Browsing by Author "Sepúlveda Varela, Pablo Andrés"

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    A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease
    (2022) Marzuca-Nassr, Gabriel Nasri; Seron, Pamela; Roman, Claudia; Galvez, Manuel; Navarro, Rocio; Latin, Gonzalo; Marileo, Tania; Molina, Juan Pablo; Sepúlveda Varela, Pablo Andrés; Oliveros, Maria Jose
    Coronary heart disease is the most common cause of death worldwide. Standard cardiac rehabilitation (face-to-face sessions) has shown benefits in increasing muscle strength and functional exercise capacity in adults and older people. However, it is unknown whether hybrid cardiac rehabilitation (a first face-to-face phase + a second remote monitoring phase) will have similar benefits in adults versus older subjects. The aim of this study was to compare the effects of a hybrid exercise-based cardiac rehabilitation program on muscle strength and functional exercise capacity in "adult " versus "older " people with coronary artery disease. We hypothesized that a hybrid exercise-based cardiac rehabilitation program would improve muscle strength and functional exercise capacity, but the impact would be smaller in the older group than the adult individuals. This study is part of a larger project (The Hybrid Cardiac Rehabilitation Trial-HYCARET). We subjected 22 adult (< 60 y) females and males (ADULT; n = 5/17 (f/m); 52 & PLUSMN; 5 y; 28.9 & PLUSMN; 3.4 kg & BULL;m-2) and 20 older (& GE;60 y) females and males (OLDER; n = 6/14 (f/m); 66 & PLUSMN; 4 y; 27.4 & PLUSMN; 3.9 kg & BULL;m-2) with coronary artery disease to 12 weeks of hybrid exercise-based cardiac rehabilitation program. Prior to and after 12 weeks of a hybrid exercise-based cardiac rehabilitation program, grip strength (handgrip), leg strength (chair stand test), and functional exercise capacity (6-minute walk test, 6MWT) were assessed. The hybrid exercise-based cardiac rehabilitation program resulted in a 9.4 & PLUSMN; 14.6% and a 6.2 & PLUSMN; 12.1% grip strength increase, a 14.4 & PLUSMN; 39.4% and a 28.9 & PLUSMN; 48.1% legs strength increase, and a 14.6 & PLUSMN; 26.4% and a 6.8 & PLUSMN; 14.0% functional exercise capacity improvement in ADULT and OLDER, respectively (p < 0.05) with no differences between groups. In conclusion, a hybrid exercise-based cardiac rehabilitation program could increase muscle strength and improve functional exercise capacity in adults and older people with coronary artery disease. More future studies comparing effectiveness among these age groups are needed to strengthen this conclusion.
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    Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension
    (2017) Gabrielli, Luigi; Ocaranza, María Paz; Sitges, Marta; Kanacri, Andrés; Saavedra Madariaga, Rodrigo Alejandro; Sepúlveda Varela, Pablo Andrés; Sepúlveda, Luis; Rossel, Víctor; Zagolin, Mónica; Verdejo Pinochet, Hugo; Baraona Reyes, Fernando Exequiel; Zalaquett Sepúlveda, Ricardo; Chiong, Mario; Lavandero, Sergio; Castro Gálvez, Pablo Federico
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    Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension
    (SOC MEDICA SANTIAGO, 2019) Sepúlveda Varela, Pablo Andrés; Ortega, Juan; Armijo, German; Torres, Jose; Ramirez, Pablo; Backhouse, Christian; Vargas, Cesar; Lopez, Leonel; Gonzalez, Felipe; Puentes, Angel; Donoso, Hernan; Bellet, Augusto; Godoy, Diego; Araya, Mario; Luz Andrade, Carmen; Pablo Molina, Juan; Nazzal, Carolina
    Background: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Aim: To report the initial experience with the "refined BPA technique" with the use of intravascular images. Patients and Methods: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. Results: We performed 16 BPA in eight patients aged 61 +/- 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 +/- 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 +/- 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 +/- 377,0 at baseline to 516,6 +/- 323,3 Dynes/sec/cm(-5) (p<0.01) and the cardiac index increased from 2.4 +/- 0.6 at baseline to 2.8 +/- 0.3 L/min/m(2) (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3 +/- 0.5 to 2.5 +/- 0.5 (p<0,01) and six minutes walking distance from 331 +/- 92 to 451 +/- 149 m (p=0.01). Conclusions: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.
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    Cambios agudos en la función auricular derecha post uso de iloprost inhalatorio en pacientes con hipertensión arterial pulmonar : estudio con técnicas de deformación de imagen
    (2015) Kanacri, Andres; Gabrielli, Luigi; Vega, Julián; Saavedra Madariaga, Rodrigo Alejandro; Cordova, Samuel; Sepúlveda Varela, Pablo Andrés; Castro Gálvez, Pablo Federico
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    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).
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    Characteristics, management, and outcomes of illicit drug consumers with acute myocardial infarction
    (SOC MEDICA SANTIAGO, 2016) Bartolucci, Jorge; Nazzal N, Carolina; Verdugo, Fernando J.; Carlos Prieto, Juan; Sepúlveda Varela, Pablo Andrés; Corbalan, Ramon; GEMI
    Background: Consumption of illicit drugs (ID) has been associated with an increased risk of acute myocardial infarction (AMI). There is limited national evidence about the impact of substance use over the clinical presentation, management and outcomes of AMI patients. Aim: To describe the prevalence of ID consumption in patients within the Chilean Registry of Myocardial Infarction (GEMI), comparing clinical characteristics, management and outcome according to consumption status. Material and Methods: We reviewed data from the GEMI registry between 2001 and 2013, identifying 18,048 patients with AMI. The sample was stratified according to presence or absence of previous ID consumption, comparing different demographic and clinical variables between groups. Results: Two hundred eighty five patients (1.6%) had history of ID consumption (cocaine in 66%, cannabis in 35% and central nervous system stimulants in 24.0%). Compared with non-users, ID consumers were younger, predominantly male and had a lower prevalence of cardiovascular risk factors, except for tobacco smoking (86.3% and 42.5% respectively, p < 0.01). Among consumers, there was a higher percentage of ST segment elevation (85.2% and 67.8% respectively, p < 0.01) and anterior wall AMI (59.9 and 49.5% respectively, p = 0.01). Additionally, they had a higher rate of primary angioplasty (48.8% and 25.5% respectively, p < 0.01). There was no difference in hospital mortality between groups when stratified by age. Conclusions: A low percentage of patients with AMI had a previous history of ID consumption in our national setting. These patients were younger and had a greater frequency of ST segment elevation AMI, which probably determined a more invasive management.
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    Combination Therapy with Oral Treprostinil for Pulmonary Arterial Hypertension A Double-Blind Placebo-controlled Clinical Trial
    (2020) White, R. J.; Jerjes Sánchez, C.; Meyer, G. M. B.; Pulido, T.; Sepúlveda Varela, Pablo Andrés; Wang, K. Y.; Grunig, E.; Hiremath, S.; Yu, Z. X.; Zhang, G. C.; Yip, W. L. J.; Zhang, S. Y.; Khan, A.; Deng, C. Q.; Grover, R.; Tapson, V. F.
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    Effect-site target-controlled infusion in the obese : model derivation and performance assessment
    (2018) Cortínez Fernández, Luis Ignacio; Sepúlveda Varela, Pablo Andrés; Rolle, Augusto; Cottin, Pauline; Guerrini, Alexandre
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    Evaluación no invasiva de la significancia funcional de las lesiones coronarias mediante Quantitative Flow Ratio (QFR). Validación con Reserva de Flujo Fraccional (FFR).
    (2021) Fuenzalida Alarcón, Alberto Javier; Vergara, Francisco; Hameau, René; Quitrala, Jorge; Sepúlveda Varela, Pablo Andrés; Martínez Sepúlveda, José Alejandro; Valenzuela, Edith; Martínez Rodríguez, Gonzalo Javier
    Introducción: La evaluación de lesiones coronarias mediante Reserva de Flujo Fraccional (FFR), es de elección para determinar su significancia funcional en el laboratorio de hemodinamia. La razón de flujo cuantitativo (Quantitative Flow Ratio, QFR) es una nueva técnica no invasiva para la evaluación de la significancia funcional de una estenosis coronaria, basada en el análisis de flujo a partir de la coronariografía diagnóstica, sin necesidad de hiperemia ni de la introducción de insumos adicionales. Objetivo: evaluar la correlación y valor predictivo del QFR comparado con FFR. Métodos: se seleccionaron arterias que contaban con medición de FFR realizados en nuestro centro y se analizó retrospectivamente el QFR a partir de las coronariografías de dichos estudios. Se excluyó lesiones de tronco y lesiones ostiales. La medición de FFR fue realizada con guía de presión ubicada distal al segmento afectado, mediante hiperemia con adenosina intracoronaria o intravenosa en infusión. Para el análisis de QFR se utilizan 2 proyecciones angiográficas ortogonales del vaso a interrogar con una separación de más de 25º entre ellas; ambas proyecciones deben coincidir en el eje para un correcto análisis. El análisis fue realizado por dos operadores, ciegos al resultado del FFR, utilizando el software QAngioXA (Medis ®, Netherland). Resultados: se analizaron 35 arterias, 57,1% Descendente Anterior (ADA), 20% Circunfleja (ACF) y 20% Derecha (ACD). El FFR promedio fue de 0,83±0,092 y 34,2% tuvieron como resultado un FFR ±0,80. El análisis retrospectivo del QFR se pudo realizar en 27 arterias; en las 8 restantes (22,9%) no fue posible su realización, ya sea por imágenes insuficientes o falta de perpendicularidad del segmento. El QFR promedio fue de 0,81±0,118. Hubo una buena correlación entre QFR y FFR (r =0,758; p<0,001), y excelente concordancia entre las dos medidas (diferencia de medias 0,0042±0,0646, 95%; p=0,74). Asimismo, en la medición del QFR existió una buena correlación Inter observadores (r=0,627, p<0,05). Sólo en 7,4% de las arterias hubo discordancia entre ambas mediciones: FFR>0,8 pero QFR±0,8 en 3,7%; y FFR ±0,8 y QFR >0,8 en 3,7%. Así, el QFR tuvo una Sensibilidad: 90,9%, Especificidad: 93,8%; Valor Predictivo Positivo: 90,9%; Valor Predictivo Negativo: 93,8%; Likelihood Ratio Positivo: 14,55 y Likelihood Ratio Negativo: 0,1. La curva ROC mostró un área bajo curva: 0,923; 95% IC: 0,801-1,00. Conclusión: Los resultados del QFR en nuestra serie son similares a las mediciones de FFR. El uso de QFR podría ser una alternativa, rápida, económica y segura, en la evaluación fisiológica de lesiones coronarias. Se requieren mayores estudios clínicos para comprobar estos resultados.
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    Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Elevation Myocardial Infarction: STREAM-2 1-Year Mortality Follow-Up
    (Lippincott Williams & Wilkins, 2024) Sinnaeve, Peter R.; Welsh, Robert C.; Arias Mendoza, Alexandra; Ristic, Arsen D.; Averkov, Oleg V.; Lambert, Yves; Kerr Saraiva, José F.; Sepúlveda Varela, Pablo Andrés; Rosell-Ortiz, Fernando; French, John K.; Music, Ljilja B.; Vandenberghe, Katleen; Bogaerts, Kris; Danays, Thierry; Bainey, Kevin R.; Armstrong, Paul W.; Van de Werf, Frans
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    Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting
    (2024) Seron, Pamela; Oliveros, Maria Jose; Marzuca-Nassr, Gabriel Nasri; Morales, Gladys; Roman, Claudia; Munoz, Sergio Raul; Galvez, Manuel; Latin, Gonzalo; Marileo, Tania; Molina, Juan Pablo; Navarro, Rocio; Sepúlveda Varela, Pablo Andrés; Lanas, Fernando; Saavedra, Nicolas; Ulloa, Constanza; Grace, Sherry L.
    IMPORTANCE While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. OBJECTIVE To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS This pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021. INTERVENTIONS Participants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists. RESULTS A total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, -11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, - 0.35% [95% CI, -7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, - 3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group). CONCLUSIONS AND RELEVANCE The results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03881150
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    Mid-term follow-up of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension : an experience in Latin America
    (2020) Sepúlveda Varela, Pablo Andrés; Hameau, R.; Backhouse, C.; Charme, G.; Pacheco, F.; Ramírez, P. A.; Fuenzalida Alarcón, Alberto Javier; Quitral, J.; Martínez, Gonzalo; Martínez Sepúlveda, José Alejandro
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    Outcomes of a modified, low-cost, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for elective, periprocedural support of high-risk percutaneous cardiac interventions: an experience from a latinamerican center
    (Sage publications, 2023) Bulnes, Juan F.; Martínez, Alejandro; Sepúlveda Varela, Pablo Andrés; Fuensalida, Alberto; Besa Bandeira, Santiago; Garrido, Luis; Martínez Rodríguez, Gonzalo Javier
    Introduction: High-risk procedures in interventional cardiology include a wide spectrum of clinical and anatomical scenarios related to a higher periprocedural morbidity and mortality. The prophylactic use of short-term mechanical circulatory support (ST-MCS) may improve both the safety and efficacy of the intervention by leading to more stable procedural hemodynamics. However, the significant costs may limit its use in resource constrained settings. To overcome this limitation, we ideated a modified, low-cost, venoarterial extracorporeal membrane oxygenator (V-A ECMO) setup. Methods: We conducted an observational prospective study including all patients undergoing a high-risk interventional cardiology procedure at our institution under prophylactic ST-MCS using a modified, low-cost version of V-A ECMO, where some components of the standard V-A ECMO circuit were replaced by supplies used for cardiac surgical cardiopulmonary bypass, achieving a cost reduction of 72%. We assessed in-hospital and mid-term outcomes, including procedural success, post-procedure complications and mortality. ResultsBetween March 2016 and December 2021, ten patients underwent high-risk IC procedures with prophylactic use of V-A ECMO. Isolated percutaneous intervention (PCI) was performed in six patients, isolated transcatheter aortic valve replacement (TAVR) in two, and a combined procedure (PCI + TAVR) in two. Mean ejection fraction was 34% (range 20–64%). Mean STS PROM was 16.2% (range 9.5–35.8%) and mean EuroScore was 23.7% (range 1.5–60%). The planned intervention was successfully performed in all cases. There were no reports of V-A ECMO malfunction. In nine patients the VA-ECMO was withdrawn immediately after the procedure but one patient required extended - 24 h - support with no significant issues. One patient experienced a periprocedural myocardial infarction and another developed a femoral pseudoaneurysm. In-hospital and 30-day survival were 100%, and 1-year survival was 80%. Conclusions: High-risk procedures in interventional cardiology can be successfully performed under prophylactic ST-MCS using a modified, low-cost V-A ECMO, suitable for limited-resource settings.
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    Performance of Propofol Target-Controlled Infusion Models in the Obese : Pharmacokinetic and Pharmacodynamic Analysis
    (2014) Cortínez Fernández, Luis Ignacio; De la Fuente, Natalia; Eleveld, Douglas J.; Oliveros, A. M.; Crovari Eulufi, Fernando; Sepúlveda Varela, Pablo Andrés; Ibacache Figueroa, Mauricio Enrique; Solari Gajardo, Sandra
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    Pharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged ≥75 Years in STREAM-1 and 2
    (American Heart Association, 2024) Bainey, Kevin R.; Welsh, Robert C.; Zheng, Yinggan; Arias-Mendoza, Alexandra; Ristic, Arsen D.; Averkov, Oleg V.; Lambert, Yves; Kerr Saraiva, Jose F.; Sepúlveda Varela, Pablo Andrés; Rosell-Ortiz, Fernando; French, John K.; Music, Ljilja B.; Temple, Tracy; Ly, Eric; Bogaerts, Kris; Sinnaeve, Peter R.; Danays, Thierry; Westerhout, Cynthia M.; van de Werf, Frans; Armstrong, Paul W.
    BACKGROUND: In STREAM-1 (Strategic Reperfusion Early After Myocardial Infarction), excess intracranial hemorrhage occurred in patients aged >= 75 years receiving full-dose tenecteplase as part of a pharmaco-invasive strategy, whereas no further intracranial hemorrhage occurred after halving the tenecteplase dose. In STREAM-2 (Second Strategic Reperfusion Early After Myocardial Infarction), half-dose tenecteplase was an effective and safe pharmaco-invasive strategy in older patients with ST-segment-elevation myocardial infarction presenting within <3 hours, compared with primary percutaneous coronary intervention (PCI). We prespecified evaluating the efficacy and safety of a half-dose versus full-dose pharmaco-invasive strategy and compared the half-dose pharmaco-invasive strategy to primary PCI in patients aged >= 75 years. METHODS: We pooled data sets in patients aged >= 75 years from STREAM-1 and STREAM-2 receiving a pharmaco-invasive strategy versus primary PCI. Resolution of ST-segment-elevation after fibrinolysis and angiography was assessed, as was the relative risk of the primary composite of 30-day all-cause death, myocardial infarction, heart failure, and shock, along with bleeding. RESULTS: A total of 390 patients were included: 42 patients were randomized to full-dose pharmaco-invasive treatment, 205 patients to half-dose pharmaco-invasive treatment, and 143 patients to primary PCI. Half-dose versus full-dose pharmaco-invasive treatment resulted in similar proportions of patients achieving >= 50% ST-segment resolution posttenecteplase (63.2% versus 62.6%), with reduced intracranial hemorrhage (7.1% versus 0%, respectively). Half-dose pharmaco-invasive treatment and primary PCI also had similar proportions of patients with >= 50% ST-segment resolution postangiography (77.9% versus 72.4%; P=0.277) and comparable composite end points (23.4% versus 28.0%; relative risk, 0.90 [95% CI, 0.62-1.30]; P=0.567) without occurrence of intracranial hemorrhage. CONCLUSIONS: Comparable efficacy exists between half- and full-dose tenecteplase pharmaco-invasive treatments with improved safety in patients with ST-segment-elevation myocardial infarction aged >= 75 years. Half-dose pharmaco-invasive therapy is a legitimate therapeutic option for elderly patients with ST-segment-elevation myocardial infarction unable to access timely primary PCI.
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    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.
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    Remodelado auricular derecho y niveles plasmáticos de Galectina-3 se relacionan con la capacidad funcional de pacientes con hipertensión arterial pulmonar
    (2016) Gabrielli, Luigi; Verdejo Pinochet, Hugo; Ocaranza, María Paz; Sepúlveda Varela, Pablo Andrés; Baraona Reyes, Fernando Exequiel; Salinas, Manuel; Saavedra, R.; Llevaneras, Silvana; Quiroga Lagos, Clara Rosa; Garayar Pulgar, Bernardita; Lavandero, Sergio; Castro Gálvez, Pablo Federico
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    Resultados Chilenos del registro internacional de factores de riesgo y tratamiento de angina inestable e infarto al miocardio sin supradesnivel del segmento ST: ACCORD (ACute CORonary syndrome Descriptive study)
    (SOC MEDICA SANTIAGO, 2011) Stockins, Benjamin; Albornoz, Francisco; Martinez, Dario; Campos, Pabla; Gajardo, Jorge; Lamich, Ruben; Manriquez, Leopoldo; Perez, Victor; Rojo, Pamela; Sepúlveda Varela, Pablo Andrés; Gabriela Pumarino, M.; Corbalan, Ramon
    Background: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however current practices are unknown in Chile. Aim: To evaluate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: One year prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5% at the end of the follow-up. Mean age was 61.6 years, and 30.6% were female. Most of the patients had at least one risk factor (98%): hypertension (84%), previous myocardial infarction (33%), dyslipidemia (54%), diabetes (33%), current smoking (30%). Main procedures during the hospitalization were coronary angiogram (67%), angioplasty (33%; 88% with stent) and coronary bypass surgery (7%). During procedures, 31% of patients received clopidogrel, and 4.2% glycoprotein IIb/IIIa antagonists. Medical management was selected for 60% of patients. In comparison to men, women received less interventional procedures despite having more risk factors. Treatments prescribed at discharge were aspirin (97%), clopidogrel (49%), beta blockers (78%), diuretics (21%), lipid lowering agents (78%), oral hypoglycemic agents (13%) and insulin (9%). At the end of the 1-year follow-up, treatments were aspirin (84%), beta blockers (72%), diuretics (19%), and dual antiplatelet therapy with clopidogrel (16%). Conclusions: A high prevalence of multiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50% at discharge and decreases during the one year-follow-up. (Rev Med Chile 2011; 139: 19-26).
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    Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar
    (2016) Herrera, Sesbastián; Gabrielli, Luigi; Paredes Cárdenas, Alejandro; Saavedra Madariaga, Rodrigo Alejandro; Ocaranza, María Paz; Sepúlveda Varela, Pablo Andrés; Donoso, Hernán; López, Leonel; Verdejo Pinochet, Hugo; Baraona Reyes, Fernando Exequiel; Castro Gálvez, Pablo Federico
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    STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial
    (2023) Van de Werf, Frans; Ristic, Arsen D.; Averkov, Oleg V.; Arias-Mendoza, Alexandra; Lambert, Yves; Saraiva, Jose F. Kerr; Sepúlveda Varela, Pablo Andrés; Rosell-Ortiz, Fernando; French, John K.; Music, Ljilja B.; Vandenberghe, Katleen; Bogaerts, Kris; Westerhout, Cynthia M.; Pages, Alain; Danays, Thierry; Bainey, Kevin R.; Sinnaeve, Peter; Goldstein, Patrick; Welsh, Robert C.; Armstrong, Paul W.
    BACKGROUND: ST-segment-elevation myocardial infarction (STEMI) guidelines recommend pharmaco-invasive treatment if timely primary percutaneous coronary intervention (PCI) is unavailable. Full-dose tenecteplase is associated with an increased risk of intracranial hemorrhage in older patients. Whether pharmaco-invasive treatment with half-dose tenecteplase is effective and safe in older patients with STEMI is unknown. METHODS: STREAM-2 (Strategic Reperfusion in Elderly Patients Early After Myocardial Infarction) was an investigator-initiated, open-label, randomized, multicenter study. Patients >= 60 years of age with >= 2 mm ST-segment elevation in 2 contiguous leads, unable to undergo primary PCI within 1 hour, were randomly assigned (2:1) to half-dose tenecteplase followed by coronary angiography and PCI (if indicated) 6 to 24 hours after randomization, or to primary PCI. Efficacy end points of primary interest were ST resolution and the 30-day composite of death, shock, heart failure, or reinfarction. Safety assessments included stroke and nonintracranial bleeding. RESULTS: Patients were assigned to pharmaco-invasive treatment (n=401) or primary PCI (n=203). Median times from randomization to tenecteplase or sheath insertion were 10 and 81 minutes, respectively. After last angiography, 85.2% of patients undergoing pharmaco-invasive treatment and 78.4% of patients undergoing primary PCI had =50% resolution of ST-segment elevation; their residual median sums of ST deviations were 4.5 versus 5.5 mm, respectively. Thrombolysis In Myocardial Infarction flow grade 3 at last angiography was approximate to 87% in both groups. The composite clinical end point occurred in 12.8% (51/400) of patients undergoing pharmaco-invasive treatment and 13.3% (27/203) of patients undergoing primary PCI (relative risk, 0.96 [95% CI, 0.62-1.48]). Six intracranial hemorrhages occurred in the pharmaco-invasive arm (1.5%): 3 were protocol violations (excess anticoagulation in 2 and uncontrolled hypertension in 1). No intracranial bleeding occurred in the primary PCI arm. The incidence of major nonintracranial bleeding was low in both groups (<1.5%). CONCLUSIONS: Halving the dose of tenecteplase in a pharmaco-invasive strategy in this early-presenting, older STEMI population was associated with electrocardiographic changes that were at least comparable to those after primary PCI. Similar clinical efficacy and angiographic end points occurred in both treatment groups. The risk of intracranial hemorrhage was higher with half-dose tenecteplase than with primary PCI. If timely PCI is unavailable, this pharmaco-invasive strategy is a reasonable alternative, provided that contraindications to fibrinolysis are observed and excess anticoagulation is avoided.