Diego Arenaza - Academia.edu (original) (raw)
Papers by Diego Arenaza
Revista argentina de …, 2006
Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles <... more Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles < 586 pg/ml. Los pacientes con NT-proBNP elevado eran más añosos, con mayor frecuencia de sexo femenino; tuvieron una proporción mayor de marcadores séricos elevados y una ...
Abstract 2337: Role of Preoperative 6 Minute Walk Test in the Assessment and Prognosis of Patients with Severe Aortic Stenosis Undergoing Aortic Valve Replacement
Circulation, Oct 31, 2006
Systematic Review of Hirudin in Acute Coronary Syndromes and Percutaneous Coronary Intervention
Current interventional cardiology reports, 2001
Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent ... more Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent platelet agonist and converts fibrinogen to fibrin. Hirudin is a powerful, direct, and specific antithrombin agent that can be used in many therapeutic scenarios in which heparin is routinely used. In this systemic review, we summarize evidence from randomized clinical trials evaluating the benefits and risks of recombinant hirudin for the treatment of acute coronary syndromes and patients undergoing percutaneous coronary intervention.
Diagnostic accuracy of carotid intima-media thickness to detect coronary atherosclerosis. Usefulness in clinical practice | Precisión diagnóstica del espesor íntima-media carotídeo para la detección de aterosclerosis coronaria. Utilidad en la práctica clínica
Revista Argentina de Cardiologia, 2013
Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo card... more Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo cardiovascular. El puntaje de calcio coronario (PCC) es un predictor superior al EIMC, pero de costo elevado y en nuestro pais pocos pacientes pueden acceder a su medicion. Objetivos 1) Evaluar la precision diagnostica del EIMC para la deteccion de un PCC > 0. 2) Determinar el punto de corte optimo del EIMC para discriminar entre la presencia o la ausencia de calcio coronario. Material y metodos Estudio descriptivo transversal de muestras consecutivas obtenidas en los consultorios de prevencion cardiovascular. Se midio el EIMC medio y maximo mediante un eco-Doppler carotideo. Se efectuo una tomografia computarizada de 64 pistas para la evaluacion del PCC. Se determino la precision diagnostica del EIMC para la deteccion de un PCC > 0 mediante un analisis ROC. Resultados Se incluyeron 202 sujetos consecutivos que participan de un programa de prevencion primaria. Caracteristicas de la poblacion (media } desviacion estandar): edad 57 } 13 anos, sexo femenino: 49%, tabaquismo: 13%, estatinas: 37%, diabetes mellitus: 13%, puntaje de Framingham en no diabeticos: 9% } 7%, EIMC medio: 0,953 } 0,342 mm, EIMC maximo: 1,383 } 0,679 mm, prevalencia de placa aterosclerotica carotidea: 37% y de PCC > 0: 62%. Las correlaciones entre el EIMC medio y maximo y el PCC fueron moderadas (r = 0,56 y r = 0,55, respectivamente). El area bajo la curva ROC del EIMC maximo fue de 0,822 (IC 95% 0,763-0,880) y la del EIMC medio fue de 0,829 (IC 95% 0,771-0,888). El punto de corte optimo del EIMC maximo para discriminar entre PCC > 0 o PCC = 0 fue de . 1,01 mm y la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) fueron del 78%, 75%, 83% y 67%, respectivamente. El punto de corte optimo del EIMC medio para discriminar entre PCC > 0 o PCC = 0 fue . 0,82 mm y la sensibilidad, la especificidad, el VPP y el VPN fueron del 77%, 78%, 85% y 67%, respectivamente. Conclusiones En esta poblacion predominantemente de riesgo bajo, la precision diagnostica del EIMC para detectar PCC > 0 fue moderada. Una ecografia Doppler carotidea gnormal no excluyo la presencia de aterosclerosis subclinica coronaria. Estos resultados podrian mejorar la seleccion de pacientes que requieran la medicion del PCC para estratificar el riesgo cardiovascular.
Normal Troponin T Values Upon Admission Prognostic Information in Patients With Acute Coronary Syndromes and N-Terminal B-Type Natriuretic Peptide Assessment Provides Incremental
Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement
Heart, 2009
The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Eurosc... more The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR) METHODS AND RESULTS: 208 patients with severe AS underwent the 6MWT before AVR, as part of a randomised trial (ASSERT) comparing stented and stentless aortic valves. Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n = 14) in patients walking <300 metres compared to 4% (n = 4) in those who walked > or =300 metres (p = 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6-minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09 to 0.85, p = 0.025). The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis before AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score.
Surgery for Papillary Fibroelastoma with Uncommon Location in Left Ventricle
Asian Cardiovascular and Thoracic Annals, 2010
Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is unc... more Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.
NT–probrain natriuretic peptide predicts complexity and severity of the coronary lesions in patients with non–ST-elevation acute coronary syndromes
American Heart Journal, 2006
NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfun... more NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfunction and adverse outcome in patients with non-ST-elevation acute coronary syndromes (NSTEACS). However, the underlying pathophysiological mechanisms responsible for this association have not been well established. We sought to explore the relation between NT-proBNP levels and extension of coronary artery disease (CAD) and the presence of more complex and severe coronary lesions. This prospective, multicenter angiographic substudy included 585 patients admitted with NSTEACS. Blinded measurements of NT-proBNP and troponin T were performed at a median time of 3 hours after admission and analyzed centrally. Angiograms were read at a core laboratory by 2 independent readers blinded to patient data. Complex coronary lesion was defined as the presence of at least one of the following: thrombus (+), TIMI flow &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 2, or ulcerated plaque. NT-probrain natriuretic peptide levels increased proportionally as LV function decreased. The levels of NT-proBNP were directly related to the extent of the CAD. This association was maintained when we analyzed patients with normal LV function (n = 257). Patients with complex coronary lesions or those with at least one of its individual component had higher levels of NT-proBNP compared with those without complex coronary lesions. After adjusting for clinical and electrocardiographic variables and other biomarkers, positive troponin (OR 2.20, 95% CI 1.50-3.22, P…
Annals of Emergency Medicine, 2004
Background Primary percutaneous coronary intervention (PCI) is shown to be the most effective rep... more Background Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. Methods The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n = 421) or immediate transport for primary percutaneous coronary intervention (PCI group, n = 429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. Results Five complications (1.2%) occurred during the transport. Randomizationballoon time in the PCI group was 97±27 min, and randomization-needle time in the TL group was 12±10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P = 0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n = 551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). Conclusions Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.
Acta Gastroenterológica Latinoamericana
Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se r... more Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se relacionan unas con otras. El análisis multivariado es una herramienta estadística para determinar la contribución relativa de diferentes causas a un determinado evento o resultado. Los investigadores clínicos necesitan este tipo de análisis, dado que las enfermedades presentan múltiples causas y el pronóstico se determina, usualmente, por un gran número de factores. Esta herramienta va a ser aplicada en dos escenarios clínicos mediante dos ejemplos.
Argentine Journal of Cardiology, 2011
La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa u... more La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa una causa importante de miocardiopatia restrictiva. En esta presentacion se describe el caso de una paciente con insuficiencia cardiaca (IC) secundaria a miocardiopatia infiltrativa por deposito amiloide y obstruccion dinamica del tracto de salida del ventriculo izquierdo. El diagnostico hematologico fue de mieloma multiple por cadenas livianas y se demostro amiloidosis en dos tejidos extracardiacos.(resumen completo en pdf)
JACC: Cardiovascular Imaging, 2021
OBJECTIVES The aim of this study was to define the variability of maximal wall thickness (MWT) me... more OBJECTIVES The aim of this study was to define the variability of maximal wall thickness (MWT) measurements across modalities and predict its impact on care in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND Left ventricular MWT measured by echocardiography or cardiovascular magnetic resonance (CMR) contributes to the diagnosis of HCM, stratifies risk, and guides key decisions, including whether to place an implantable cardioverter-defibrillator (ICD). METHODS A 20-center global network provided paired echocardiographic and CMR data sets from patients with HCM, from which 17 paired data sets of the highest quality were selected. These were presented as 7 randomly ordered pairs (at 6 cardiac conferences) to experienced readers who report HCM imaging in their daily practice, and their MWT caliper measurements were captured. The impact of measurement variability on ICD insertion decisions was estimated in 769 separately recruited multicenter patients with HCM using the European Society of Cardiology algorithm for 5-year risk for sudden cardiac death. RESULTS MWT analysis was completed by 70 readers (from 6 continents; 91% with >5 years' experience). Seventy-nine percent and 68% scored echocardiographic and CMR image quality as excellent. For both modalities (echocardiographic and then CMR results), intramodality inter-reader MWT percentage variability was large (range-59% to 117% [SD AE20%] and-61% to 52% [SD AE11%], respectively). Agreement between modalities was low (SE of measurement 4.8 mm; 95% CI 4.3 mm-5.2 mm; r ¼ 0.56 [modest correlation]). In the multicenter HCM cohort, this estimated echocardiographic MWT percentage variability (AE20%) applied to the European Society of Cardiology algorithm reclassified risk in 19.5% of patients, which would have led to inappropriate ICD decision making in 1 in 7 patients with HCM (8.7% would have had ICD placement recommended despite potential low risk, and 6.8% would not have had ICD placement recommended despite intermediate or high risk). CONCLUSIONS Using the best available images and experienced readers, MWT as a biomarker in HCM has a high degree of inter-reader variability and should be applied with caution as part of decision making for ICD insertion. Better standardization efforts in HCM recommendations by current governing societies are needed to improve clinical decision making in patients with HCM.
Revista Argentina de Radiología / Argentinian Journal of Radiology, 2020
ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infec... more ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad.El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.
Clinical Profile of Patients with Hypertrophic Cardiomyopathy at a University Hospital
Argentine Journal of Cardiology, Mar 19, 2014
Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy... more Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy and there is no available information on base - line characteristic...
Cardiovascular diagnosis and therapy, 2014
Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute cor... more Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are criti...
Cardiovascular diagnosis and therapy, 2014
Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious d... more Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan. Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocard...
[Undifferentiated cardiac sarcoma]
Medicina, 2013
Journal of the American College of Cardiology, 2004
OBJECTIVES The purpose of this study was to determine the pathologic basis of Q-wave (QW) and non... more OBJECTIVES The purpose of this study was to determine the pathologic basis of Q-wave (QW) and non-Q-wave (NQW) myocardial infarction (MI). BACKGROUND The QW/NQW distinction remains in wide clinical use but the meaning of the difference remains controversial. We hypothesized that measurement of total MI size and transmural extent by late gadolinium enhancement cardiovascular magnetic resonance (CMR) would identify the pathologic basis of QWs. METHODS A total of 100 consecutive patients with documented previous MI had electrocardiogram and CMR on the same day. Patients with acute MI within seven days were excluded. Left ventricular function and the size and transmural extent of MI were quantified in the three major arterial territories and correlated with the presence of QW. RESULTS Subendocardial MI showed QW in 28%. Transmural MI showed NQW in 29%. Of all MIs, 48% were at some point transmural, and 99% of these were at some point non-transmural. As MI size and number of transmural segments increased, the probability of QW increased (anterior: total size chi-square ϭ 53, p Ͻ 0.0001, transmural extent chi-square ϭ 36, p Ͻ 0.0001; inferior: total size chi-square ϭ 16, p ϭ 0.001, transmural extent chi-square ϭ 10, p ϭ 0.001). These findings did not hold for lateral MI. In a multivariate model, the transmural extent of MI was not an independent predictor of QW when total size of MI was removed. The QW/NQW classification was a good test for size of MI (area under receiver operating characteristic curve: anterior 0.90, inferior 0.77). CONCLUSIONS The QW/NQW distinction is useful, but it is determined by the total size rather than transmural extent of underlying MI.
Revista argentina de …, 2006
Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles <... more Resultados Ochenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles < 586 pg/ml. Los pacientes con NT-proBNP elevado eran más añosos, con mayor frecuencia de sexo femenino; tuvieron una proporción mayor de marcadores séricos elevados y una ...
Abstract 2337: Role of Preoperative 6 Minute Walk Test in the Assessment and Prognosis of Patients with Severe Aortic Stenosis Undergoing Aortic Valve Replacement
Circulation, Oct 31, 2006
Systematic Review of Hirudin in Acute Coronary Syndromes and Percutaneous Coronary Intervention
Current interventional cardiology reports, 2001
Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent ... more Thrombin plays a key role in the pathogenesis of acute coronary syndromes because it is a potent platelet agonist and converts fibrinogen to fibrin. Hirudin is a powerful, direct, and specific antithrombin agent that can be used in many therapeutic scenarios in which heparin is routinely used. In this systemic review, we summarize evidence from randomized clinical trials evaluating the benefits and risks of recombinant hirudin for the treatment of acute coronary syndromes and patients undergoing percutaneous coronary intervention.
Diagnostic accuracy of carotid intima-media thickness to detect coronary atherosclerosis. Usefulness in clinical practice | Precisión diagnóstica del espesor íntima-media carotídeo para la detección de aterosclerosis coronaria. Utilidad en la práctica clínica
Revista Argentina de Cardiologia, 2013
Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo card... more Introduccion El espesor intima-media carotideo (EIMC) es un marcador independiente de riesgo cardiovascular. El puntaje de calcio coronario (PCC) es un predictor superior al EIMC, pero de costo elevado y en nuestro pais pocos pacientes pueden acceder a su medicion. Objetivos 1) Evaluar la precision diagnostica del EIMC para la deteccion de un PCC > 0. 2) Determinar el punto de corte optimo del EIMC para discriminar entre la presencia o la ausencia de calcio coronario. Material y metodos Estudio descriptivo transversal de muestras consecutivas obtenidas en los consultorios de prevencion cardiovascular. Se midio el EIMC medio y maximo mediante un eco-Doppler carotideo. Se efectuo una tomografia computarizada de 64 pistas para la evaluacion del PCC. Se determino la precision diagnostica del EIMC para la deteccion de un PCC > 0 mediante un analisis ROC. Resultados Se incluyeron 202 sujetos consecutivos que participan de un programa de prevencion primaria. Caracteristicas de la poblacion (media } desviacion estandar): edad 57 } 13 anos, sexo femenino: 49%, tabaquismo: 13%, estatinas: 37%, diabetes mellitus: 13%, puntaje de Framingham en no diabeticos: 9% } 7%, EIMC medio: 0,953 } 0,342 mm, EIMC maximo: 1,383 } 0,679 mm, prevalencia de placa aterosclerotica carotidea: 37% y de PCC > 0: 62%. Las correlaciones entre el EIMC medio y maximo y el PCC fueron moderadas (r = 0,56 y r = 0,55, respectivamente). El area bajo la curva ROC del EIMC maximo fue de 0,822 (IC 95% 0,763-0,880) y la del EIMC medio fue de 0,829 (IC 95% 0,771-0,888). El punto de corte optimo del EIMC maximo para discriminar entre PCC > 0 o PCC = 0 fue de . 1,01 mm y la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) fueron del 78%, 75%, 83% y 67%, respectivamente. El punto de corte optimo del EIMC medio para discriminar entre PCC > 0 o PCC = 0 fue . 0,82 mm y la sensibilidad, la especificidad, el VPP y el VPN fueron del 77%, 78%, 85% y 67%, respectivamente. Conclusiones En esta poblacion predominantemente de riesgo bajo, la precision diagnostica del EIMC para detectar PCC > 0 fue moderada. Una ecografia Doppler carotidea gnormal no excluyo la presencia de aterosclerosis subclinica coronaria. Estos resultados podrian mejorar la seleccion de pacientes que requieran la medicion del PCC para estratificar el riesgo cardiovascular.
Normal Troponin T Values Upon Admission Prognostic Information in Patients With Acute Coronary Syndromes and N-Terminal B-Type Natriuretic Peptide Assessment Provides Incremental
Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement
Heart, 2009
The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Eurosc... more The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR) METHODS AND RESULTS: 208 patients with severe AS underwent the 6MWT before AVR, as part of a randomised trial (ASSERT) comparing stented and stentless aortic valves. Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n = 14) in patients walking <300 metres compared to 4% (n = 4) in those who walked > or =300 metres (p = 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6-minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09 to 0.85, p = 0.025). The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis before AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score.
Surgery for Papillary Fibroelastoma with Uncommon Location in Left Ventricle
Asian Cardiovascular and Thoracic Annals, 2010
Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is unc... more Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.
NT–probrain natriuretic peptide predicts complexity and severity of the coronary lesions in patients with non–ST-elevation acute coronary syndromes
American Heart Journal, 2006
NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfun... more NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfunction and adverse outcome in patients with non-ST-elevation acute coronary syndromes (NSTEACS). However, the underlying pathophysiological mechanisms responsible for this association have not been well established. We sought to explore the relation between NT-proBNP levels and extension of coronary artery disease (CAD) and the presence of more complex and severe coronary lesions. This prospective, multicenter angiographic substudy included 585 patients admitted with NSTEACS. Blinded measurements of NT-proBNP and troponin T were performed at a median time of 3 hours after admission and analyzed centrally. Angiograms were read at a core laboratory by 2 independent readers blinded to patient data. Complex coronary lesion was defined as the presence of at least one of the following: thrombus (+), TIMI flow &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 2, or ulcerated plaque. NT-probrain natriuretic peptide levels increased proportionally as LV function decreased. The levels of NT-proBNP were directly related to the extent of the CAD. This association was maintained when we analyzed patients with normal LV function (n = 257). Patients with complex coronary lesions or those with at least one of its individual component had higher levels of NT-proBNP compared with those without complex coronary lesions. After adjusting for clinical and electrocardiographic variables and other biomarkers, positive troponin (OR 2.20, 95% CI 1.50-3.22, P…
Annals of Emergency Medicine, 2004
Background Primary percutaneous coronary intervention (PCI) is shown to be the most effective rep... more Background Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. Methods The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n = 421) or immediate transport for primary percutaneous coronary intervention (PCI group, n = 429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. Results Five complications (1.2%) occurred during the transport. Randomizationballoon time in the PCI group was 97±27 min, and randomization-needle time in the TL group was 12±10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P = 0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n = 551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). Conclusions Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.
Acta Gastroenterológica Latinoamericana
Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se r... more Muchos eventos –médicos, políticos y sociales– poseen múltiples causas, muchas de las cuales se relacionan unas con otras. El análisis multivariado es una herramienta estadística para determinar la contribución relativa de diferentes causas a un determinado evento o resultado. Los investigadores clínicos necesitan este tipo de análisis, dado que las enfermedades presentan múltiples causas y el pronóstico se determina, usualmente, por un gran número de factores. Esta herramienta va a ser aplicada en dos escenarios clínicos mediante dos ejemplos.
Argentine Journal of Cardiology, 2011
La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa u... more La amiloidosis es una enfermedad infiltrativa sistemica que compromete el corazon y representa una causa importante de miocardiopatia restrictiva. En esta presentacion se describe el caso de una paciente con insuficiencia cardiaca (IC) secundaria a miocardiopatia infiltrativa por deposito amiloide y obstruccion dinamica del tracto de salida del ventriculo izquierdo. El diagnostico hematologico fue de mieloma multiple por cadenas livianas y se demostro amiloidosis en dos tejidos extracardiacos.(resumen completo en pdf)
JACC: Cardiovascular Imaging, 2021
OBJECTIVES The aim of this study was to define the variability of maximal wall thickness (MWT) me... more OBJECTIVES The aim of this study was to define the variability of maximal wall thickness (MWT) measurements across modalities and predict its impact on care in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND Left ventricular MWT measured by echocardiography or cardiovascular magnetic resonance (CMR) contributes to the diagnosis of HCM, stratifies risk, and guides key decisions, including whether to place an implantable cardioverter-defibrillator (ICD). METHODS A 20-center global network provided paired echocardiographic and CMR data sets from patients with HCM, from which 17 paired data sets of the highest quality were selected. These were presented as 7 randomly ordered pairs (at 6 cardiac conferences) to experienced readers who report HCM imaging in their daily practice, and their MWT caliper measurements were captured. The impact of measurement variability on ICD insertion decisions was estimated in 769 separately recruited multicenter patients with HCM using the European Society of Cardiology algorithm for 5-year risk for sudden cardiac death. RESULTS MWT analysis was completed by 70 readers (from 6 continents; 91% with >5 years' experience). Seventy-nine percent and 68% scored echocardiographic and CMR image quality as excellent. For both modalities (echocardiographic and then CMR results), intramodality inter-reader MWT percentage variability was large (range-59% to 117% [SD AE20%] and-61% to 52% [SD AE11%], respectively). Agreement between modalities was low (SE of measurement 4.8 mm; 95% CI 4.3 mm-5.2 mm; r ¼ 0.56 [modest correlation]). In the multicenter HCM cohort, this estimated echocardiographic MWT percentage variability (AE20%) applied to the European Society of Cardiology algorithm reclassified risk in 19.5% of patients, which would have led to inappropriate ICD decision making in 1 in 7 patients with HCM (8.7% would have had ICD placement recommended despite potential low risk, and 6.8% would not have had ICD placement recommended despite intermediate or high risk). CONCLUSIONS Using the best available images and experienced readers, MWT as a biomarker in HCM has a high degree of inter-reader variability and should be applied with caution as part of decision making for ICD insertion. Better standardization efforts in HCM recommendations by current governing societies are needed to improve clinical decision making in patients with HCM.
Revista Argentina de Radiología / Argentinian Journal of Radiology, 2020
ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infec... more ResumenLa inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad.El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.
Clinical Profile of Patients with Hypertrophic Cardiomyopathy at a University Hospital
Argentine Journal of Cardiology, Mar 19, 2014
Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy... more Resumen en: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy and there is no available information on base - line characteristic...
Cardiovascular diagnosis and therapy, 2014
Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute cor... more Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are criti...
Cardiovascular diagnosis and therapy, 2014
Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious d... more Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan. Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocard...
[Undifferentiated cardiac sarcoma]
Medicina, 2013
Journal of the American College of Cardiology, 2004
OBJECTIVES The purpose of this study was to determine the pathologic basis of Q-wave (QW) and non... more OBJECTIVES The purpose of this study was to determine the pathologic basis of Q-wave (QW) and non-Q-wave (NQW) myocardial infarction (MI). BACKGROUND The QW/NQW distinction remains in wide clinical use but the meaning of the difference remains controversial. We hypothesized that measurement of total MI size and transmural extent by late gadolinium enhancement cardiovascular magnetic resonance (CMR) would identify the pathologic basis of QWs. METHODS A total of 100 consecutive patients with documented previous MI had electrocardiogram and CMR on the same day. Patients with acute MI within seven days were excluded. Left ventricular function and the size and transmural extent of MI were quantified in the three major arterial territories and correlated with the presence of QW. RESULTS Subendocardial MI showed QW in 28%. Transmural MI showed NQW in 29%. Of all MIs, 48% were at some point transmural, and 99% of these were at some point non-transmural. As MI size and number of transmural segments increased, the probability of QW increased (anterior: total size chi-square ϭ 53, p Ͻ 0.0001, transmural extent chi-square ϭ 36, p Ͻ 0.0001; inferior: total size chi-square ϭ 16, p ϭ 0.001, transmural extent chi-square ϭ 10, p ϭ 0.001). These findings did not hold for lateral MI. In a multivariate model, the transmural extent of MI was not an independent predictor of QW when total size of MI was removed. The QW/NQW classification was a good test for size of MI (area under receiver operating characteristic curve: anterior 0.90, inferior 0.77). CONCLUSIONS The QW/NQW distinction is useful, but it is determined by the total size rather than transmural extent of underlying MI.