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Resumen Introduccion y objetivo Determinar el cambio en las caracteristicas clinicas y pronosticas de pacientes ingresados por sindrome coronario agudo (SCA) durante un periodo de los anos 2005 y 2015 en un hospital de referencia provincial. Material y metodo Estudio observacional transversal que compara las caracteristicas del SCA de los anos 2005 y 2015. Se analizaron factores de riesgo cardiovascular, tratamientos al alta, complicaciones y mortalidad. Resultados La incidencia de SCA en 2015 fue un 15,3% menor. La incidencia de hipertension arterial, diabetes y dislipemia fue similar, pero hubo mas fumadores en 2015 (25,9% vs 18,3%; p = 0,005). La reperfusion coronaria y la prescripcion de tratamientos de prevencion secundaria aumentaron respecto a 2005. La mortalidad hospitalaria fue similar. Conclusion La incidencia de SCA ha disminuido en la ultima decada en paralelo a una mejoria en el pronostico relacionado con un uso mas frecuente de los tratamientos recomendados en las guias.

Resumen La existencia de una buena coordinacion entre los distintos niveles asistenciales constituye un factor fundamental en el desarrollo de una asistencia sanitaria de calidad y eficiente. El medico de atencion primaria es fundamental en la prevencion secundaria de la enfermedad cardiovascular, y la estrecha colaboracion entre atencion primaria y cardiologia constituye un factor clave en el control de la enfermedad cardiovascular. El proyecto CAPaCERES (Colaboracion AP-Cardiologia en Caceres) pretende mejorar la coordinacion entre atencion primaria y cardiologia desde la perspectiva del conocimiento mutuo y la mejora de la comunicacion entre los profesionales que la desarrollan, y con ello a mejorar la calidad de la asistencia al paciente cronico con enfermedad cardiovascular.

Background: Low-density lipoprotein cholesterol (LDL-C) contributes decisively to the development of cardiovascular disease (CVD). In the LYNX registry we determined the rate of achievement of the target value of LDL-C, the use of lipid-lowering therapy (LLT) and the predictive factors of not reaching the target in patients with stable coronary heart disease (CHD). Methods: LYNX included consecutive patients with stable CHD treated at the University Hospital of Caceres, Extremadura (Spain) from September 2016 to September 2018, and those who must have an LDL-C target below 70 mg/dL according to the European Society of Cardiology (ESC) 2016 guidelines. The variables independently associated with the breach of the LDL-C objective were evaluated by multivariable logistic regression. Results: A total of 674 patients with stable CHD were included. The average LDL-C levels were 68.3 ± 24.5 mg/dL, with 56.7% showing a level below 70 mg/dL. LLT was used by 96.7% of patients, 71.7% were treated with high-powered statins and 30.1% with ezetimibe. The risk of not reaching the target value of LDL-C was higher in women, in active smokers, and in those who had multivessel CHD or had atrial fibrillation. Patients with diabetes mellitus, those who took potent statins or co-administration treatment with ezetimibe were more likely to reach the target level of LDL-C. Conclusions: The treatment of dyslipidemia in patients with chronic CHD remains suboptimal; however, an increasing number of very high-risk patients achieve the LDL-C objective, although there is still enormous potential to improve cardiovascular outcome through the use of more intensive LLT. Cardiol Res. 2020;11(5):311-318 doi: https://doi.org/10.14740/cr1079

Introduction and objective To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. Material and method Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. Results The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P = .005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. Conclusion The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines.

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Caceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease.

Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of70mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area.An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed.The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3±11.8 for women and 65.8±12.6 for men (P.001). A total of 52.3% patients achieved the LDLc target of70mg/dl, with no gender differences. Only 44.8% of the patients55 years achieved their lipid targets, compared to 59.3% of the patients75 years. About 68.2% of men had an HDLc40mg/dl, and 54.8% of women had an HDLc50mg/dl. Overall, 79.4% of patients had a TG150mg/dl, with no gender differences, and 59.8% had a non-HDLc100mg/dl.Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence.

Resumen Introduccion y objetivos El sindrome metabolico (SM) confiere un riesgo cardiovascular elevado a los individuos que lo padecen. El objetivo del estudio SIMCERES fue determinar la prevalencia de SM en pacientes con enfermedad cardiovascular (ECV) previa (cardiopatia isquemica, ictus y enfermedad arterial periferica), definido este por los criterios de la National Cholesterol Education Program/Adult Treatment Panel (ATP) III y la Federacion Internacional de Diabetes (IDF). Metodos Se eligio al azar mediante muestreo aleatorio usando el codigo de identificacion de asistencia sanitaria de los medicos de atencion primaria una muestra poblacional de 1.498 individuos mayores de 14 anos de la provincia de Caceres. Se les hicieron las determinaciones necesarias para realizar el diagnostico de SM segun criterios del ATP-III y la IDF, y se los interrogo sobre antecedentes personales y familiares de ECV. Se detecto a 204 individuos con ECV previa, un 13,6% de la poblacion. Resultados La prevalencia de SM en individuos con ECV fue del 32,8% segun criterios del ATP-III y del 42,6% segun criterios de la IDF con una edad media de 72,26±12,61 anos segun el ATP-III y de 70,99±13,05 anos segun la IDF, sin que hubiera diferencias entre varones y mujeres en ninguna de las 2 definiciones. Se encontro asociacion estadistica entre la presencia de ECV y SM, tanto con los criterios del ATP-III ( odds ratio ATP-III: 3,2/intervalo de confianza 95%: 2,29–4,47) como con los criterios de la IDF ( odds ratio IDF: 3,08/intervalo de confianza 95%: 2,26–4,2) (p Conclusiones El SM es muy prevalente en la poblacion de la provincia de Caceres con ECV previa, y dicha prevalencia aumenta con la edad de la poblacion, siendo igual en ambos sexos.

The complete atrioventricular (AV) heart block is a rare complication in the course of systemic lupus erythematosus. We describe a case of a young woman with systemic lupus erythematosus and lupus cardiomyopathy who was admitted into our hospital with a syncopal attack showing on the electrocardiogram a paroxysmal complete AV heart block. The syncopal attack was resolved with a pacemaker implantation.

Resumen La seguridad para determinar el indice tobillo-brazo con metodo Doppler o con un aparato automatico convencional de medir la presion arterial no esta bien establecida cuando realizan la determinacion medicos con poca experiencia. Para evaluar la eficacia diagnostica de cada metodo en este grupo profesional, calculamos mediante angiografia la sensibilidad, la especificidad y los valores predictivos positivo y negativo en 158 piernas de 85 pacientes con sintomas de claudicacion intermitente. Del total de piernas analizadas, 131 (83%) presentaron obstruccion significativa. El metodo oscilometrico mostro sensibilidad del 97%, especificidad del 89%, valor predictivo positivo del 98% y valor predictivo negativo del 86%. El metodo Doppler mostro sensibilidad del 95%, especificidad del 56%, valor predictivo positivo del 91% y valor predictivo negativo del 68%. Los resultados indican que el equipo automatico de presion arterial tiene mejor rentabilidad diagnostica cuando realizan la prueba medicos no especialmente entrenados en el manejo de la sonda Doppler.

Los farmacos antiarritmicos administrados porvia intravenosa conllevan el riesgo de provocar unasituacion de colapso hemodinamico, incluso en manosde personal experto y correctamente utilizados. Las arritmias en el seno de un sindrome de preexcitacionconstituyen una situacion especial en laque debe extremarse la cautela cuando se utilizanfarmacos intravenosos, ya que la conduccion a travesde la via accesoria puede variar dependiendode muchos y diversos factores. Describimos el caso una paciente con una via accesoriaauriculoventricular y una taquicardia conmovimiento circular ortodromico que tras la infusionintravenosa de varios farmacos antiarritmicosdesarrollo un paro cardiocirculatorio por una taquicardiacon QRS ancho de frecuencia rapida.

El seudoaneurisma ventricular izquierdo se asocia principalmente con infarto de miocardio y rotura de la pared libre del ventriculo izquierdo, aunque puede asociarse a otras afecciones. La rotura del seudoaneurisma causa el colapso y la defuncion si no se interviene de forma temprana. Presentamos un caso poco frecuente del aneurisma ventricular izquierdo en un paciente con lesiones coronarias que desencadenan un infarto de miocardio silente con rotura de la pared libre, creacion de un gran seudoaneurisma posterolateral y rotura de la primera bolsa seudoaneurismatica con creacion de una segunda, lo cual provoco shock y el fallecimiento del paciente.

Relatively little is known on how the Doppler method compares with oscillometric measurement using a conventional automatic blood pressure device to determine the ankle-brachial index, when determinations are performed by physicians with little experience. To assess the diagnostic efficacy of both methods in this professional group, we calculated their sensitivity, specificity, and positive and negative predictive value in 158 legs of 85 patients with symptoms of intermittent claudication. Angiography was used as the gold standard. Of the legs examined, 131 showed significant arterial obstruction. The oscillometric method showed 97% sensitivity, 89% specificity, 98% positive predictive value, and 86% negative predictive value. The Doppler method showed 95% sensitivity, 56% specificity, 91% positive predictive value, and 68% negative predictive value. This study suggests that the automatic blood pressure equipment has greater diagnostic accuracy when the test is performed by physicians not specifically trained to use the Doppler probe. Full English text available from: www.revespcardiol.org.

Left ventricular pseudoaneurysm is usually associated with myocardial infarction and ventricular wall rupture, although it can also be associated with other pathological conditions. Rupture causes shock, and death if not repaired urgently. We report the very rare case of a man with coronary lesions that resulted in a silent myocardial infarction with rupture of the myocardial wall and the subsequent development of a large, posterolateral, left ventricular pseudoaneurysm. This was followed by rupture of the primary pseudoaneurysm and the consequent creation of a second pseudoaneurysm, which finally resulted in shock and death.

6. Webb JG, Pasupati S, Humphries K, Thompson C, Altwegg L, Moss R, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007;116:755-63. 7. Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second and current third generation self-expanding CoreValve prosthesis. J Am Coll Cardiol. 2007;50:69-76. 8. Moreno R, Calvo L, Filgueiras D, Lopez T, Sanchez-Recalde A, Jimenez-Valero S, et al. Implantacion percutanea de protesis valvulares aorticas en pacientes con estenosis aortica severa sintomatica rechazados para cirugia de sustitucion valvular. Rev Esp Cardiol. 2008;61:1215-9. 9. Garcia E, Pinto AG, Sarnago F, Pello AM, Paz M, GarciaFernandez MA, et al. Implantacion percutanea de protesis valvular aortica: experiencia inicial en Espana. Rev Esp Cardiol. 2008;61:1210-4.

Dear Editor, A 24-year-old woman was seen in the rheumatology clinic because of a left wrist monoarthritis in January 2001. Her blood analysis showed: hemoglobin 136 g/dl, leukocytes 7.1× 10/l, eosinophils making up 81% of all leukocytes, and platelets 159×10/l. Immunocytometry showed that 4% of all leukocytes in the peripheral blood were an abnormal lymphocyte population of CD3−, CD4+, CD2+, and CD7+. Karyotype of blood and bone marrow was 46XX. T cell receptor (TCR) beta and gamma rearrangements were clonal and FIPL1/PDGFα rearrangement was negative. Bone marrow showed hypereosinophilia; no dysplastic morphology was found and blastic population did not reach 1% of all nucleated bone marrow cells. A left axillary lymphadenopathy of 1.5 cm grew in February 2002. A pathological review diagnosed it as a non-Hodgkin’s peripheral T lymphoma. Computer tomography of the thorax and pelvis only showed a spleen of 15 cm and no lymphadenopathies. Bone marrow biopsy did not show infiltration by lymphoma. The patient was treated with four cycles of Mega CHOP (cyclophosphamide 1,500 mg/m, doxorubicin 50 mg/m, vincristine 2 mg/m, and prednisone 60 mg/m) every 21 days. After four cycles of treatment, abnormal CD3−/ CD4+ lymphocytes with eosinophilia persisted in blood. Despite this fact, the patient was in good health and without clinical progression. In March 2004, an echocardiogram disclosed an extensive hyperechogenic lesion that occupied half of the right ventricle and also the left ventricle. Endomyocardial biopsy of the right ventricle showed an extensive thrombus, eosinophilic infiltration of the myocardium, and no lymphoma. The patient was treated with fractionated heparin and corticoids, but 2 months later, another echocardiogram showed that only a third of the right chamber was free. The patient has an HLA identical brother. Reduced intensity peripheral blood stem cell transplantation was performed in November 2004. The cardiac ejection fraction was 60% and the patient had no symptoms of heart failure. Conditioning regimen consisted in fludarabine 25 mg/m× 5 days and melphalan 80 mg/m on day −1. Peripheral blood CD34 infused was 4.9×10. Graft versus host prophylaxis included a short course of metrotrexate (5 mg/m on days 1, 3, 6, and 11) and cyclosporine (for 6 months). Grade II GVHD consisting of rash and diarrhea occurred on day +23; it was treated with a short course of corticoids. Veno-occlusive disease (VOD) occurred on +12 day after stem cell infusion. Defibrotide was administered to treat VOD for 16 days. Neutrophil count was normal on +35 day and eosinophilia disappeared from the blood. Platelet count was normal a year after transplantation. FISH determination of chromosome Y at this time Ann Hematol (2008) 87:937–938 DOI 10.1007/s00277-008-0505-9