). No significant differences in rehospitalizations for HF or death were found.

Conclusions: Incorporation of LUS into clinical follow-up of patients with HF significantly reduced the risk of urgent visits for worsening HF.
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http://dx.doi.org/10.1016/j.ahj.2020.06.003DOI Listing
September 2020

Complete atrioventricular block as an initial manifestation of aortic dissection: A case report.

Cir Cir 2020 ;88(4):511-513

Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México.

The right coronary artery involvement occurs in 1-2% of aortic dissection and may cause atrioventricular (AV) block due to obstruction of blood supply to the AV node. A 59-year-old man with a history of hypertension presented to the emergency department with chest pain and complete AV block. After the diagnostic approach, aortic dissection Stanford A was diagnosed. Aortic dissection must be suspected in hypertensive patients who present with AV block and chest pain.
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http://dx.doi.org/10.24875/CIRU.19001232DOI Listing
May 2021

Lung ultrasound for the identification of COVID-19 pneumonia.

Arch Cardiol Mex 2020 ;90(Supl):15-18

Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Secretaría de Salud, Ciudad de México, México.

The SARS-CoV-2 infection has as a clinical manifestation the disease known as COVID-19. Although knowledge of the nature of the disease is dynamic, with dozens of scientific articles being published every day about new features of COVID-19, the typical presentation is that of interstitial pneumonia. Despite the large amount of information that has been developed in recent weeks, it has been estimated that this disease can have up to 72% underdiagnosis, which requires clinical tools that are simple, easily accessible, and increase the detection of cases in a feasible way and that yield information with prognostic value. Given this need, some proposals have emerged to be able to diagnose, monitor and respond to the treatment of patients with COVID-19, such as pulmonary ultrasound (USP). It is worth mentioning that the USP has proven to be an efficient and easily reproducible technique for diagnosing heart failure and pleuro-pulmonary pathologies, especially in critically ill patients. Evidence of the usefulness of USP in COVID-19 is still scarce, although preliminary, it seems to be a sensitive technique whose findings have a high gold standard. In this brief review we will emphasize its technical aspects, the advantages and disadvantages, and finally a proposal for the approach in this type of patient.
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http://dx.doi.org/10.24875/ACM.M20000071DOI Listing
June 2020

Excerpts from the documents of Mexican positions and recommendations in cardiovascular diseases and COVID-19.

Arch Cardiol Mex 2020 ;90(Supl):100-110

Asociación Nacional de Cardiólogos de México.

The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.
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http://dx.doi.org/10.24875/ACM.M20000057DOI Listing
June 2020

Impact of COVID-19 on reperfusion strategies for acute coronary syndromes.

Arch Cardiol Mex 2020 ;90(Supl):62-66

Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Secretaría de Salud, Ciudad México, México.

Reperfusion therapy is a measure of care in patients with ST-elevation myocardial infarction (STEMI), which should be performed once we have the diagnosis. Percutaneous coronary intervention is considered the gold standard, however in patients with SARS-CoV-2 infection, the reperfusion strategy is more focused on fibrinolytic therapy due to the shorter time required to perform and less exposure. This pandemic represents a contact problem in health personnel, since cases are increasing worldwide, so it is important to know the measures that must be followed to avoid coronavirus disease (COVID-19).
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http://dx.doi.org/10.24875/ACM.M20000069DOI Listing
June 2020

Evaluation of pharmacoinvasive strategy versus percutaneous coronary intervention in patients with acute myocardial infarction with ST segment elevation at the National Institute of Cardiology (PHASE-MX).

Arch Cardiol Mex 2020 ;90(2):158-162

Urgencias y Unidad de Cuidados Coronarios, Instituto Nacional de Cardiología Ignacio Chávez, México.

Objective: The objective of PHASE-MX registry is to validate the efficacy and safety of the pharmacoinvasive strategy in comparison with percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI) in a metropolitan region of Mexico. The primary outcome will consist of the composite of cardiovascular death, re-infarction, stroke and cardiogenic shock.

Methods: The PHASE-MX registry will include a prospective cohort of patients with STEMI who received reperfusion treatment (mechanical of pharmacological) in the first 12 h after the onset of symptoms. The registry is designed to compare the efficacy and safety of primary PCI and pharmacoinvasive strategy. The simple size was calculated in 344 patients divided into two groups, with an estimated loss rate of 10%. Patients included in the PHASE-MX cohort will be followed for up to one year.

Conclusion: In Mexico, only 5 out of 10 patients with STEMI have access to reperfusion therapy. Pharmacoinvasive strategy is takes advantage of the accessibility of fibrinolysis and the effectiveness of PCI. The present research protocol aims to provide information that serves as a link between information derived from controlled clinical trials and records derived from real world experience.
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http://dx.doi.org/10.24875/ACM.19000185DOI Listing
July 2021

On stethoscopes, patient records, artificial intelligence and zettabytes: a glimpse into the future of digital medicine in Mexico.

Arch Cardiol Mex 2020 ;90(2):193-199

Inteligencia Artificial en Cardiología, Departamento de Cardiología, Universidad de Groningen, University Medical Center Groningen, Groningen, Países Bajos, Finlandia.

Science and technology are modifying medicine at a dizzying pace. Although access in our country to the benefits of innovations in the area of devices, data storage and artificial intelligence is still very restricted, the advance of digital medicine offers the opportunity to solve some of the biggest problems faced by medical practice and public health in Mexico. The potential areas where digital medicine can be disruptive are: accessibility to quality medical care, centralization of specialties in large cities, dehumanization of medical treatment, lack of resources to access evidence-supported treatments, among others. This review presents some of the advances that are guiding the new revolution in medicine, discusses the potential and potential barriers to implementation, and suggests crucial elements for the path of incorporation of digital medicine in Mexico.
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http://dx.doi.org/10.24875/ACM.20000269DOI Listing
July 2021

Electrical storm: an unusual manifestation of coronary ectasia.

Arch Cardiol Mex 2020 ;90(2):224-226

Departamento de hemodinámica. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México.

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http://dx.doi.org/10.24875/ACM.19000010DOI Listing
July 2021

Central blood pressure and vascular stiffness in Mexican population.

Arch Cardiol Mex 2020 ;90(1):21-27

Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México.

Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry.

Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4.

Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified.

Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.
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http://dx.doi.org/10.24875/ACM.19000183DOI Listing
October 2020

Right ventricular free wall strain predicts functional capacity in patients with repaired Tetralogy of Fallot.

Int J Cardiovasc Imaging 2020 Apr 1;36(4):595-604. Epub 2020 Jan 1.

Echocardiography Laboratory, National Institute of Cardiology of Mexico, Ignacio Chávez, Juan Badiano 1, Seccion XVI, Tlalpan, Mexico City, Mexico.

To investigate the role of right ventricular free wall strain (RVFWSL) to predict low functional capacity in repaired tetralogy of Fallot (rTOF). We prospectively enrolled 33 patients with rTOF with moderate to severe PR who underwent rest and peak exercise echocardiography on a semisupine cycloergometer. Conventional function and strain imaging parameters of both ventricles were measured. Patients performing < 7 METS were defined to have low functional capacity. Logistic regression was used to identify parameters associated with low functional capacity. Eleven patients (33.3%) had low functional capacity. These patients were shorter (height 155 ± 7 vs 163 ± 9 cm, p = 0.023), more frequently female (27.3 vs 72.7%, p = 0.024) and had history of Blalock-Taussig shunt (45.5 vs 9.1%, p = 0.027). On multivariate analysis RVFWSL was the only predictor of low functional capacity OR 1.39 (CI 95%, 1.06-1.83., p = 0.018) per % change. A RVFWSL < 17% (absolute value) had an AUC of 0.785, sensitivity of 81.8% and specificity of 77.3% to predict low functional capacity. Right ventricular free wall strain is an independent predictor of low functional capacity in repaired tetralogy of Fallot with moderate to severe PR. A value < 17% might be useful in deciding when to perform pulmonary valve replacement, when functional capacity cannot be objectively measured.
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http://dx.doi.org/10.1007/s10554-019-01753-zDOI Listing
April 2020

Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction.

Gac Med Mex 2020 ;156(6):559-569

Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico.

Introduction: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries.

Objective: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status.

Method: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence.

Results: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI.

Conclusion: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status.

IntroducciÓn: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos.

Objetivo: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica.

MÉtodo: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente.

Resultados: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias.

ConclusiÓn: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.
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http://dx.doi.org/10.24875/GMM.M21000455DOI Listing
January 2020

Lung ultrasound in cardiology: realities and promises.

Arch Cardiol Mex 2019 ;89(4):369-375

Unidad Coronaria. Instituto Nacional de Cardiología Ignacio Chávez, Secretaría de Salud, Ciudad de México, México.

Lung ultrasound is an easily available, reproducible examination tool, both in ambulatory and critically-ill patients, which is used to evaluate congestion status and to differentiate the etiology of dyspnea. In this review, we explain lung ultrasound technique, acquisition protocols and their interpretation, as well as the evidence that shows its effectiveness among stable and critically-ill patients. Lung ultrasound should be used as an add-on to traditional physical examination in order to give an accurate diagnosis and a rapid treatment to patients with pulmonary congestion.
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http://dx.doi.org/10.24875/ACM.19000178DOI Listing
September 2020

Risk factors and temporal trends for vascular access-related complications in coronary procedures: evolving from femoral to radial approach.

Arch Cardiol Mex 2019 ;89(4):301-307

Departamento de Cardiología, Instituto Nacional de Cardiología "Ignacio Chávez", Secretaría de Salud, Ciudad de México, México.

Introduction: Radial access is the gold standard for ST-elevation myocardial infarction; nevertheless, there is scarce information in Mexico.

Objectives: The objectives of this study were to describe the differences in radiation exposure, intervention time, fluoroscopy time, complications and temporal trends, and risk factors among radial and femoral access for coronary procedures.

Materials And Methods: A total of 493 patients underwent coronary interventions by femoral or radial access. Sociodemographic and procedural data were recorded. A logistic regression model to determine risk factors for complications was performed.

Results: The population included 346 men and 147 women, with a median age of 63 years, 159 underwent radial and 334 femoral approaches. Complications occurred in 18 patients (3.6%), 11 in radial and 7 in femoral access, with a higher trend in the first 5 months (n = 14). Vasospasm was the most common (n = 9) complication. Median fluoroscopy time was 12 min for radial and 9 min for femoral groups, with a total radiation dose of 2282 µ and 2848 µ, respectively. Temporal trends showed that complications occurred most frequently during the first 6 months of the study. The main predictors for complications were intervention time and one-vessel disease.

Conclusions: Radial access had higher frequency of complications than femoral approach and they were more common during the first 6 months. The main risk factor was intervention time longer than 60 min.
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http://dx.doi.org/10.24875/ACM.M19000042DOI Listing
September 2020

Heart failure with preserved ejection fraction: the dark side of an old disease.

Arch Cardiol Mex 2019 ;89(4):360-368

Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México.

Heart failure is a global public health problem, with more than 37 million patients living with heart failure around the world. Heart failure with preserved ejection fraction is an increasingly common category (approximately 60% of the cases) and shows remarkable differences in diagnosis and treatment when compared with heart failure with reduced ejection fraction. The current review covers epidemiology, risk factors, pathophysiologic mechanisms, clinical and paraclinical characteristics and diagnostic criteria of heart failure with preserved ejection fraction and concludes with a plea for original research in our country.
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http://dx.doi.org/10.24875/ACM.19000170DOI Listing
September 2020
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