Cardiología.artículos

Patent foramen ovale: is a change in the diagnostic paradigm necessary?

Wed, 01 Jan 2025 00:00:00 GMT

Patent foramen ovale: is a change in the diagnostic paradigm necessary? Magariños, Eduardo; Scuteri, Antonio; Romano, Ariel; Herrera Paz, Juan José; Razzini, Sofía; Lagos, Roberto; Colombero, Darío; Pujol Lereis, Virginia Andrea; Ameriso, Sebastián Francisco The patent foramen ovale has been a well-known medical entity for a long time. With the advent of new diagnostic tools, the methodology for evaluating patients with stroke and suspected patent foramen ovale is evolving. In this article, we review the patent foramen ovale and the ultrasound methods used for its detection. Finally, we present a new paradigm for its study.

Quality of care delivery in patients with acute heart failure: insights from the international REPORT-HF registry

Fri, 10 Jan 2025 00:00:00 GMT

Quality of care delivery in patients with acute heart failure: insights from the international REPORT-HF registry Tay, Wan Ting; Katherine, Teng Tiew-Hwa; Ouwerkerk, Wouter; Angermann, Christiane E.; Dickstein, Kenneth; Cleland, John G. F.; Dahlstrom, Ulf; Ertl, Georg; Hassanein, Mahmoud; Perrone, Sergio Víctor; Ghadanfar, Mathieu; Schweizer, Anja; Obergfell, Achim; Collins, Sean P.; Filippatos, Gerasimos; Lam, Carolyn S. P.; Tromp, Jasper Background: Heart Failure (HF) quality of care (QoC) is associated with clinical outcomes. Therefore, we investigated differences in HF QoC across worldwide regions (with differing national income) and the association of quality indicators with outcomes. Methods: We examined the quality of care (QoC) in acute heart failure (HF) patients across different regions using quality indicators (QIs) from the European Society of Cardiology (ESC) and the American Heart Association (AHA) to evaluate QoC. The analysis included 17,632 patients enrolled from 358 medical centres in 44 countries between 23 July 2014 and 24 March 2017, all part of the prospective REPORT-HF cohort study. We investigated how QoC varied by region and its relationship with mortality rates at 30 days and 1 year after hospital discharge. For each QI, percentage attainment of QI among eligible patients was calculated and compared across regions. Findings: Among 17,632 patients (median age: 67 years; 61% women) followed up for a median of two years, we assessed 16 QIs. QIs that were least often achieved included measurement of natriuretic peptides, performance of echocardiography, treatment with guideline medical therapy, and a scheduled follow-up consultation after discharge. QI achievement was significantly lower in lower-than higher-income countries. Higher (≥50% vs. <50%) achievement of cumulative QIs was associated with lower 30-day (hazard ratio [HR] 0.58, 95% Confidence Interval [CI] 0.40-0.83; p < 0.001), and 1-year mortality (HR 0.58, 95% CI 0.50-0.68; p < 0.001). Interpretation: QoC is lower in lower-than higher-income countries and lower QoC is associated with worse outcomes. Improving QoC by addressing structural barriers and quality improvement programs may improve the outcomes of patients with HF.

Prognostic Implications and Global Perspectives of Atrial Fibrillation in Patients Hospitalized for Heart Failure

Wed, 05 Feb 2025 00:00:00 GMT

Prognostic Implications and Global Perspectives of Atrial Fibrillation in Patients Hospitalized for Heart Failure Chyou, Janice Y.; Tay, Wan Ting; Tromp, Jasper; Ouwerkerk, Wouter; Hang Yiu, Kai; Cleland, John G. F.; Collins, Sean P.; Angermann, Christiane E.; Ertl, Georg; Dahlström, Ulf; Dickstein, Kenneth; Perrone, Sergio Víctor; Ghadanfar, Mathieu; Schweizer, Anja; Obergfell, Achim; Filippatos, Gerasimos; Lam, Carolyn S. P. Background: Atrial fibrillation (AF) and heart failure (HF) each contributes to global disease burden and can coexist. The interplay of prior HF, prior AF, and presenting rhythm have not previously been jointly considered in prognostic implication. Objectives: The authors sought to assess 1-year all-cause mortality according to permutations of prior HF, prior AF, and AF as presenting rhythm, in a global cohort of patients hospitalized for HF. Methods: REPORT-HF enrolled patients during hospitalization for acute HF from 44 countries over 6 continents. Cox proportional hazard models were used to compute HRs for the primary outcome of 1-year all-cause mortality. Results: Of 13,401 participants (median age 67 years, 61% men), 58% had prior HF. AF prevalence (prior or newly detected) at HF admission was 39%, varying by left ventricular ejection fraction and race subgroups. Compared with patients with no prior HF, no prior AF, and presenting in sinus rhythm, 1-year all-cause mortality was elevated in patients with prior HF, prior AF, and presenting in AF (adjusted HR: 1.54 [95% CI: 1.34-1.78]; P < 0.001) and in patients with prior HF, no prior AF, and presenting in AF (adjusted HR: 1.51 [95% CI: 1.20-1.90]; P < 0.001), but not in patients with no prior HF and with prior AF or presenting in AF. These results were conserved across left ventricular ejection fraction and race subgroups. Conclusions: In a global cohort of patients hospitalized for HF, permutations of prior HF, prior AF, and AF as presenting rhythm differentiate outcome. History of prior HF influences the prognostic implications of AF in patients hospitalized for HF. (Global Noninterventional Heart Failure Disease Registry [REPORT-HF]; NCT02595814).

The second Latin American catheter ablation registry ("II LAHRS EP registry")

Thu, 14 Nov 2024 00:00:00 GMT

The second Latin American catheter ablation registry ("II LAHRS EP registry") Rojel Martinez, Ulises; Llorente, José; López Cabanillas, Nestor; Mondragón, Luis Ignacio; Scanavacca, Mauricio Ibrahim; Zerpa Acosta, Juan Carlos; Vargas, William Fernando Bautista; Santillan, María Eugenia; García Frias, Dulce María; Pérez Silva, Armando; Onetto, Leonardo; Dal Forno, Alexander; Morales Molina, Hermes Leonel; Abello, Mauricio S.; Monjes, Enrique; Soto Becerra, Richard; Alfie, Alberto; Diaz Martinez, Juan Carlos; Rodríguez Guerrero, Diego Andrés; II LAHRS EP Registry” investigators Background: Patient's clinical characteristics, technical resources, center and operator volume, and operator experience and training are known variables impacting outcomes. Although international standards have been agreed to maximize the benefits of this therapy, regional and global differences still exist. Latin American information has not been updated in the last 10 years. This study aimed to analyze current information on operators, centers, and CA in Latin America. Methods: Observational, retrospective study collecting Latin American information on operators and centers participating in CA, and procedures performed in 2023, from January 1 to December 31. Results: Electrophysiologists 178 (18 countries). Mean age 46,8 ± 9,2 (28-74) years. Male 86,5%. AFib, VT, and cardioneuroablation were performed by 80,2%, 70,9%, and 35,5% of operators respectively. Centers 175 (17 countries). Private 79,4% and academic 44,0%. Low volume (< 50/year) represented 36,6% and 38,3% performed ≥ 100 ablations/year. Procedures 7.595 (8.284 arrhythmias, 17 countries, 134 centers, 76 electrophysiologists). Patients mean age 51,5 ± 19,3 (1-95) years, male 55,3%, and 77,5% had a structurally normal heart. RF was the energy in 95,6% of procedures, cryoablation in 4,7%, and PFA in 0,2%. The most frequently treated arrhythmias were AFib (28,2%), AVNRT (20,9%), APs (15,8%), and PVC/NSVT (8,3%). Global success and complication rates were 93,6% and 3,0%, respectively and mortality 0,05%. Conclusion: II LAHRS EP Registry brings new and interesting data related to EP in Latin America. Electrophysiologists showed acceptable levels of experience, skills, and qualification. Although centers revealed an under-ideal availability of infrastructure and technical resources, the results of CA were comparable to other registries worldwide.