Revista Uruguaya de Cardiología

ST segment elevation as an atypical presentation of a cardiac tumor. Diagnostic role of a multimodal imaging approach

Victoria Briano — 2021-12-01

Malignant cardiac tumors are rare neoplasms that can present in various forms, making their diagnosis difficult. Echocardiography and cardiac magnetic resonance imaging are fundamental techniques for the diagnosis, characterization, and evaluation of tumor extension. Identification of the tumor line is essential when initiating targeted cancer therapy. Although the “gold standard” for this purpose is the pathological study (obtained by biopsy or surgical resection), in cases where this is not possible, cardiac resonance is the non-invasive technique that provides a better diagnostic approach. The treatment of choice is surgical resection and the prognosis is generally poor. We present the case of a patient with an atypical clinical presentation, in which a multimodal approach provides key and complementary information for tumor diagnosis and tissue characterization.

Sinus venosus atrial septal defect with abnormal pulmonary venous return. Case report

Maximiliano Hernández — 2021-12-01

Sinus venosus atrial septal defect is a low prevalence congenital heart disease, more frequently found in women, usually associated with abnormal pulmonary venous return. Transesophageal echocardiography is the most frequently used diagnostic method, and must be complemented with other imaging studies such as chest angiography or magnetic resonance. This assessment is essential to characterize the anatomical aspects that are essential for planning the corrective surgical strategy. In patients where the anomalous pulmonary venous return empties above the right atrium into the superior vena cava, the Warden surgical technique is effective, with a low incidence of complications and good longterm results.

Acute myopericarditis versus acute coronary syndrome: case report

Osman Guevara Manzano — 2021-12-01

Acute myopericarditis is an acute pericarditis with minor myocardial compromise. During the first hours from onset the clinical presentation can be confused with an acute coronary syndrome, especially when the electrocardiogram presents with ST segment elevation and increased markers of myocardial necrosis. Cardiac magnetic resonance imaging plays an important role to differentiate between these two diseases. We present the case of a 36-year-old male who was admitted with chest pain, ST segment elevation and increased markers of myocardial necrosis. Coronary angiography is performed reporting no significant angiographic findings. Cardiac magnetic resonance imaging with contrast medium (gadolinium) is performed, reporting mild pericardial effusion, presence of edema, and delayed uptake with a subepicardial and intramyocardial patchy pattern on the lateral wall. These test findings confirm the diagnosis of myopericarditis.

When not everything is what it seems… Extra-cardiac mass in the left atrium: a case report in Uruguay

Pablo Fontes — 2021-12-01

Hiatal hernia is a relatively common entity, and may be an incidental finding in an echocardiographic study. We describe the case of a patient with a diagnosis of a mass in the left atrium with no clear etiology, in whom the diagnosis of hiatal hernia is made by cardiac magnetic resonance imaging and then demonstrated by contrast echocardiography the gastric content of the mass after the ingestion of a carbonated drink, which allows quickly and easily to clarify the diagnosis.

Primary pericardial T/NK cell lymphoma. Case report

Guillermo Agorrody — 2021-04-01

Primary cardiac lymphomas are a rare subtype of lymphomas in which the primary lesion is in the heart. The tumors are usually located in the right atria, followed by the pericardium and are frequently infiltrative. Mortality is remarkably high in this group and the delayed diagnosis is the main factor for its poor prognosis. We describe the case of a patient that presented with obstructive shock due to profuse pericardial effuse caused by a rare kind of primary cardiac tumor, a T/NK cell pericardial lymphoma.

A clinical case of mitral valve in valve implant. New skyline in the treatment of prosthetic valve dysfunction

Daiana Giménez — 2021-12-01

Prosthetic valve dysfunction is increasingly common due to the aging of the bioprosthesis-bearing population, and it presents a challenge at the time of diagnosis, evaluation, and treatment. A multimodal imaging approach is essential for its management. In relation to treatment, a minimally invasive percutaneous valve replacement procedure called valve in valve arises as a new alternative, mainly in patients with high surgical risk. We present one of first local cases of percutaneous implantation of a transseptal mitral prosthesis within a dysfunctional surgical mitral bioprosthesis.

Severe preeclampsia associated with the onset of systemic lupus erythematosus and massive gestational vulvar edema

Jorge Castelli — 2021-08-01

The onset of systemic lupus erythematosus during pregnancy, complicated with severe preeclampsia, associated with massive gestational vulvar edema, is rare and difficult to diagnose. A 19-year-old patient is reported, with 35 weeks of gestation, who started with systemic lupus erythematosus during her third trimester of pregnancy, and consulted due to cutaneous manifestations caused by erythema on the pads of the fingers. Severe preeclampsia was observed. An emergency cesarean section was performed, and the patient was admitted to the Intensive Care Unit. She developed a massive vulvar edema that disabled ambulation.

Malignant ventricular arrhythmia associated to gossypiboma. Clinical case report

Joaquín Vázquez — 2021-08-01

A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.

Highlights of the 2020 European Society of Cardiology Guidelines on the Management of Adults with Congenital Heart Disease

Guillermo Agorrody — 2021-12-01

Medicine and society: the wavering of things

Baltasar Aguilar Fleitas — 2021-04-01

Lean Cardiology. Eliminate waste to deliver better quality of care

Gerardo Soca — 2021-12-01

Impact of the COVID-19 pandemic on the practice of cardiac electrophysiology in Latin America: A Survey of the Latin American Heart Rhythm Society

Alejandro Cuesta — 2021-12-01

Introduction: at the beginning of the COVID-19 pandemic, restrictive clinical guidelines were implemented, including Electrophysiology Services (EFS).

Objectives: analyze the healthcare activity and to know the situation of the EFS in Latin America two months after the restrictions began.

Method: descriptive-analytical and cross-sectional observational study, using a survey of electrophysiologists in March / 2020. The clinical and invasive activity carried out before and during the pandemic was compared.

Results: 147 surveys were included, from 74 cities in 18 Latin American countries. Weekly clinical events were reduced from 75 (45/127) to 20 (10/40) (p <0.001), they fell 71%. Monthly invasive procedures were reduced from 26 (13/39) to 4 (2/9) (p <0.001), down 77%. Forty-nine percent surveyed worked in ?3 healthcare centers and 89% shared a laboratory with a hemodynamic service. Hospital bed occupancy was low 37%, intermediate 28% and high 35%. Thirty percent referred a doctor from their team was quarantined for infection / contact. Fifty-three percent reported that no screening test was done on the patients prior to the procedures and 77% on the staff. Most perceived difficulties as important or very important, but 63% were considering reopening to normal functioning.

Conclusion: There was a significant reduction in clinical and invasive activity. Most did not have high bed occupancy. Respondents worked in various centers and in hemodynamic rooms. Prevention measures had not yet been fully implemented yet. There was a perception that in a short time normality would return.

Impact of public health policies on the incidence of acute myocardial reperfusion during the initial stages of the COVID-19 pandemic in Uruguay

Victor Dayan — 2021-12-01

Introduction: the emergency health measures imposed to contain SARS-CoV-2 can have collateral effects in the care of cardiovascular diseases. Global country data on the incidence of ST acute myocardial infarction during the pandemic are critical for future health policy.

Objectives: our objective was to determine if the emergency health measures imposed in Uruguay had a direct impact on the quality of ST elevation acute myocardial infarction care.

Methods: we carried out a population-based retrospective study of the entire country to determine the incidence of reperfusion of ST elevation acute myocardial infarction (fibrinolytic and percutaneous) during the emergency health period. The incidence rate of reperfusion, time to reperfusion, and associated mortality were collected from the Fondo Nacional de Recursos (the only government organization in charge of the reperfusion of ST elevation myocardial infarction in Uruguay). These same data were recovered for 2019, 2018 and 2017.

Results: fewer patients were treated in 2020 (136 patients) compared to 2019 (180 patients), 2018 (182 patients), and 2017 (174 patients). Fibrinolytics was performed as the only treatment in 5.1%, 7.2%, 7.7% and 12.1% respectively. The proportion in incidence rate of ST elevation myocardial infarction during the study period in 2020 was lower (0.74, 95% CI: 0.59-0.91). The median time to reperfusion was similar compared to 2019, 2018, and 2017 (p = 0.4). Mortality at 15 days was similar in 2017 (8%), 2018 (6%), 2019 (11%) and 2020 (8%).

Conclusion: emergency health measures were associated with a decrease in the incidence of reperfusion of ST elevation myocardial infarction without affecting the time to reperfusion and mortality.

Use of a mobile electronic technology device for atrial fibrillation screening. Pilot study

Virginia Estragó — 2021-08-01

Atrial fibrillation (AF) is a public health problem generating important morbidity and mortality mainly in > 65 years old population. Detection is key in the population at risk. This pilot study was designed to assess a mobile electronic technology device (METD) usefulness in AF screening.

Objective: evaluate validity and reliability of a METD in AF identification.

Secondary objective: to validate the process of collection, transmission, storage, method and interpretation of obtained data.

Method: participants in 5 Ibirapitá Plan workshops (October 15-November 30, 2018) were invited to participate in the study. A KardiaMobile Alive Cor® METD was used, whose ECG recording was compared with a 12L ECG taken almost at the same time. Automatic METD report was compared with 2 independent cardiologists report considering the METD recording and the 12L ECG.

Results: 114 participants (78 female), mean age 72,5 y.o. (SD 5,36; range 53-87) were included. METD sensitivity for AF diagnosis was 100% with a 96.6% specificity (PPV=57,1% NPV=100%), and a 96.8% number of correct diagnosis. A 18.4% of recordings were catalogued as “unclassified” by the METD. Considering this, the proportion of correct diagnosis decreased to 78.9%; there were not false negatives.

Conclusions: AF screening with a METD in an older population is feasible and reliable. The finding of 18.4% METD recordings as “unclassified” raises the needs for experts review during diagnosis confirmation.

Valve degeneration in patients with aortic porcine bioprosthesis evaluated through 18Fsodium fluoride PET

Amparo Fernández — 2021-12-01

Introduction: prosthetic valve degeneration is a relevant clinical disorder; conventional imaging methods allow diagnosis in the later stages. ¹⁸Ffluoride positron emission tomography (PET) can detect subclinical degeneration earlier.

Objective: correlate parameters of prosthetic structural deterioration by PET with echocardiographic hemodynamic parameters one year after aortic valve replacement (AVR) by porcine bioprosthesis.

Methods: prospective ad hoc study of a clinical trial. Patients undergoing AVR by porcine bioprosthesis were recruited in two national centers between 01/01/2019 and 02/13/2020. Clinical and echocardiographic controls were carried out. 19 subjects were randomly selected and underwent ¹⁸Fsodium fluoride PET with CT angiography one year after AVR. Tracer uptake in the valve (SUVavV) and right atrium (SUVavA) was measured, creating the SUVavV/SUVavA index, which was compared with the mean and maximum gradients at one year, using Spearman’s correlation analysis.

Results: of a total of 140 subjects, PET was performed on 19 at 16.3 months (15.9-16.9) after the AVR. The median SUVavV/SUVavA ratio was 1.17 (1.11-1.27). A moderate negative correlation was found between. ¹⁸Ffluoride uptake and the mean gradient (correlation coefficient -0.516, p = 0.028) and maximum (coefficient of -0.589, p = 0.010) at one year.

Conclusions: we found low uptake values in PET, echocardiographic gradients in normal range and no positive correlation between both parameters. It is the first national report with these imaging techniques.

Enrique Soto Durán

Daniel Barreiro — 2022-04-04

El Consejo Directivo de la Sociedad Uruguaya de Cardiología nos ha encomendado escribir estas líneas como sentido homenaje al Dr. Enrique Soto Durán.
No es difícil encarar esta tarea, cuando la vida de Enrique ha sido ejemplo de permanente compromiso humanista y actitud de servicio.

Heyde syndrome

Jorge Estigarribia Passaro — 2021-12-01

Since Edward Heyde perceived in 1958 a mysterious association between aortic stenosis and gastrointestinal bleeding, six decades have passed and no little controversy has arisen.

At the time it was proposed, the technical and methodological status of medical science and a biased interpretation of his original idea prevented obtaining a statistical and pathophysiological support that would grant it wide recognition as and individual clinical entity.

Advances in several disciplines allowed to demonstrate that its frequency of presentation exceeds the effect of chance, besides clarifying with precision and elegance its pathophysiological mechanisms. Its consolidation as a syndrome reveals a true crossroads between Cardiology, Gastroenterology, Hematology and Laboratory, specialties involved both in its understanding process and in its practical management today.

However, despite having a not negligible incidence and acquiring a central role in the clinical conduction of aortic stenosis, this entity seems to have gone from being resisted to relatively ignored.

With the objective of contributing to its visibility, this review offers a comprehensive overview of the subject, covering the main historical contributions to its knowledge and approaching in depth its mechanisms, the keys to its clinical detection and its impact on the management of aortic stenosis and other entities with related pathophysiology.

The best of the 2021 ACC Congress

Keril Gianoni — 2021-12-01

The Annual meeting of the American Cardiology College Congress was held virtually between 15th and 17th of May in present 2021. This is indeed one of the most expected and relevant scientific events in the world of Cardiology.

We had excellent speakers and outstanding presentations updating central themes in our clinical practice referring to a wide range of frequent situations such us: cardiac surgery, interventional cardiology, management of arrhythmias. Bellow, we select and summarize some of the most significant works:

Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM).

TicAgrelor versus CLOpidogrel in Stabilized Patients with Acute Myocardial Infarction (TALOS-AMI).

Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke III (LAAOS III).

Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF).

A Randomized Ablation-based atrial Fibrillation rhythm control versus rate control Trial in patients with heart failure and high burden Atrial Fibrillation (RAFT-AF).

Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE).

Postoperative atrial fibrillation. Awolfwith lamb skin?

Jorge Estigarribia Passaro — 2021-01-01

Since an early age of heart surgery, atrial fibrillation has been a frequent companion of the postoperative period, and its decline is not to be expected in the near future.

The interpretation of its clinical significance has changed in recent years, after knowing its recurrent trend and its association with serious immediate and long-term complications.

This fact unveils a new challenge, as it is no longer a minor problem of consideration restricted to the perioperative period and has become a topic of concern and follow-up in the distant future, still with uncertainties as to its evolution and management.

The effective prophylaxis of this arrhythmia, a logical response to the problem, has been difficult by the multiplicity of risk factors and the intricate of its genesis, not yet completely elucidated, added to the increasing age of the patients involved, the greater complexity of the procedures, the possible side effects of the drugs used and the absence of a reliable predictive algorithm that could allow to rationalize preventive measures.

In addition, many recommendations from current clinical practice guidelines are based on information obtained from studies in primary atrial fibrillation, so their adoption in the heart surgery scenario has been less than desirable.

All these aspects are analyzed in this review, which ends with directives for the practical management of the arrhythmia in the perioperative environment.

Digital Cardiology (e-Cardiology): useful tools for diagnosis and management of atrial fibrillation

Walter Reyes Caorsi — 2021-12-01

The mobile digital technology (mHealth), a tool still underutilized, has the potential to become an essential aid in clinical practice, particularly in Cardiology. Atrial fibrillation is the most frequent arrhythmia whose prevalence increases with age and its most feared complication is cerebrovascular accident. Its prevention depends on a timely diagnosis, an adequate risk stratification and the use of oral anticoagulants. However, it is frequently paroxysmal and asymptomatic, which makes its diagnosis difficult. The contribution of technology through the development of applications for cell phones, watches, portable or implantable devices that record the heart rhythm and allow prolonged, outpatient and remote monitoring, facilitate its detection. The main evidences that justify the application of these screening strategies are reviewed, when it is indicated to perform it, how and to whom to do it. Finally, the usefulness of these prolonged monitoring strategies in the management and prevention of atrial fibrillation is also considered.

The best of the 2020 Uruguayan Congress of Cardiology

Carlos Guamán Valdivieso — 2021-12-01

The 37^th Uruguayan Congress of Cardiology was held in virtual mode, from May 26 to 28. It had national and international guests, allowing the development of an update space in different areas of cardiology. As in previous years, a space was set aside to present the scientific activity carried out by national researchers through the presentation of free topics. Various free topics of 2020 were reviewed and approved by the scientific committee, whose presentation was deferred due to the COVID-19 pandemic. Below we comment on some of the papers presented at the congress, as follows:

Primary implantation of a definitive cardiac pacemaker in the pediatric population and evolution: 15 years of experience in a pediatric cardiology referral center in Uruguay.

Quality of oral anticoagulation with warfarin in a cardiology polyclinic, one-year follow-up.

Prognostic value of mild/moderate anemia and/or preoperative iron deficiency in the postoperative period of cardiac surgery.

Prognostic impact of stress echocardiography with negative physical exercise in a chest pain unit. 2019-2020 period with one-year follow-up.

Invasiveconservative strategy in ST elevation infarction. Proof of concept.

Cardiovascular impact of the COVID-19 pandemic during the first half of 2020 in Uruguay. Ecological study.

Correlation between hemodynamic parameters and 18 F-fluoride uptakes by PET in the short term after aortic valve replacement.

Indication, results and mortality of coronary angioplasty with unprotected left main coronary artery stent implantation.

The best of the 2020 AHA virtual congress

Keril Gianoni — 2021-04-01

During the 13^th-17^th november 2020 period, the anual meeting of the American Heart Association was held. Due to the global pandemic situation that we are going through, it was carried out virtually in its entirety, which allowed a greater participation worldwide. The Guidelines for Cardiopulmonary Resucitation were presented as well as multiple interesting and relevant studies for cardiology, from which we highlight:

- Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve: the RIVER trial.

- Ferric Carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trail: AFFIRM-AHF trial.

- Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease: SCORED trial.

- Cardiac Miosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure: the GALACTIC-HF trial.

- Phase 3 Trial of Interleukin-1 Trap Rilonacept in Recurrent Pericarditis: RHAPSODY trial.

- Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation: the EARLY-AF trial.

Recommendations for the management of cardiotoxicity related to cancer treatment. Part one

Andreina Gómez — 2021-04-01

New oncological therapies have been successful in increasing cancer patient survival, but they have also led to an increase in morbidity and mortality linked to their side effects. During cancer treatment, the development of cardiovascular side effects has a negative impact in prognosis, but also in cancer survivors, in whom cardiovascular diseases and secondary malignancies are the main cause of death.

Cancer related cardiotoxicity is defined as the development of cardiovascular diseases related to cancer treatment. Clinical presentation is broad involving ventricular dysfunction, heart failure, myocardial ischemia, arterial hypertension and arrhythmias among others. This may result from the direct cardiovascular effect of a cancer treatment or accelerated development of cardiovascular diseases.

Frequently, in the literature cardiotoxicity and chemotherapy related ventricular dysfunction are used as synonyms. However, cardiotoxicity includes a broad spectrum of cardiovascular manifestations, thus in this text we refer to chemotherapy related ventricular dysfunction as the presence of left ventricular systolic impairment.

Chemotherapy related ventricular dysfunction and heart failure are two of the most feared complications of cancer treatment due to its impact on cardiovascular and oncological prognosis, affecting treatment options.

Numerous worldwide cardio-onco-hematology societies have emerged to generate clinical practice guidelines and improve the diagnosis and evaluation of cardiovascular cancer treatment side effects.

Cardio-Oncology is a discipline in continuous growth and development. We strongly believe that continuum medical education and a multidisciplinary approach is necessary to provide a quality health care.

This text is the result of a multidisciplinary work involving cardiologists, hematologists and oncologists. It is our goal to provide information to the health care team involved in the assistance of cancer patients. Due to its extension, it will be published in three parts.

Diabetes and cardiovascular disease

Carlos Guamán — 2021-04-01

Diabetes mellitus is one of the main causes of morbidity and mortality worldwide. This group of patients generally represents a population with high or very high cardiovascular risk, that is the reason for an early stratification of risk, seeking to objectively focus on pharmacological and non-pharmacological approach with an intensive strategy.

Cardiovascular disease represents the main cause of mortality, but in recent years there have been advances in therapeutics that have been shown to reduce major cardiovascular events. This article reviews the interaction between diabetes, cardiovascular diseases and their treatment.

Gliflozins: more than oral antidiabetics. A brief review of the literature

Verónica González — 2021-08-01

Diabetes mellitus, heart failure, and chronic kidney disease are highly prevalent in the population. Likewise, these pathologies are included in a “vicious circle” because they share pathophysiological mechanisms that predispose to their coexistence in the same patient, significantly increasing the risk of cardiovascular events. Gliflozins, a group of drugs with benefits in the three mentioned pathologies, have recently been added to the therapeutic arsenal. Knowing how research with these drugs and its mechanisms of action is essential to optimize the treatment of patients.

Syncope and cardiorespiratory arrest, severe forms of presentation of central pulmonary embolism. Report of three clinical cases

Gimena Loza — 2021-08-01

Pulmonary thromboembolism has a varied clinical presentation. It is essential to have a high index of suspicion to arrive at a timely diagnosis. Syncope is associated with severe cases and is of prognostic significance. Thrombolytic treatment is the cornerstone in the subgroup of high-risk patients. Three clinical cases of high-risk pulmonary thromboembolism are presented in order to discuss the clinical presentation scenario and the established treatment.

Recommendations for the management of cardiotoxicity related to cancer treatment. Part two

Andreina Gómez — 2021-12-01

Frequently, in the literature cardiotoxicity and chemotherapy related ventricular dysfunction are used as synonyms.

However, cardiotoxicity includes a broad spectrum of cardiovascular manifestations, thus in this text we refer to chemotherapy related ventricular dysfunction as the presence of left ventricular systolic impairment.

Numerous worldwide cardio-onco-hematology societies have emerged to generate clinical practice guidelines and improve the diagnosis and evaluation of cardiovascular cancer treatment side effects.

New and old ethical dilemmas and problems in times of pandemic

Delia M. Sánchez — 2021-12-01

Recommendations for cardiovascular evaluation of people under 35 years of age who perform exercise and sports are presented in a joint work

Sonia Rossi — 2021-12-01

Guidelines are established regarding the assessment and qualification that said evaluation will have, who will be in charge of carrying it out and what are the fundamental components of a correct cardiovascular evaluation. The family and personal history and an exhaustive physical examination are taken into account and the performance of the electrocardiogram is considered advisable as a mandatory integral part. Reference is made to other functional studies as optional as well as possible referral to specialists when deemed necessary.

List of reviewers of the Uruguayan Journal of Cardiology 2021

Federico Ferrando — 2021-12-01

News from the European Society of Cardiology 2020 Guidelines on the Management of Acute Coronary Syndrome without Persistent ST-Segment Elevation

Carlos Guamán — 2021-08-01

Cardiovascular disease is the leading cause of death worldwide. The management of coronary syndromes has advanced dramatically in the last 50 years, reducing ischemic risk, but observing an increase in bleeding risk. The European Society of Cardiology published in 2020 the guideline on the management of acute coronary syndrome without ST-segment elevation, where changes in risk stratification algorithms and antiplatelet and anticoagulant therapy are highlighted as two of the main aspects. This editorial summarizes the main developments published in this document.

Highlights of the European Atrial Fibrillation Guidelines

Juan Manuel Castro — 2021-08-01

La fibrilación auricular (FA) es a nivel mundial la arritmia sostenida más frecuente en la población adulta. A pesar de los crecientes conocimientos acerca de sus mecanismos fisiopatológicos subyacentes, herramientas diagnósticas y terapéuticas, se mantiene como una causa importante de insuficiencia cardíaca (IC), accidente cerebrovascular (ACV) y morbilidad cardiovascular a nivel mundial. Esto se traduce en disminución de la calidad de vida y aumento en la mortalidad de los pacientes, generando elevados costos socioeconómicos.

Las Guías de Práctica Clínica (GPC) para el diagnóstico y manejo de la FA, desarrolladas por la Sociedad Europea de Cardiología en colaboración con la Asociación Europea de Cirugía Cardiotorácica publicadas en el año 2020, sintetizan la evidencia disponible para el manejo de la FA con el fin de facilitar las decisiones clínicas en la práctica habitual. Se resumen en el presente texto sus aspectos más destacados.

Magda Heras 2021. Deserved highlight adorns our journal in times of pandemic

Federico Ferrando — 2021-12-01

We need each other…

Sonia Rossi — 2021-04-01

The journal in times of pandemic. More yours than ever

Federico Ferrando — 2021-08-01

Continue working...

Sonia Rossi — 2021-12-01