Browsing by Author "Enriquez, Andres"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Cambios en el pronóstico a largo plazo de la hipertensión arterial pulmonar
    (SOC MEDICA SANTIAGO, 2011) Enriquez, Andres; Castro, Pablo; Sepúlveda Varela, Pablo Andrés; Verdejo, Hugo; Greig, Douglas; Gabrielli, Luigi; Ferrada, Marcela; Lapostol, Carolina
    Background: Pulmonary artery hypertension (PAR) is a progressive disease with high mortality. Major advances had been made in the treatment of this condition during the last decade. Aim: To characterize the clinical evolution and mortality of a cohort of Chilean patients. Material and Methods: Seventeen patients with PAH diagnosed in the last 10 years in two Chilean hospitals were enrolled. Measurements at diagnosis included hemodynamic variables and 6-minute walk test. The patients were followed clinically for 3 years and the observed mortality was compared with that predicted by the prognostic equation proposed by the historic registry of the National Institutes of Health (NIH). Results: The mean age of patients was 45 years and 80% had an idiopathic PAH. The mean median pulmonary artery pressure was 57 +/- 15 mmHg, the cardiac index was 2.4 +/- 0.7 l/min/m(2) and the right atrial pressure was 12 +/- 8 mmHg. The 6-minute walk distance was 348 +/- 98 m. All patients received anticoagulants. Eighty two percent received ambrisentan, 12% received bosentan, 29% received iloprost and 24% sildenafil. At the end of follow-up only 3 patients had died, with an observed survival rate of 88, 82 and 82% at 1, 2 and 3 years, respectively. In contrast, the survival calculated according to the predictive formula of the NIH was 67, 56 and 45%, respectively. Among surviving patients, an improvement in exercise capacity was observed after one year (p < 0.05). Conclusions: The observed survival rate was significantly better than that estimated according to historical data. Furthermore, therapy was associated with an improvement in functional capacity after one year. This prognostic improvement is consistent with data of other contemporary registries published after the NIH Registry. (Rev Med Chile 2011; 139: 327-333).
  • Thumbnail Image
    Item
    Left Atrial Dysfunction Is a Predictor of Postcoronary Artery Bypass Atrial Fibrillation: Association of Left Atrial Strain and Strain Rate Assessed by Speckle Tracking
    (WILEY, 2011) Gabrielli, Luigi; Corbalan, Ramon; Cordova, Samuel; Enriquez, Andres; Mc Nab, Paul; Verdejo, Hugo E.; Godoy, Ivan; Zalaquett, Ricardo; Lavandero, Sergio
    Background: Even though atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG), its etiology remains poorly understood. Several factors are linked to postoperative AF (POAF), including advanced age and systemic inflammation. However, left atrial (LA) contractile dysfunction has not been evaluated in the perioperative scenario. Aim: To evaluate LA function through strain and strain rate in patients with coronary artery disease undergoing CABG and its correlation with POAF. Methods: We studied 70 patients undergoing CABG in sinus rhythm at the time of surgery. Preoperative echocardiography with evaluation of LA strain and strain rate by speckle tracking was performed. The occurrence of POAF was evaluated by continuous monitoring. Baseline and postoperative C-reactive protein (CRP) levels were measured to evaluate systemic inflammation. Results: After 1-week follow-up 26% of subjects developed AF. LA strain s wave (LASs) and LA strain rate s (LASRs) and a wave (LASRa) were significantly decreased in patients who developed POAF: LASs (10 +/- 1% vs. 24 +/- 1%, P < 0.001), LASRs (0.6 +/- 0.1 sec1 vs. 1.2 +/- 0.1 sec-1, P < 0.001), LASRa (-0.6 +/- 0.1 sec1 vs. 1.8 +/- 0.1 sec-1, P < 0.001). LASRs, LASRa, age, and LA volume were independent predictors of POAF. CRP at baseline was similar irrespective of POAF development. Conclusions: LA dysfunction, evaluated by strain and strain rate is an independent predictor of POAF and contributes to classic risk factors like age and atrial volume. (Echocardiography 2011;28:1104-1108)
  • Thumbnail Image
    Item
    Relationship between mechanical and metabolic dyssynchrony with left bundle branch block: Evaluation by 18-fluorodeoxyglucose positron emission tomography in patients with non-ischemic heart failure
    (ELSEVIER SCIENCE INC, 2012) Castro, Pablo; Luis Winter, Jose; Verdejo, Hugo; Orellana, Pilar; Carlos Quintana, Juan; Greig, Douglas; Enriquez, Andres; Sepulveda, Luis; Concepcion, Roberto; Sepúlveda Varela, Pablo Andrés; Rossel, Victor; Chiong, Mario; Garcia, Lorena; Lavandero, Sergio
    BACKGROUND: Ventricular dyssynchrony is a common finding in patients with heart failure (HF), especially in the presence of conduction delays. The loss of ventricular synchrony leads to progressive impairment of contractile function, which may be explained in part by segmental abnormalities of myocardial metabolism. However, the association of these metabolic disarrangements with parameters of ventricular dyssynchrony and electrocardiography (ECG) findings has not yet been studied. METHODS: Our aim was to determine the correlation between the presence of left bundle branch block (LBBB) with left ventricular (LV) mechanical synchrony assessed by multiple-gated acquisition scan (MUGA) and with patterns of 18-fluorodeoxyglucose ((18)FDG) uptake in patients with non-ischemic heart failure. Twenty-two patients with non-ischemic cardiomyopathy, LV ejection fraction (LVEF) <= 45% and New York Heart Association (NYHA) Functional Class II or III symptoms under standard medical therapy were included, along with 10 healthy controls matched for age and gender. A 12-lead ECG was obtained to measure the length of the QRS. Mechanical LV synchrony was assessed by MUGA using phase analysis. All patients and controls underwent positron emission tomography with (18)FDG to determine the distribution of myocardial glucose uptake. The standard deviation of peak (18)FDG uptake was used as an index of metabolic heterogeneity. Student's t-test and Pearson's correlation were used for statistical analysis. RESULTS: The mean age of the patients with HF was 54 +/- 12 years and 72% were male. The length of the QRS was 129 +/- 31 milliseconds and LBBB was present in 9 patients. Patients with HF had decreased LV (18)FDG uptake compared with controls (7.56 +/- 3.36 vs 11.63 +/- 4.55 standard uptake value; p = 0.03). The length of the QRS interval correlated significantly with glucose uptake heterogeneity (r = 0.62; p = 0.002) and mechanical dyssynchrony (r = 0.63; p = 0.006). HF patients with LBBB showed marked glucose uptake heterogeneity compared with HF patients without LBBB (41.4 +/- 10 vs 34.7 +/- 4.9 ml/100 g/min, respectively; p = 0.01). CONCLUSIONS: Patients with non-ischemic heart failure exhibit a global decrease in myocardial glucose uptake. Within this group, subjects who also have LBBB exhibit a marked heterogeneity in segmental glucose uptake, which directly correlates with QRS duration. J Heart Lung Transplant 2012;31:1096-101 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.