Antecedentes La hipertrofia ventricular izquierda se asocia a una morbimortalidad aumentada en la población de hipertensos y el descenso nocturno de la presión arterial es menor en los pacientes con incremento de la masa ventricular. ObjetivosEl propósito de nuestro estudio fue la determinación de las presiones clínica y ambulatoria en pacientes hipertensos con diferentes geometrías de acuerdo con las mediciones ecocardiográficas realizadas en modo M guiado por Eco 2D. Material y métodoLa población en estudio estuvo constituida por sesenta y tres hipertensos en estadios I y II de acuerdo con la clasificación del JNC V, sin tratamiento durante los tres meses previos . La misma comprendió 24 mujeres y 39 varones, con edades entre 24 y 77 años (media 52 ±11). Los procedimientos de toma de las presiones clínica y ambulatoria fueron los habituales . Se calcularon el índice de masa ventricular izquierda y engrosamiento parietal relativo . Los límites superiores del índice de masa ventricular izquierda fueron 108 g/m2 en las mujeres y 118 g/m2 en los varones, mientras que el límite del engrosamiento parietal relativo fue 0,41 en ambos sexos . Los pacientes se consideraron como de geometría normal si tanto el índice de masa ventricular izquierda como el engrosamiento parietal relativo fueron menores que dichos valores, hipertrofia concéntrica si ambos estuvieron elevados, hipertrofia excéntrica si el índice de masa ventricular izquierda estuvo elevado y el engrosamiento parietal relativo normal, y remodelado concéntrico cuando el índice de masa ventricular izquierda fue normal y el engrosamiento parietal relativo elevado. ResultadosSi bien los cuatro grupos tuvieron similar presión clínica, existieron diferencias significativas en los cuatro grupos en todos los parámetros de presión ambulatoria analizados y los pacientes con hipertrofia excéntrica presentaron los valores más elevados de presión arterial media de 24 horas, y también de presión arterial diastólica y presión arterial media en el período comprendido entre las 18 y las 24 horas y presión arterial media durante el descanso nocturno (0 a 6 horas)

Abstract Background Influenza vaccination has been shown to reduce the occurrence of cardiovascular events, both in the general population and especially in individuals with cardiovascular disease. However, the extent to which cardiologists and other physicians support and prescribe influenza vaccination for patients with cardiovascular diseases is not known. Purpose To explore cardiologists' and other specialists' opinions on the safety and efficacy of influenza vaccination in preventing cardiovascular events. Methods From September 2023 to February 2024, a survey was conducted among physicians of any specialty, following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). The survey was available in 5 languages. Participants' opinions were assessed using Likert-type scales. Non-probabilistic convenience sampling was employed, and duplicated responses were prevented using the SurveyMonkey® platform that identifies duplicated IP addresses. Results A total of 2550 physicians from 44 countries answered the survey; the mean age was 46.1±13.1 years, 46.4% were women, and 17.1% were in training. Among respondents 43.6% were cardiologists. While 91.8% of participants considered the influenza vaccine to be very safe, and 90.6% believed that adverse effects of this intervention were rare, a significant proportion did not consider Influenza vaccine to be very beneficial in reducing acute myocardial infarction (54.4% for cardiologists vs 59.3% for other specialists, p=0.013) or stroke (62.2% for cardiologists vs 64.9% for other specialists, p=0.167). summarizes the participants’ opinions regarding the benefits and risks of influenza vaccination. Regarding potential barriers to achieving higher vaccination rates among patients with cardiovascular disease, cardiologists' opinions were similar to those of other specialists (Table 2). Patient beliefs and patients’ fear of vaccine-related adverse effects were identified as major barriers by both cardiologists and other specialists. Only 19.0% of participants reported having some type of checklist system to remind them to recommend the vaccine to their patients. While 73.0% of participants found this topic highly relevant to their daily clinical practice, with no differences between groups (p=0.178), a notable proportion, comprising 48.5% of cardiologists and 47.1% of other specialists, expressed the necessity for additional training to address the risk-benefit ratio of influenza vaccination with their patients (p=0.485). Conclusion Our data suggest that cardiologists and other specialists view the influenza vaccine as safe with a low rate of adverse effects, both in the general population and in individuals with cardiovascular disease. However, a significant proportion of them are unaware of the vaccination's benefit in reducing cardiovascular events. Additionally, about half of the surveyed professionals expressed a need for further education to discuss the benefits of vaccination with their patients.

Abstract Background The SECURE trial demonstrated that the CV-polypill strategy (acetylsalicylic acid [ASA]+atorvastatin+ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction (MI) compared to standard care over 3 years (median). The 2023 ACS ESC Guidelines recommend the polypill strategy to improve outcomes and treatment adherence. The CV-polypill inclusion in the 2023 World Health Organization's essential medicines list signifies its effective and affordable response to a global secondary prevention healthcare requirement. Purpose To reach consensus among medical experts from various countries regarding key implementation aspects of the CV-polypill strategy (ASA+atorvastatin+ramipril) as baseline preventive treatment after a CV event (CVe) in routine clinical practice. Methods A two-round modified Delphi method was employed. A questionnaire consisting of 30 evidence-based statements was developed and validated with input from 8 distinguished cardiologists. The Delphi panel, 50 physicians from 19 countries across Europe, Latin America, and Asia, used a three-point Likert scale to establish their agreement and perceived importance of the statements. Consensus was reached when ≥80% agreed or deemed statements 'very important' or 'important. Statements without consensus in the first round underwent refinement based on evidence and panellists’ feedback in the second round. Persistent disagreements were resolved in a face-to-face meeting with experts. Descriptive statistics were applied. Results 38/50 panellists participated in round 1, and 37/50 in round 2. 31/38 were cardiologists. 28/38 routinely prescribed the CV-polypill strategy. 97.4% of panellists believed that the 24% relative risk reduction in major CVe over 3 years (median), attained with the CV-polypill strategy (ASA+atorvastatin+ramipril) compared to standard care could replicate in clinical practice while maintaining equal safety (97.4%). Unanimous consensus (100%) supported initiating the CV-polypill strategy as baseline preventive treatment upon hospital discharge or at first follow-up. Its efficacy and safety were also acknowledged for stroke (94.7%), peripheral artery disease (92.1%), and both genders (84.2%). 89.5% supported CV-polypill affordability for preventing CHD events and strokes. Algorithms for initiation (97.3%) and transition (97.4%) to the CV-polypill strategy from cardioprotective drugs, considering patient preferences (97.5%), were confirmed. A unanimous consensus (100%) affirmed the positive impact of the simplified CV-polypill treatment on patient satisfaction, with 94.7% recognizing its convenience (Figure 1). Conclusions Skilled medical experts across continents reached consensus on critical implementation aspects and strongly endorse the early use of the CV-polypill strategy (ASA+atorvastatin+ramipril). This adoption aims to reduce CVD recurrence, improve prognosis, and potentially enhance affordability in CVD treatment after a CVe.Consensus on CV polypill implementation

Chronic Obstructive Pulmonary Disease (COPD) is a characterized by exacerbations (COPD-E) during the course of the disease. COPD-E are a well known cause of morbidity and mortality. We analized retrospectively all the patients admitted to our hospital for COPD-E from january 2009 to December 2011. There were 264 admissions for COPD-E in the admiting diagnosis: 88 were excluded because of an other dignosis was stablished during the hopsital course (CAP, Asthma, heart failure, etc), 71 were eliminated because of insuficient data, thus only 105 patients were able to be analized. From the 105 COPD-E admissions, 48, 1 % had a previous COPD-E hospitalization, 32,4% was during the previous year, 29,4% had a previous ICU admission for COPD-E. A prior COPD diagnosis was known by the patients in 77.5% of the admitions, of the patients who knew their severity, 2.9% was mild, 6,9% was moderate, 24.5% was severe, 11.8% was very severe, the rest was unkown by the patients. Immunizations: 24,5% had a flu shot during the previous year and 22.5% pneumococcal vaccine. During the hospital course 26 patients died (24,7%), 6 (5,7 %)because of the COPD-E and 20 (19%) because of other cause (heart failure, nosocomial pneumonia,etc). Conclusions: Patients admited for COPD-E have a 24,7% death rate during the hospitalization, almost half of them had a previous admission for COPD-E. There was a highly low prehospital treatment rate for COPD-E and low vaccination rate.

INTRODUCTION The most frequent cause of a pleural effusion is heart failure. The diagnosis is based on clinical findings and biochemical parameters. RATIONALE The existence of a specific heart biomarker could avoid unnecessary studies for the diagnosis of cardiac origin of pleural fluids. OBJECTIVE The purpose of our study was to evaluate the diagnostic accuracy of pleural fluid aminoterminal fragment N-terminal pro-brain natriuretico peptide (NTpro-BNP) for pleural effusions of cardiac origin compared with Framingham criteria. MATERIAL AND METHODS We studied 32 consecutive patients admitted at the work site. Pleural and blood samples were simultaneously obtained NTpro-BNP was measured in blood and pleural fluids (Bio Merieux® Enzyme-Linked Fluorescent Assay). Light criteria and serum-pleural albumin gradient was used to discriminate transudates from exudates. RESULTS The cut-off value of pleural fluid NTpro-BNP level to discriminate between pleural effusions due to heart failure was ≥1.791 pg/mL. The sensitivity and specificity was 75.0%(95%CI 47.6-92.6) and 81.2%(95%CI 54.4-95.7) respectively; with a positive predictive value of 80.0%(95%CI 51.9-96.0), negative predictive value 81.8%(95%CI 50.1-93.2), positive likelihood ratio 4.0(95%CI 20.8-5.8) and negative likelihood ratio 0.3(95%CI 0.1-1.2). CONCLUSIONS Pleural fluid NTpro-BNP is a very useful biomarker with high diagnostic accuracy for distinguishing pleural effusions of cardiac origin.

Pulse wave velocity is a reliable marker of arterial compliance. Stiffness of large and elastic arteries leads to a faster propagation of pulse wave. The aim of this study was to evaluate changes in arterial distensibility using antihypertensive drugs. This treatment focused on the inhibition of the renin‐angiotensin‐aldosterone system and the changes produced in blood pressure. Measurements were taken at baseline and throughout 60 months in 66 previously untreated hypertensive patients (22 men and 44 women, aged 54±9.5 years, range 38–73 years at baseline). All patients received either angiotensin‐converting enzyme inhibitors or, in case of adverse effects, angiotensin receptor blockers. To control blood pressure, diuretics, calcium channel blocking agents, or â blockers were added when appropriate. Statistical analysis was performed by means of ANOVA with á=0.05. Systolic and diastolic blood pressure decreased during the first year without significant changes thereafter. There were no significant changes in pulse pressure. Pulse wave velocity showed a continuous and significant decrease throughout the follow‐up period, but its reduction since the third year was more evident than the decrease in systolic and diastolic blood pressure (p<0.0001 for both). This observation could be related to changes in arterial remodeling probably due to angiotensin‐converting enzyme inhibition or renin angiotensin system blockade. Further investigations are needed to establish this relationship.

The end systolic stress–strain relationship (mean end‐systolic fiber stress (MESFS) and the logarithm ln(h0/h) [h0 = wall thickness extrapolated to a “cero” ventricular volume; h = end‐systolic wall thickness]), evaluates the mechanics of the left ventricle (LV) independently of its mass and geometry. Objectives: To compare the LV mechanics in patients without and with compensated systolic heart failure (HF) using the MESFS–ln(h0/h) relationship. Methods: We perform echo Doppler studies in 37 patients with compensated HF (11 women) 65±15 years old (18–85) and 162 patients without HF (102 women) 50±16 years old (18–83). MESFS and ln(h0/h) were calculated and compared between the groups, and the resulting curve was plotted. Results. (o) without HF; with HF. Conclusion: Patients with compensated HF have higher‐end systolic MESFS and ln(h0/h). Consequently, they show a rightward shift in the end‐systolic MESFS‐ ln(h0/h) curve.

lavicoli, O. R.; Bellido, C. A.; Pineiro, D. J.; Rusak, E. J.; Sanz, A. P.; Vazquez, S. T.; Pittaluga, E. L.; Lerman, J. Author Information

Systolic and diastolic blood pressures and urinary albumin excretion (UAE) have been recognized as predictors for cardiovascular risk. Furthermore, arterial compliance (AC) disorders assessed by increased aortic pulse wave velocity (PWV) are closely related to changes in blood pressure and strongly correlated with cardiovascular mortality and presence or extent of atherosclerosis. Our purpose in the present study was to determine a relationship between AC using PWV and UAE in a group of non-smoking patients with essential hypertension, and the level of interaction of ACE inhibition on these two variables. A total of 70 non-smoking never treated hypertensive patients (33 men and 37 women), aged 50 +/- 7 years (range 35-69), have been enrolled in this study. All of them underwent PWV by a computerized device (Complior) and UAE determination by radial immunodiffusion method, on baseline and after six months of treatment with perindopril (4.6 +/- 1.4 mg/day). We have found a significant decrease of systolic blood pressure (160.2 +/- 10.6 vs. 131.9 +/- 7.1 mmHg, p < 0.01), diastolic blood pressure (100.6 +/- 5 vs. 81.6 +/- 4.8 mmHg, p < 0.01), PWV (13.4 +/- 1 vs. 9.1 +/- 0.9 m/sec, p < 0.01), and UAE (42.2 +/- 19.3 vs. 11.1 +/- 3.6 mg/day, p < 0.01) at the end of the sixth month when they were compared to baseline values. Furthermore, renal function was also improved by the treatment at the end of the study as illustrated by creatinine clearance (87.5 + 22.5 vs. 102.1 + 23.5 ml/min, p < 0.01). Moreover, a high positive correlation between UAE and PWV at the beginning of the study (r = 0.81; p < 0.01) and after six months of treatment (r = 0.66; p < 0.01) was observed. In addition, PWV vs. UAE, differences between sixth month and baseline have shown a high correlation (r = 0.67; p < 0.01) and using a multiple regression test we found that PWV (t ratio 5.76; p < 0.001) was the most important and significant independent variable that correlates with UAE. These results suggest the existence of a real link between UAE and AC in non-smoking patients with arterial hypertension, and that ACE inhibition can similarly modify these two parameters.

Endocardial fractional shortening (EFS) expresses chamber function and mesoparietal fractional shortening (MFS) gives a clue of myocardial function. Both parameters have an inverse correlation with end systolic stress (ESS). The relationship between effective arterial elastance and the systolic left ventricular elastance (Ea/Ees) expresses the ventricular-arterial coupling. To correlate EFS, MFS and both parameters corrected by circumferential end systolic stress (ESSc) with Ea/Ees. We studied 171 hypertensive patients (I-II JNC-VI), 108 women and 63 men, aged 51 ± 15 years. We determined the systolic (SBP) and diastolic blood pressure (DBP), and performed M-mode echo guided by 2-D. We calculated ESF, MSF, ESSc, ESF corrected by ESSc (ESF%), MSF corrected by ESSc (MSF%) and Ea/Ees. We considered end systolic pressure as 0.4 SBP + 0.6 DBP + 1.4 Correlations of the different parameters with Ea/Ees In hypertensive patients, impairment of left ventricular-arterial coupling correlates well with fall in both chamber and myocardial left ventricular function. (See Table)

Bellido, A.; Costa, M.; Iavícoli, O. R.; Forcada, P.; Piñeiro, D. J.; Lerman, J.; Toblli, J. E. Author Information

Large artery properties can be improved by a direct action of a drug on the vessel wall and/or indirectly by the decrease in blood pressure. On the other hand pulse wave velocity (PWV) is a way to measure arterial elasticity. This study was designed to assess the PWV changes in a cohort of hypertensive patients (HT) at baseline and during the antihypertensive treatment at short and long time (2–36 months) in regard to other haemodynamic parameters. 121 untreated HT (Stages I–II, JNC-VI), 70 women and 51 male, aged 53 ± 11.35 years were studied at baseline and thereafter at different times ranging from 2 to 36 months under antihypertensive treatment. PWV by means of the Complior® and blood pressure were recorded in all of them. (See Table) p<0.05 p<0.05 PWV diminishes with short time antihypertensive treatment and remains unchanged thereafter. The improvement of PWV parallels the decrease of BP.

According to numerous published papers large artery properties correlate closely with aging and blood pressure. Nevertheless, several other variables need to be considered in regard to the analysis of pulse wave velocity (PWV), a major marker of arterial wall structure and an accurate method for measuring arterial elasticity. This study was designed to assess the independent variables of PWV in a cohort of untreated patients. 326 untreated subjects, 222 women and 104 male, aged 51 ± 16 years were studied. PWV was recorded by means of the Complior®. In univariate analysis PWV correlates with: In multivariate analysis PWV correlates with age, SBP, height, and heart rate (PWV = −7.98 + 0.0819 age + 0.0451 SBP + 0.0426 height + 0.0267 heart rate [r = 0.80, p<0.000001]) In this wide cohort of untreated patients PWV closely correlates with age, anthropometric variables, SBP and heart rate. (See Table)

Figure 1. A 68-year-old woman was admitted to the emergency room with sudden left hemiparesis. A computed tomographic scan of the brain showed an image consistent with infarction of the right frontal lobe. A transthoracic echocardiogram suggested that dissection of the ascending aorta had occurred. Transesophageal echocardiography was performed immediately thereafter and confirmed the diagnosis. A wide dissection of the proximal aorta compromised more than 270 degrees of the vessel's circumference and extended to the descending thoracic aorta. The redundant, dissected wall was plicated, producing a wave-shaped image in the transverse plane of the echocardiogram (Panel A) and duplicated aortic . . .