Cardiovascular diseases represent a major health problem for women in Argentina. Since 2007, more women than men die in our country due to heart disease and a woman dies every 11 minutes, according to the latest published vital statistics. We performed a telephone survey in a representative sample of women from Buenos Aires in order to assess whether they are aware they may suffer from cardiovascular diseases and their knowledge about these pathologies. Results from 600 respondents showed that the vast majority of women have an adequate level of knowledge about cardiovascular risk factors, symptoms of heart disease and stroke, as well as behaviors that prevent or reduce the likelihood of becoming ill. However, most women, especially the younger ones, perceive breast cancer as a main health concern rather than cardiovascular diseases. The results also show that women get most of the information about cardiovascular diseases mainly from mass media and rarely from their doctors. Raising women awareness about their risk of suffering heart disease might lead to the adoption of better preventive behaviors and, in the case of an acute cardiovascular event, seek immediate help to have access to the best treatment.

En la Argentina, las enfermedades cardiovasculares representan el principal problema de salud de las mujeres. Desde el año 2007 mueren más mujeres que hombres en nuestro país por causa cardiovascular y de acuerdo con las últimas estadísticas vitales publicadas, muere una mujer cada 11 minutos. Evaluar si las mujeres perciben que pueden sufrir enfermedades cardiovasculares así como valorar el grado de conocimiento que tienen sobre estas patologías fueron los objetivos de una encuesta telefónica realizada en una muestra representativa de mujeres de Buenos Aires. Los resultados obtenidos en 600 encuestadas mostraron que la gran mayoría de las mujeres tienen un grado de conocimiento adecuado acerca de los factores de riesgo cardiovascular, de los síntomas de enfermedad coronaria y accidente cerebrovascular y de las conductas que previenen o reducen la probabilidad de enfermarse. Sin embargo, gran parte de las mujeres, y en especial las jóvenes, perciben mucho más al cáncer de mama como un problema de salud que a las enfermedades cardiovasculares. Los resultados obtenidos también muestran que la información que tienen las mujeres sobre las enfermedades cardiovasculares rara vez proviene de sus médicos y mayoritariamente se origina en los medios de comunicación masiva. El hecho de que las mujeres incrementen su percepción sobre el riesgo de padecer enfermedades cardiovasculares podría traducirse en una mayor adopción de conductas preventivas y, ante la eventualidad de presentar un evento cardiovascular agudo, en una pronta consulta y mayor y mejor acceso al tratamiento.

INTRODUÇÃO: Os estudos com stents farmacológicos têm avaliado predominantemente populações masculinas de descendência europeia. O estudo de braço único SPIRIT Women avalia o stent eluidor de everolimus XIENCE TM V em lesões de novo complexas em uma população feminina do mundo real, incluindo pacientes latino-americanas. Esta análise permite compreender como essa população responde ao implante de stent, comparativamente a pacientes não-latino-americanas. MÉTODOS: Das 1.572 pacientes matriculadas em 73 locais fora dos Estados Unidos, 138 (9%) foram recrutadas na Argentina, no Brasil e na Venezuela. RESULTADOS: As lesões-alvo tinham diâmetro de referência do vaso entre 2,25 mm e 4 mm e extensão da lesão ≤ 28 mm. As características basais foram semelhantes entre os grupos, com exceção de maior prevalência de hipertensão arterial, infarto do miocárdio (IM) de parede anterior e história familiar de doença arterial coronária na coorte latino-americana. As lesões tendiam a ser mais complexas em mulheres latino-americanas, com menor diâmetro de referência do vaso-alvo, maior extensão da lesão, maior excentricidade e angulação e mais lesões tipo B2/C. Os eventos foram adjudicados de acordo com as definições do Academic Research Consortium. Em um ano, o desfecho combinado de morte por todas as causas, IM e revascularização do vaso-alvo (RVA) foi de 12,1% na população não-latino-americana e de 10,1% na população latino-americana (P = 0,58). CONCLUSÕES: Em um ano, os baixos índices de eventos cardíacos adversos, incluindo trombose do stent, falha da lesão-alvo, morte cardíaca, IM e RVA nas mulheres latino-americanas foram comparáveis aos das mulheres não-latino-americanas, apesar da maior complexidade das lesões. Esses resultados demonstram a segurança e a eficácia do stent XIENCE TM V nessa pequena coorte de pacientes latino-americanas, à semelhança do que é observado com populações maiores e mais variadas.

BACKGROUND: Drug-eluting stent trials have predominantly examined male populations of European descent. SPIRIT Women single-arm study evaluates the XIENCE TM V everolimus-eluting stent in complex de novo lesions in a real world female population, including Latin American patients. This analysis provides an insight into how this population responds to stenting when compared to non-Latin American patients. METHODS: Of the 1,572 patients enrolled from 73 non-US sites, 138 (9%) were recruited from Argentina, Brazil and Venezuela. RESULTS: Target lesions had reference vessel diameter ranging between 2.25 mm and 4 mm and lesion length ≤ 28 mm. Baseline characteristics were similar between the groups, with exception to a higher prevalence of hypertension, anterior myocardial infarction (MI) and family history of coronary artery disease in the Latin American cohort. Lesions tended to be more complex in Latin American women with a smaller reference vessel diameter, longer lesion length, increased eccentricity and angulation, and more type B2/C lesions. Events were adjudicated according to the guidelines of the Academic Research Consortium. At 1 year, the composite endpoint of death, MI and target vessel revascularization (TVR) was 12.1% in the non-Latin American population and 10.1% in the Latin American population (P = 0.58). CONCLUSIONS: At 1 year, the low rates of adverse cardiac events, including stent thrombosis, target lesion failure, cardiac death, MI and TVR in Latin American women were comparable to those of the non-Latin American women, despite the higher complexity of lesions. These results demonstrate the safety and efficacy of the XIENCE TM V stent in this small cohort of Latin American patients, in line with what is observed in larger and more varied populations.

In Argentina, one out of three deaths is of cardiovascular origin and acute myocardial infarction (AMI) is one of the most aggressive and frequent. In our country epidemiological data related to infarction are scarce. Various surveys and reports have been carried out in the past 25 years by different scientific societies, which, even though they provide valuable information, enclose only a small range of the population with access to high complexity centers. Though these records show a gradual increase in the rate of reperfusion, this has not resulted in a mortality reduction. This review is committed to provide all available information about the AMI in Argentina, in order to provide the necessary resources to the right diagnosis and therapeutic handling of this disease.

En la Argentina, una de cada tres muertes es de origen cardiovascular y el infarto agudo de miocardio (IAM) es una de sus presentaciones más agresivas y frecuentes. Sin embargo, en nuestro país los datos epidemiológicos relacionados al infarto son escasos. Diversas encuestas y registros se han realizado en estos últimos 25 años por las diferentes sociedades científicas, las cuales, si bien aportan valiosa información, sólo representan a una parte de la población con posibilidades de acceso a centros de alta complejidad. Los datos proporcionados por estos registros evidencian un aumento progresivo en la tasa de reperfusión; sin embargo, esto no se tradujo en una reducción de la mortalidad. Esta revisión tiene como objetivo aportar toda la información disponible sobre el IAM en la Argentina, y busca identificar los recursos necesarios para lograr un adecuado manejo diagnóstico-terapéutico de esta enfermedad.

Background The advent and the development of drug eluting stents (DES) have reduced the prevalence of restenosis according to different series; however, its incidence still remains significant. Genetic factors contribute to restenosis and thus should be taken into account and undergo thorough investigation. Some polymorphisms are known to have a relation with in-stent restenosis: platelet polymorphism and endothelial nitric oxide synthase gene polymorphism. Objective To demonstrate if platelet IIb-IIIa (PlA2) and endothelial nitric oxide synthase (eNOS) gene polymorphisms (Glu298Asp, -786T>C, 922A/G and 420/393) present greater risk of in-stent restenosis after coronary angioplasty (PTCA). Material and Methods A coronary angiography was performed in 92 patients who had undergone PTCA in the previous 1 to 12 month, due to suspected restenosis. Patients were divided in two groups: with angiographic restenosis (<50%) (cases) and without restenosis (controls). A polymerase chain reaction (PCR) was performed for each polymorphism using specific restriction enzymes. Multiple logistic regression analysis included clinical, angiographic and genetic factors. Results Age, gender and risk factors were similar among both groups (cases = 41 patients with restenosis, controls: 51 patients without restenosis). A 60% of drugs eluting stents were implanted in each group. The rate of restenosis in patients with PlA2 polymorphic allele was significantly greater than in non carriers (21.9% versus 1.9%, OR 14.1, 95% CI 1.7-116.3; p=0.002). Patients with variant allele for 922A/G polymorphism showed a similar behavior (41.5% versus 19.6%, OR 2.9, 95% CI 1.2-7.4; p=0.02). The prevalence of restenosis was similar in both groups in patients with 298Asp, 420/393 and 786T-C polymorphisms. Multivariate analysis revealed that PlA1/A2 was the only predictor of restenosis (p=0.02). Conclusions This study demonstrates that PlA2 polymorphic allele is an independent predictor of in-stent restenosis; its detection might have important clinical implications in decisionmaking.

Introducción Con la aparición y el desarrollo de los stents liberadores de droga (SLD), los porcentajes de reestenosis han disminuido según lo demuestran distintas series, pero igualmente siguen siendo clínicamente significativos. Factores genéticos contribuyen a ello, por lo que éstos constituyen una de las causas que deben tenerse en cuenta e investigarse a fondo. Se conocen algunos polimorfismos que presentan una bien documentada relación con la reestenosis intrastent, entre ellos el polimorfismo plaquetario y el de la óxido nítrico sintetasa endotelial. Objetivo Demostrar si el polimorfismo plaquetario IIb-IIIa (PlA2) y de la óxido nítrico sintetasa endotelial (eNOS) (Glu298Asp, -786T>C, 922A/G y 420/393) presentan mayor riesgo de reestenosis intrastent posangioplastia coronaria (ATC). Material y métodos La población estuvo compuesta por 92 pacientes con ATC realizada entre 1 y 12 meses previos a la inclusión en el estudio, en los que se efectuó una angiografía por sospecha clínica de reestenosis. Se consideraron casos las reestenosis angiográficas (> 50%) y controles a los pacientes sin reestenosis. Se realizó la prueba de la reacción en cadena de la polimerasa (PCR) para cada polimorfismo con enzimas de restricción específicas. Se efectuó un análisis de regresión logística múltiple, que incluyó factores clínicos, angiográficos y genéticos. Resultados Entre los casos y los controles, 41 pacientes con reestenosis y 51 sin reestenosis, respectivamente, la edad, el sexo y los factores de riesgo fueron similares. Se utilizó un 60% de stents liberadores de droga por grupo. Los pacientes con alelo polimórfico PlA2 tuvieron una tasa de reestenosis significativamente mayor que los no portadores (21,9% versus 1,9%, OR 14,1, IC 95% 1,7-116,3; p = 0,002). Algo similar se observó con el polimorfismo 922A/G (41,5% versus 19,6%, OR 2,9, IC 95% 1,2-7,4; p = 0,02). El resto de los polimorfismos (298Asp, 420/393 y 786T-C) mostraron una frecuencia similar de reestenosis en ambos grupos. En el análisis multivariado, el PlA1/A2 fue el único predictor independiente de reestenosis (p = 0,02). Conclusiones Este estudio muestra que el alelo polimórfico PlA2 es un predictor independiente de riesgo de reestenosis intrastent coronario y su detección podría tener implicaciones importantes en la toma de decisiones.

INTRODUÇÃO: A valvuloplastia aórtica por balão voltou a ganhar interesse desde o início da era da substituição percutânea da valva aórtica, por ser um procedimento que pode ser repetido como ponte e também por ser boa estratégia para a seleção de pacientes para o novo procedimento. MÉTODO: De janeiro de 2001 a janeiro de 2009, 174 pacientes consecutivos com estenose aórtica sintomática grave e alto risco cirúrgico calculado pelo EuroSCORE/ STS foram submetidos a valvuloplastia aórtica por balão na França e na Argentina, utilizando-se a mesma técnica. Desse total, 21 (12,1%) precisaram repetir a valvuloplastia aórtica por balão em decorrência de reestenose e os resultados foram comparados aos dos 153 pacientes que realizaram somente o primeiro procedimento. A técnica mais utilizada foi o acesso retrógrado com abordagem femoral utilizando introdutores de 10 F, 12 F ou 14 F, com tamanhos de balão variando de 20 mm a 23 mm. RESULTADOS: A média de idade foi de 80,4 ± 9,7 anos e o EuroSCORE foi de 21 ± 2%. Abordagem femoral retrógrada foi utilizada em 95% dos casos. Os resultados do procedimento primário foram os seguintes: a área valvar aórtica aumentou de 0,9 ± 19 cm² para 1,02 ± 0,20 cm² e o gradiente médio caiu de 50 ± 21 mmHg para 22 ± 11 mmHg. Os resultados foram semelhantes após a repetição da valvuloplastia aórtica por balão em termos da área valvar aórtica, com melhora de 0,60 ± 0,1 cm² para 1,01 ± 0,25 cm² em um período de 13 ± 9 meses entre os dois procedimentos. As taxas de complicações hospitalares foram: morte, 3,3% vs. 9,5% (P = 0,20); acidente vascular cerebral embólico, 1,3% vs. 0 (P = 0,20); regurgitação aórtica maciça, 3,3% vs. 9,5% (P = 0,20); ruptura do balão, 1,3% vs. 0 (P = 0,20); tamponamento pericárdico, 0 vs. 5% (P = 0,12); e complicações vasculares, 3,9% vs. 9,5% (P = 0,25). No total, 48 pacientes (27,5%) foram selecionados como bons candidatos para substituição percutânea da valva aórtica durante o período de acompanhamento nos dois países, dos quais 36 realizaram o procedimento na França e 4, na Argentina. CONCLUSÕES: A repetição da valvuloplastia aórtica por balão é uma estratégia útil em pacientes idosos nãocirúrgicos com estenose aórtica sintomática grave para aliviar os sintomas após reestenose e como ponte para a substituição percutânea da valva aórtica. Essa técnica pode ser repetida com baixa taxa de complicações.

BACKGROUND: Balloon aortic valvuloplasty (BAV) has regained interest since the onset of percutaneous aortic valve replacement (PAVR) as it can be repeated as a bridge to transcatheter aortic valve implantation (TAVI) and is also a good strategy for patient selection. METHOD: From January 2001 to January 2009, 174 consecutive patients with severe symptomatic aortic stenosis (AS) and high surgical risk calculated by EuroSCORE/STS underwent BAV in France and Argentina using the same technique. Twenty one (12.1%) of these patients underwent repeat BAV for restenosis and the results were compared with those of the 153 patients undergoing the primary procedure. The most used technique was retrograde access by femoral approach, using 10, 12 or 14 F introducers, with balloons sizes ranging from 20 to 23 mm. RESULTS: Patients' mean age was 80.4 ± 9.7 years and EuroSCORE was 21 ± 2%. The retrograde femoral approach was used in 95% of the cases. Results of the primary procedure were as follows: aortic valve area (AVA) increased from 0.9 ± 19 cm² to 1.02 ± 0.20 cm² and mean gradient decreased from 50 ± 21 mmHg to 22 ± 11 mmHg. The results were similar after repeat BAV in terms of AVA, with an improvement of 0.60 ± 0.1 cm² to 1.01 ± 0.25 cm² in a period of 13 ± 9 months between the two procedures. The rates of complications were: death, 3.3% vs. 9.5% (P = 0.20); embolic stroke, 1.3% vs. 0 (P = 0.20); massive aortic regurgitation, 3.3% vs. 9.5% (P = 0.20); balloon burst, 1.3% vs. 0 (P = 0.20); pericardial tamponade, 0 vs. 5% (P = 0.12); and vascular complications, 3.9% vs. 0.5% (P = 0.25). Forty eight patients (27.5%) were selected as good candidates for PAVR during the follow up period in both countries. Thirty six patients underwent PAVR in France and four patients in Argentina. CONCLUSIONS: Repeat BAV is a useful strategy in nonsurgical elderly patients with severe symptomatic AS to relieve symptoms after restenosis and as a bridge to transcatheter aortic valve implantation. This technique can be repeated with low complication rates.

It is known that patients with arterial hypertension and ventricular hypertrophy have diastolic alterations, in particular during exercise. However, it is controversial if diastolic dysfunction continues once exercise had concluded. The objective was to assess the effects of isometric exercise on the diastolic function in patients with arterial hypertension. Five control patients (group 1, G1) and 7 patients with arterial hyper-tension (group 2, G2) were studied. All patients underwent cardiac catheterization and performed isometric exercise until heart rate increased 43±7%. Left ventricular systolic pressure (LVSP) and end diastolic pressure (LVEDP) were measured. We calculated, +dP/dt max, the time constant of isovolumic pressure decay (tau) and t1/2 were all measured. Results: The LVSP increased in G1 and G2 during exercise from 140±3 to 195±14 mm Hg (p<0.05) and 161±9 to 238±15 mm Hg, respectively; returning to their basal values once exercise had concluded. The tau (t) and t1/2 increased, while exercising in G2, from 23±2 and 15±2 msec to 35±7 and 23±4 msec, respectively. After exercise both variables continued elevated reaching 41±6 msec (p<0.05) and 23±3 msec (p<0.05), respectively. In conclusion, isometric exercise decreases relaxation rate and increases LVEDP in patients with arterial hypertension and ventricular hypertrophy. After exercise, isovolumic relaxation remained altered suggesting the presence of stunned myocardium.

Es conocido que los pacientes con hipertrofia ventricular por hipertensión arterial presentan alteraciones diastólicas, particularmente durante el ejercicio. Sin embargo, es controvertido si luego del esfuerzo esta disfunción se normaliza. El objetivo fue evaluar la función diastólica durante y después de la realización de ejercicio, en pacientes con hipertensión arterial. Se estudiaron 6 pacientes controles (grupo 1, G1) y 7 con diagnóstico de hipertensión arterial (Grupo 2, G2). Los pacientes fueron sometidos a un cateterismo cardíaco y realizaron ejercicio isométrico durante el estudio, hasta que la frecuencia cardíaca se incrementó un 43±7% (p<0.05), con respecto al valor basal. Se midió la presión sistólica ventricular izquierda (PSVI) y la presión de fin de diástole (PFDVI) y se calculó la máxima velocidad de ascenso de la presión (+dP/dt máx), la constante de tiempo de caída de la presión ventricular tau (t, mseg), el tiempo que tarda en caer la presión hasta un 50% de su valor al momento de la -dP/dt máx (t1/2, mseg). La PSVI se incrementó, durante el ejercicio, desde 140±3 hasta 195±14 mm Hg (p<0.05) en G1 y de 161±9 hasta 238±15 mm Hg en G2; retornando luego a sus valores basales. El tau y el t1/2 se incrementaron en G2, durante el ejercicio, desde un valor de 23±2 y 15±2 mseg hasta 35±7 y 23±4 mseg, respectivamente. Luego del esfuerzo, ambas variables permanecieron elevadas con respecto al basal, alcanzando valores de 41±6 mseg (p<0.05) y 23±3 mseg (p<0.05), respectivamente. El ejercicio isométrico disminuye la velocidad de relajación e incrementa la PFDVI en pacientes con hipertensión arterial e hipertrofia del ventrículo izquierdo. Luego del ejercicio la relajación permaneció alterada, a pesar de que el resto de las variables hemodinámicas retornaron a su valor basal, sugiriendo la presencia de atontamiento miocárdico.