Browsing by Author "Verdejo H."

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    An unusual case of pulmonary arterial hypertension
    (Oxford University Press, 2021) Bulnes J.F.; Castro P.; Sepúlveda P.; Verdejo H.; Castro P.; Verdejo H.
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    Cardiac dyssynchrony correlates with left ventricular remodeling after myocardial infarctionLa disincronía cardíaca se correlaciona con el remodelado ventricular izquierdo postinfarto agudo al miocardio
    (2009) McNab P.; Castro P.; Gabrielli L.; Verdejo H.; Quintana J.; Rodríguez J.; Corbalán R.
    Background: Cardiac dyssynchrony is common in advanced heart failure (HF), but the changes in cardiac synchrony after myocardial infarction (MI) have not been adequately described. Aim: To study the relationship between cardiac synchrony and left ventricular remodeling after acute myocardial infarction. Material and methods: Forty nine patients aged 59±10 years (77% men) with a first episode of a ST segment elevation MI, were studied. Scintigraphic left ventricular function and synchrony analyses were performed at baseline and after a six months follow-up. Determinations were compared with 33 healthy subjects. Results: At baseline, patients with MI had a decreased left ventricular ejection fraction (LVEF) and significant dyssynchrony, when compared with controls. LVEF was 36.4%±10%, left ventricular end-diastolic volume (LVEDV) 127±38 mL, interventricular delay (IEV) 29±35 miliseconds (ms), and intraventricular delay (IAV), 234±89 ms. After 6 months, LVEF significantly improved (38%±10%, p =0.042) without significant changes in LVEDV (129±32 mL, p =0.97), IEV (24±17, p =0.96) or IAV (231±97, p =0.34). At baseline there were significant correlations between IAV and LVEF, and between IAV and LVEDV (r =-0.48, p =0.001 and r =-0.41, p =0.004, respectively). These correlations remained significant after 6 months. There was a positive correlation between IAV and LVEDV changes at six months (r =0.403, p =0.04). Conclusions: The development of cardiac dyssynchrony correlates with adverse left ventricular remodeling after MI.
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    Determinaciones de niveles de creatina y lípidos mediante espectroscopia por resonancia magnética en miocardio de pacientes con insuficiencia cardiaca no isquémica
    (Sociedad Medica de Santiago, 2010) Winter J.L.; Castro P.; Chalhub M.; Verdejo H.; Greig D.; Gabrielli L.; Hernández C.; Uribe S.; Meneses L.; Chiong M.; Lavandero S.; Concepción R.; Mellado R.
    Background: Heart failure (HF) is characterized, among other features, by the development of alterations in myocardial energy metabolism, involving a decrease in glucose utilization and increased free fatty acid uptake by cardiomyocytes, associated with decreased deposits of high-energy phosphates (creatine phosphate/ creatine transporter). Magnetic resonance (MR) imaging allows a direct and noninvasive assessment of myocardial metabolites. Aim: To measure myocardial creatine and lipids by MR spectroscopy among patients with HF. Material and Methods: Cardiac MR spectroscopy (1.5 Tesla) with Hydrogen antenna and single voxel acquisition was performed in five patients with non-ischemic heart failure, aged 58 ± 9.7 years, (60% males) and 5 healthy volunteers matched for age and sex. We analyzed the signals of creatine (Cr), lipids (L) and water (W) in the interventricular septum, establishing the water/lipid (W/L) and water/creatine (W/Cr) index to normalize the values obtained. Results: Among patients, left ventricular ejection fraction was 32 ± 6.9%, 60% were in functional capacity II, 60% had hypertension and one was diabetic. Spectroscopic curves showed a depletion of total Cr, evidenced by the W/ Cr index, among patients with heart failure, when compared with healthy controls (1.46 ± 1.21 and 5.96 ± 2.25 respectively, p < 0,05). Differences in myocardial lipid content, measured as the W/L index, were not significant (5.06 ± 2.66 and 1.80 ± 1.62 respectively, p = 0.08). Conclusions: Among patients with heart failure of non-ischemic etiology, there is a depletion of creatine levels measured by MR spectroscopy.
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    Estimación auscultatoria de la presión sistólica de arteria pulmonar: ¿Es factible?. Correlación con determinación ecocardiográfica
    (Sociedad Medica de Santiago, 2010) Mcnab P.; Castro P.; Verdejo H.; Martínez G.
    Background: The clinical assessment of pulmonary artery systolic pressure (PASP) by means of heart auscultation may be comparable to the measures obtained by Doppler echocardiography. Aim: To compare PASP estimated by heart auscultation and echocardiography. Material and Methods: Thirty consecutive patients aged 70 ± 16 years (68% women) were evaluated prospectively, all of whom had an echocardiogram requested by their attending physician. Echocardiographic evaluation of PASP was made by tricuspid regurgitation velocity plus right atrial pressure estimate. Two trained clinicians, blinded for the clinical history and rest of physical examination, auscultated the patients. PASP was estimated from the auscultatory intensity of the pulmonary component in comparison to the aortic component of the second heart sound and its propagation towards the apex, in accordance to a pre-established algorithm. Correlation between auscultatory and echocardiographic measures of PASP was made by Pearson test. Variability between both methods and among observers was evaluated with Bland-Altman analysis. Results: Fifty two per cent of patients were hypertensive and 20% diabetic. Admission diagnoses were heart failure in 50% of cases, exacerbation of chronic obstructive pulmonary disease in 20%, pulmonary thromboembolism in 10% and other clinical entities in 20%. A significant correlation was found between auscultatory and echocardiographic estimation of PASP (r = 0.64, p = 0, 01). Bland-Altman analysis showed a mean difference between both determinations of 7.6 ± 7.6 mmHg. Bland-Altman analysis between both operators showed an average difference of 5.4 ± 8.4 mm Hg. Conclusions: Heart auscultatory evaluation allows a precise and reproducible estimation of PASP and compares favorably with echocardiographic assessment.
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    Predictors of acute coronary syndrome without ST segment elevation and risk stratification in the chest pain unitPredictores de síndrome coronario agudo sin supradesnivel del ST y estratificación de riesgo en la unidad de dolor torácico. Experiencia en 1.168 pacientes
    (2008) Gabrielli L.; Castro G. P.; Verdejo H.; McNab P.; Llevaneras S.; Mardonez J.; Corbalán R.; Castro G. P.
    Background: Nearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis. Aim: To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit. Material and methods: Prospective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression. Results: In a four years period, 1,168 patients aged 62±23 years (69% males), were studied. After initial evaluation, 62% of the patients were admitted to the hospital for further testing and in 71% of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95% confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95% CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95% CI 1.25-2.69), age over 65 years (OR 1.73, 95% CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95% CI 3.72-8.29). Conclusions: Simple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.