El cerebro es el órgano más afectado por la hipertensión arterial, y esta es el principal factor de riesgo vascular potencialmente modificable para desarrollar deterioro cognitivo, enfermedad de Alzheimer y otras demencias. El daño vascular del cerebro permanece silente durante al menos una década y su expresión clínica dependerá de la condición del paciente hipertenso frente al tratamiento antihipertensivo, del control de los factores de riesgo asociados y la reserva cognitiva. Por tal motivo, la evaluación cognitiva temprana del paciente hipertenso –como un “biomarcador” (subrogado) del daño vascular del cerebro mediado por la hipertensión–, mejora la estratificación del riesgo vascular global y previene la enfermedad cognitiva. Este documento proporciona un algoritmo práctico, basado en la evidencia científica, y herramientas sencillas, como el test del reloj, plausible de ser utilizado en la práctica médica asistencial y detectar en forma temprana el compromiso del cerebro como órgano blanco de la hipertensión arterial.
Introduction: heart failure leads to hospital readmissions, with potential differences in renal biomarkers and serum electrolytes measured during the prior hospitalization. Objective: to evaluate which renal biomarkers and serum electrolytes predict six-month emergency readmission in patients with heart failure, stratified by sex. Materials and Methods: retrospective cohort study using a secondary database that included 1904 hospitalized heart-failure patients with complete information on renal biomarkers, serum electrolytes, age, sex, and six-month emergency readmission. The variables analyzed were creatinine, urea, uric acid, calcium, potassium, chloride, cystatin C, and GFR. The outcome was emergency readmission within six months. Descriptive analyses and sex-stratified Cox regression models were applied. Results: in men, each 1 mL/min decrease in GFR was associated with an increased risk of emergency readmission (HR = 1.007; p = 0.01), whereas this association was not significant in women. Calcium was associated with higher risk only in women (HR = 2.212; p = 0.002), as was age ≥70 years (HR = 1.308; p = 0.034). No significant associations were observed for creatinine, uric acid, urea, potassium, chloride, or cystatin C. When including sex interactions, the interactions sex × creatinine (p = 0.045) and sex × chloride (p = 0.007) were significant. Conclusions: renal biomarkers and serum electrolytes showed sex-specific prognostic associations. In particular, calcium in women and GFR in men, along with older age, demonstrated utility in identifying patients at higher risk of emergency readmission within six months following hospitalization for heart failure.
La insuficiencia cardíaca continúa siendo un problema de salud pública por su altísima mortalidad, y por las tasas de rehospitalización elevadas que comprometen el pronóstico. El análisis diferenciado por sexo de biomarcadores renales y electrolitos séricos emerge como estrategia pronóstica esencial. La evidencia reciente demuestra que la tasa de filtración glomerular predice reingreso en hombres, mientras que el calcio sérico lo hace en mujeres, con interacciones significativas entre sexo y creatinina/cloruro. Estos hallazgos subrayan la necesidad de abandonar el enfoque sin diferenciación de sexo en cardiología, y desarrollar modelos predictivos diferenciados por sexo. Los biomarcadores renales, accesibles y de bajo costo, ofrecen oportunidades para estratificación de riesgo personalizada en el seguimiento postalta. La medicina cardiovascular debe incorporar sistemáticamente la perspectiva de sexo biológico para optimizar resultados clínicos.
Obesity is a chronic disease that increases cardiovascular risk, with its own pathophysiology, requiring a specific algorithm for its assessment and risk stratification, in a context associated with multiple cardiovascular risk factors and comorbidities. The advent of drugs with enterohepatic mechanisms of action, which improve adipocyte function and, consequently, associated diseases, is changing thenatural history of the disease, requiring a comprehensive approach. This practical guide serves as a roadmap for clinical cardiologists in their daily practice.
La enfermedad renal crónica es un problema de salud pública global caracterizado por una elevada prevalencia, sub diagnóstico y alta morbimortalidad, principalmente por desenlaces cardiovasculares. Actualmente se considera un factor de riesgo independiente mayor para la presencia de enfermedad cardiovascular aterosclerótica y no aterosclerótica, cuyo riesgo aumenta conforme disminuye el filtrado glomerular y se incrementa la albuminuria. Esta asociación se explica por la sinergia de factores tradicionales de riesgo cardiovascular, y por mecanismos fisiopatológicos no tradicionales muy comunes en la enfermedad renal crónica, entre los que destacan las alteraciones del metabolismo mineral y óseo, anemia, sobrecarga de volumen, toxinas urémicas, estrés oxidativo, inflamación crónica, disbiosis, y la sobre activación del sistema renina-angiotensina-aldosterona y del sistema nervioso simpático. Estos procesos contribuyen a la disfunción endotelial, la aterosclerosis acelerada y remodelado cardiaco anormal, que concurren en una elevada morbimortalidad cardiovascular.
Introducción: La revascularización endovascular es clave en el manejo de la isquemia crónica de extremidades inferiores. Objetivo: describir los resultados de angioplastia subintimal en el tratamiento de la oclusión crónica total de la arteria femoral superficial. Materiales y métodos: Estudio observacional, descriptivo, transversal y prospectivo. La población de estudio estuvo conformada por pacientes diagnosticados con oclusión total crónica de la arteria femoral superficial, atendidos en un centro de referencia de la Ciudad Autónoma de Buenos Aires durante el período de enero del 2022 a diciembre del 2023. Resultados: Se seleccionaron 42 pacientes, presentando una mediana de edad de 68 años, 16 de ellos eran mujeres (38.1%), con una escala de Leriche- Fontaine grado III en 32 pacientes (76.2%), y IV en 10 (23.8%), y una longitud de oclusión de más de 10 cm en toda la muestra. El ITB pre-procedimiento fue menor a 0.9 en todos los casos, y superior a 0.9 post-procedimiento (p<.001). Se presentaron eventos adversos intra-procedimiento en 28 pacientes (66.7 y solo en tres fue necesario la reintervención Conclusión: la angioplastía subintimal y endoluminal representan técnicas de revascularización viable y eficaz en el tratamiento de pacientes con ICE en arteria femoral.
Obesity is a chronic disease that increases cardiovascular risk, with its own pathophysiology, requiring a specific algorithm for its assessment and risk stratification, in a context associated with multiple cardiovascular risk factors and comorbidities. The advent of drugs with enterohepatic mechanisms of action, which improve adipocyte function and, consequently, associated diseases, is changing the natural history of the disease, requiring a comprehensive approach. This practical guide serves as a roadmap for clinical cardiologists in their daily practice.
Acute aortic syndrome includes various conditions such as aortic dissection, which has a high mortality rate. We present the case of a 67-year-old hypertensive male who presented with severe epigastric pain and hemodynamic instability. CT angiography revealed extensive aortic dissection from the aortic valve to the iliac artery bifurcation. A focused cardiac ultrasound showed aortic dilation and severe pericardial effusion. During surgical preparation, the patient developed cardiac tamponade and cardiac arrest, dying despite resuscitation. This case highlights the atypical presentation of extensive aortic dissection and the value of cardiac ul-trasound in emergency settings.
Cardiovascular disease remains the leading cause of death in Argentina, underscoring the importance of strengthening preventive strategies grounded on healthy lifestyle habits. In parallel, the use of dietary supplements has increased significantly, driven by social media, mar-keting claims, and the widespread availability of over-the-counter products, despite the lack of rigorous control over their composition. Although many supplements are promoted as benefi-cial for cardiovascular health or physical performance, the scientific evidence supporting these claims is limited, and in some cases, their effects in patients with established cardiovascular disease or those receiving specific treatments remain unknown. In this context, the Committee of Young Cardiologists of the Argentine Federation of Cardiology considers it necessary to issue a position statement to promote evidence-based prescribing.
Introduction: cardiovascular disease is the leading cause of death among women worldwide. However, awareness of this condition, even within the healthcare sector itself, appears to be insufficient. The main objective of this study was to identify the perception of cardiovascular disease as the leading cause of death among female healthcare professionals. Methods: descriptive, cross-sectional study conducted between 2020 and 2021. Argentine female health care professionals with access to electronic devices and the internet were included. Results: the final sample consisted of 1,089 surveys. The mean age was 43.1 +/- 10.8 years, and the mean time since graduation was 16.2 +/- 10.7 years. A total of 58.7% were involved in teaching activities, and 1.2% were retired. Cardiovascular disease was not identified as the leading cause of death in women by 62.5% of participants. Only 25.9% had primary care physicians. Moreover, 59.3% reported not having undergone a clinical check-up in the previous year, and 59.9% indicated seeking informal consultations with colleagues to address health concerns. Blood pressure measurement was reported in 18.6% of gynecological visits and 62.7% of clinical check-ups. Conclusions: six out of ten health care professionals did not recognize cardiovascular disease as the leading cause of death among women. Self-care practice was low. Blood pressure measurement during medical check-ups was infrequently reported.
Objectives: to describe the current characteristics of echocardiography practice in Argentina, including training, equipment, working conditions, use of advanced techniques, and reported difficulties. Materials and Methods: observational, descriptive, cross-sectional study based on a voluntary digital survey administered to cardiologists performing echocardiography in Argentina. Demographic, occupational, training, and technological data were collected. Responses included both closed and open questions, the latter subsequently categorized for descriptive analysis. Results: a total of 173 professionals from all regions of the country responded. Median age was 42 years and median professional experience 10 years. Only 12% worked exclusively in echocardiogra-phy, and most worked in two or more institutions. The predominant contractual modality was payment by percentage of the study's cost. The median number of monthly studies was 100, with higher volumes among those working exclusively in the private sector (p < 0.007). Availability of advanced technology varied: 62% reported access to software for left ventricular deformation analysis and less than 30% for other chambers. Forty-three percent were trained in transesophageal echocardiography and stress echocardiography. The main reported difficulty was low remuneration, followed by high clinical demand and lack of professional recognition. Conclusions: echocardiography practice in Argentina shows a solid professional foundation but is characterized by heterogeneous training, substantial technological gaps, and fragile working conditions that primarily affect remuneration. Coordinated policies on certifications, continuous training, and technological integration are required to strengthen the quality and equity of echocar-diographic practice nationwide.
Introduction: cardiovascular diseases represent the leading cause of mortality and hospitalization worldwide. Among them, non-ST-segment elevation acute coronary syndromes are a common manifestation. In Argentina, disparities in access to specialized services hinder a uniform approach to this condition. Objective: the RENASCA.AR registry aimed to characterize the clinical, therapeutic, and evolutionary profile of patients with NSTEACS across different levels of healthcare in the country. Methods: a prospective, multicenter study was conducted, including 679 patients hospitalized in 31 centers between November 2022 and December 2024. Results: the mean age was 63 years, and 27.1% were women. The most frequent clinical presentation was NSTEMI (65%), followed by unstable angina (25%) and MINOCA (10%). Coronary angiography was performed in 90% of patients, with a median time to procedure of 22 hours. The overall rate of percutaneous coronary intervention (PCI) was 67%, significantly higher in men than in women (67% vs. 45%; p<0.001). In-hospital mortality was 1.4%, and the composite event rate (death and/or decompensated heart failure) was 11.1%, with a higher prevalence in women than men (15.2% vs 9.6%; p<0.04). Conclusions: RENASCA.AR revealed a high use of invasive strategies and low overall mortality, although with significant sex-related differences. This registry provides key insights into the current management of NSTE-ACS in Argentina and highlights the need to improve access and equity in cardiovascular care.
Introduction: In Argentina, the influenza and pneumococcal disease mortality rate has increa-sed in recent years. Objective: the objective of this sub-analysis of the Inter-American Registry of Influenza and Pneumococcal Disease Vaccination (CorVacc) is to determine vaccination rates and analyze the factors that influence them in Argentina. Materials and methods: A cross-sectional survey of the general population was conducted in 19 Latin American countries. Adults over 18 years of age completed a 34-question online survey. The data were grouped into seven categories: demographic, socioeconomic, and vaccination profile.Results: 2,128 responses out of 21,389 were obtained from Argentina; 61% (n = 1,349) of the participants were female, and the mean age was 46.59 +/- 15.88 years; 58.23% of the sam-ple received annual influenza vaccination, 49.67% received the pneumococcal disease vaccine, and 88.33% received at least three doses of the COVID-19 vaccine. Low educational attainment and poor confidence on vaccines were the main barriers to vaccination. Older individuals and healthcare professionals received vaccines more frequently. Conclusions: the vaccination rate in Argentina is lower than that recommended by ministerial authorities and medical practice guidelines. The Inter-American Registry of Influenza and Pneumo-coccal Disease Vaccination (CorVacc) identified some of the implementation barriers. Public health authorities and health funders will be able to use this information to design their action plans.
Introduction: heart failure leads to hospital readmissions, with potential differences in renal biomarkers and serum electrolytes measured during the prior hospitalization. Objective: to evaluate which renal biomarkers and serum electrolytes predict six-month emergency readmission in patients with heart failure, stratified by sex. Materials and Methods: retrospective cohort study using a secondary database that included 1904 hospitalized heart-failure patients with complete information on renal biomarkers, serum electrolytes, age, sex, and six-month emergency readmission. The variables analyzed were creatinine, urea, uric acid, calcium, potassium, chloride, cystatin C, and GFR. The outcome was emergency readmission within six months. Descriptive analyses and sex-stratified Cox regression models were applied. Results: in men, each 1 mL/min decrease in GFR was associated with an increased risk of emergency readmission (HR = 1.007; p = 0.01), whereas this association was not significant in women. Calcium was associated with higher risk only in women (HR = 2.212; p = 0.002), as was age >= 70 years (HR = 1.308; p = 0.034). No significant associations were observed for creatinine, uric acid, urea, potassium, chloride, or cystatin C. When including sex interactions, the interactions sex & times; creatinine (p = 0.045) and sex & times; chloride (p = 0.007) were significant. Conclusions: renal biomarkers and serum electrolytes showed sex-specific prognostic associations. In particular, calcium in women and GFR in men, along with older age, demonstrated utility in identifying patients at higher risk of emergency readmission within six months following hospitalization for heart failure.
Chronic kidney disease is a global public health problem characterized by high prevalence, underdiagnosis, and substantial morbidity and mortality, primarily driven by cardiovascular outcomes. It is currently recognized as a major independent risk factor for both atherosclerotic and non-atherosclerotic cardiovascular disease, with risk increasing in parallel with declining glomerular filtration rate and rising albuminuria. This association is explained by the synergistic interaction between traditional cardiovascular risk factors and non-traditional pathophysiological mechanisms that are highly prevalent in chronic kidney disease. These include mineral and bone disorder, anemia, volume overload, uremic toxins, oxidative stress, chronic inflammation, dysbiosis, and overactivation of the renin-angiotensin-aldosterone system and the sympathetic nervous system. Collectively, these processes promote endothelial dysfunction, accelerated atherosclerosis, and maladaptive cardiac remodeling, ultimately contributing to the high cardiovascular morbidity and mortality observed in this population.
Introduction: the assessment of ventricular hemodynamic forces (HDF) by cardiac magne-tic resonance (CMR), derived from Global Longitudinal Strain, is an emerging technique for structural cardiac evaluation currently under investigation. This method may allow earlier detection of structural cardiac abnormalities and prediction of cardiovascular events. Objective: to assess hemodynamic forces in a population of patients undergoing CMR to determine their potential as markers of cardiovascular events. Materials and Methods: The authors conducted a retrospective analysis of 137 patients who underwent CMR with HDF assessment and clinical follow-up between 2015 and 2023. The primary endpoint was a composite of acute myocardial infarction, hospitalization for heart failure, and cardiac death. The authors analyzed apex-base and lateral-septal HDF, using cut-off values that maximized the risk of the composite endpoint. A multivariate survival analysis using the Cox proportional hazards regression model was performed to evaluate the hazard ratio (HR) of HDF. Results: a total of 126 patients completed the CMR evaluation and were included in the HDF analysis. Apex-base HDF with a cut-off value of 7.5% identified which patients would develop the compo-site event, while other predictors were not significant. The area under the ROC curve was 0.829 (95% CI 0.725-0.934), p < 0.0001. The presence of apex-base HDF < 7.5% showed an adjusted hazard ratio (HR) of 4.90 (1.63-14.68, p = 0.005), whereas the other CMR-derived predictors were not significant. Conclusions: the presence of apex-base HDF below 7.5% was significantly associated with a higher incidence of the composite endpoint compared with patients with HDF values above 7.5%.
La apolipoproteína B (ApoB) es el principal componente proteico de las lipoproteínas aterogénicas, como las de muy baja densidad (VLDL), densidad intermedia (IDL) y baja densidad (LDL). Por lo tanto, la concentración plasmática de ApoB permite estimar el número total de partículas aterogénicas. En los últimos años, diversos estudios epidemiológicos y de intervención han demostrado que la medición de ApoB predice de forma independiente el riesgo cardiovascular, superando incluso a parámetros lipídicos convencionales como el colesterol unido a LDL (c-LDL), que sigue siendo la principal diana terapéutica en el tratamiento lipídico, con objetivos claramente definidos. El objetivo de esta colaboración entre prestigiosas sociedades científicas es elaborar un documento de posicionamiento que aborde, de forma clara y práctica, diversos aspectos relacionados con la medición de ApoB, respondiendo a diez preguntas clave. Los mensajes principales se resumen en la figura central.
Introduction: aortic morphometry varies across its segments and may reflect diverse clinical influences. Objective: to identify which segments of the aorta show the greatest association with clinical variables using neural networks. Materials and methods: an analytical and cross-sectional study was conducted with 801 adults from the Harvard Dataverse repository (2018–2019) who underwent non-contrast chest CT. Aortic diameters from the sinus of Valsalva to the abdominal aorta, measured using artificial intelligence, were assessed, along with 20 clinical variables. A multilayer neural network was applied as a nonlinear statistical analysis tool. Results: in the performance analysis of the neural network model, the diameter with the lowest relative error was that of the middle descending aorta, whose relative error was 0.356 in the testing phase, obtaining a coefficient of determination of 0.613, indicating that the model explains 61.3% of the variability in diameter. Its most influential variables were age (importance of 0.168), creatinine (0.106), AST (0.082), and potassium (0.071). The mean square error was 0.324 in the training phase and 0.356 in the testing phase. Conclusions: the neural network model reveals a stronger nonlinear association between clinical variables and the diameter of the mid-descending aorta, highlighting its sensitivity to hemodynamic and metabolic influences and reinforcing its value as a structural marker in cardiovascular disease assessment.
Se sabe que la FA es una arritmia caracterizada por una activación eléctrica auricular descoordinada,siendo la arritmia sostenida más común a nivel mundial y asociada con una morbimortalidadsignificativa. La FA puede ir desde ser asintomática (subclínica), pasando por episodiosmanifiestos de las arritmias (paroxismos) hasta permanente (anteriormente denominadacrónica). Algunas veces su primera manifestación clínica puede ser un ictus (evento vascularcerebral o accidente cerebrovascular). Por lo tanto, es importante identificar a los pacientes conmayor propensión a desarrollar FA.La asociación entre FA y asma es bidireccional. Por un lado, la evidencia sugiere que la FAcomparte con el asma un trasfondo de inflamación sistémica. El asma, al ser una enfermedadinflamatoria sistémica, pudiese estar afectando las aurículas y así, favorecer la aparición de unamiocardiopatía auricular, la cual predispondría a la aparición de la FA.
Introduction: hypertensive cardiovascular disease is a complex, multifactorial, and chronic illness, frequently beginning during childhood or adolescence, that could lead to functional and/or structural organ damage by increase in arterial stiffness and the volume/pressure curve, that in turn can increase the stress into the ventricular-arterial coupling and could produce the appearance of arrhythmias such as atrial fibrillation. This study aims to evaluate patients with bronchial asthma with non-invasive arterial tonometry to determine its possible similarity with systemic inflammatory diseases and also the capability of presenting brief episodes of atrial fibrillation. Materials and Methods: this was a retrospective, cross-sectional study of 435 patients, of whom 93 were chronic asthmatics and the rest had systemic inflammatory diseases such as psoriasis, rheumatoid arthritis, celiac disease, Sjögren's syndrome and Crohn's disease, ulcerative colitis, endometriosis, and polycystic ovary syndrome. General and anthropological data, blood pressure, and central hemodynamic parameters were recorded using noninvasive arterial tonometry. Episodes of atrial fibrillation were recorded during 24-hour ambulatory electrocardiographic Holter monitoring. Results: statistically comparing the data of asthmatics with all systemic inflammatory diseases and in both sexes separately, no significant differences were observed. Conclusions: According to these observations, bronchial asthma presents a similarity with systemic inflammatory diseases due to damage to the arterial wall and the presence of brief phases of atrial fibrillation.
