Desde sus inicios en el siglo pasado, el cateterismo de arteria pulmonar (CAP) ha ido evolucionando hasta ser una técnica de evaluación hemodinámica invasiva que puede realizarse en la cama del paciente a través de un catéter Swan-Ganz; este procedimiento ha mantenido un curso intermitente en cuanto a su uso; no obstante, actualmente ha demostrado relevancia en escenarios específicos. El CAP permite el acceso a la circulación venosa central, el corazón derecho y la arteria pulmonar; realiza el cálculo de variables hemodinámicas de manera directa o indirecta mediante fórmulas y métodos establecidos. Esto hace posible realizar una evaluación y clasificación hemodinámica adecuada, realizar pruebas específicas (p. ej. prueba de vasorreactividad), que ayudan a definir el diagnóstico, la conducta terapéutica, monitorizar la respuesta al tratamiento, la evaluación previa a terapias avanzadas (p. ej. el trasplante cardiaco o dispositivos de asistencia circulatoria mecánica), y el pronóstico en los pacientes. En este artículo profundizamos sobre los conceptos y la utilidad del cateter de arteria pulmonar.
La definición de síndrome coronario crónico de alto riesgo varía según la prueba no invasiva empleada para evidenciar isquemia, lo que se consigue a través de un aumento del trabajo miocárdico y la demanda de oxígeno, generados con el uso de fármacos o el ejercicio. El abordaje inicial nos sumerge en la discusión de contextualizar en qué casos priorizar la terapia médica óptima inicial, frente al manejo invasivo inicial con el objetivo de lograr la revascularización miocárdica. Este aspecto central será desarrollado en esta revisión, tomando en cuenta diversos estudios realizados hasta la fecha, en los que el manejo invasivo inicial no ha demostrado ser superior a la terapia médica óptima inicial en resultados clínicos relevantes como muerte o eventos adversos cardiovasculares mayores.
Background and Aim: The role of vitamin D plus calcium to protect against hip fracture in postmenopausal women remains controversial. Two major studies on this subject presented diverse outcomes; they implemented different doses of Vitamin D and Calcium, and they studied different populations. One study found evidence that Calcium plus Vitamin D do protect against fractures; the second study failed to demonstrate such protection. The aim of the present study is to test the hypothesis that a higher dose of vitamin D plus calcium is effective in reducing hip fractures in non-osteoporotic elderly women when compared to placebo. Methods: This will be a randomized, double-blinded superiority, multicenter trial involving three centers in São Paulo, Lima and Mexico City. After a three-month run-in period, 7176 participants will receive Calcium + Vitamin D or Placebo. The primary outcome is the occurrence of hip fractures assessed by the pelvic radiographic image; secondary outcomes include other fractures, the variation of Bone Mass Density, and the adverse effects rate. Conclusion: There is an increase in morbidity, mortality, and costs resulting from hip fractures since it is an important risk fact following accidents. A possible lack of benefit inside the active group drives more attention to an eventual over-prescription of those substances. Therefore, further studies including a phase II trial with different exclusion criteria could be desirable to confirm these findings and help to reduce the incidence of hip fractures..
The definition of high-risk chronic coronary syndrome varies depending on the noninvasive test used to trigger ischemia. The triggering occurs through increased myocardial work and oxygen demand, either through exercise or drugs. The initial approach to the chronic coronary syndrome leads us to discuss in which cases to prioritize an optimal initial medical therapy or to perform an initial invasive procedure of myocardial revascularization. In this article we analyze both approaches based on previous studies carried out to date, where the initial invasive management has not been shown to be superior to initial optimal medical therapy in outcomes such as death or major adverse cardiovascular events.
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